以醫病共享決策選擇戒菸藥物對戒菸成效的影響

Shared Decision-Making in Drug Selection for Improving Effectiveness of Smoking Cessation

黃煒霖(Wei-Lin Huang) ； 林軒毓(Hsuan-Yu Lin) ； 劉淑麗(Shu-Li Liu)

《台灣家庭醫學雜誌》 32卷3期 (2022/09) Pp. 173-182

https://doi.org/10.56106/168232812022093203003

摘要

目的：探討使用決策輔助工具（patient decision aids，PDA）選擇戒菸藥物，是否能提升戒菸成效。方法：本研究是一篇歷史對照研究（historical control trial），研發一份紙本決策輔助工具，輔助戒菸者在varenicline與合併尼古丁替代療法（combination nicotine replacement therapy）兩類藥物中做出選擇。2020年1月至2021年3月期間，於家庭醫學科戒菸門診進行收案，針對有意願接受藥物戒菸的民眾，由醫師擔任醫病共享決策的引導員（coach），使用決策輔助工具協助其決定藥物的種類。對照組為2019年全年度在家庭醫學科戒菸門診接受藥物戒菸服務者，無使用決策輔助工具。以電話訪問調查第三個月以及第六個月的戒菸狀況，再以logistic regression等統計方法探討使用PDA是否影響戒菸成功率。結果：排除療程中更換處方和失聯者，總共199人被納入研究（PDA組62人：男性佔80.6％，平均年齡為46.0歲；對照組137人，男性佔74.5％，平均年齡為49.4歲）。PDA組傾向選擇varenicline作為戒菸藥物（aOR 1.94，95％ CI 1.02－3.71）；兩組六個月點戒菸率無顯著差異（aOR 1.43，95％ CI 0.74－2.79）。結論：以決策輔助工具選擇戒菸藥物，民眾偏好varenicline甚於合併尼古丁替代療法，但是並未對戒菸成功率造成顯著影響。醫病共享決策能否提升戒菸藥物的順從性，並增進戒菸治療的效益，需要進一步的研究。

關鍵字

醫病共享決策 ； 決策輔助工具 ； 戒菸 ； varenicline ； 合併尼古丁替代療法

並列摘要

Purpose: The study explored whether the use of patient decision aid (PDA) to select smoking cessation drugs can improve the effectiveness of smoking cessation. Methods: This historical control trail developed a paper-based PDA to help smokers choose between varenicline and a combination of nicotine replacement therapy. From January 2020 to March 2021, people visiting the smoking cessation clinic of a family medicine department and willing to take drugs to quit smoking were enrolled into the PDA group of the study with doctors serving as coaches for shared decision-making and applying the PDA to help them decide on the types of drugs to use. Members in the control group were enrolled from people receiving the drug smoking cessation services in the same smoking cessation clinic in 2019 without using PDA. The smoking status after 3 and 6 months were collected by telephone interview. The effects of using PDA on smoking cessation were analyzed by logistic regression. Results: A total of 199 people participating in the study, excluding those who changed prescriptions and lost contact during the course of treatment. Of the 62 participants in the PDA group, 80.6% were male, and the average age was 46.0. Of the 137 participants in the control group, 74.5% were male, and the average age was 49.4. The PDA group preferred varenicline as the smoking cessation drug (aOR 1.94, 95% CI 1.02-3.71). There was no significant difference in the smoking cessation rate between the two groups at six months (aOR 1.43, 95% CI 0.74-2.79). Conclusion: When using PDA to select smoking cessation drugs, people appear to prefer varenicline over a combination of nicotine replacement therapy; however, this preference produces no significant influence on the success rate of smoking cessation. Whether shared decision-making help improve the compliance with the instructions of smoking cessation products and enhance the effectiveness of smoking cessation treatment requires further research.

並列關鍵字

combination nicotine replacement therapy ； patient decision aids ； shared decision making ； smoking cessation ； varenicline

參考文獻

Stacey D, Légaré F, Lewis K, et al: Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017; 4: CD001431.

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衛生福利部國民健康署：「戒菸服務補助計畫」作業須知。2022年1月23日，取自https://ttc.hpa.gov.tw/Web/Download.aspx.

Baker TB, Piper ME, Stein JH, et al: Effects of nicotine patch vs varenicline vs combination nicotine replacement therapy on smoking cessation at 26 weeks: a randomized clinical trial. JAMA 2016; 315: 371-9.

Cahill K, Stevens S, Perera R, Lancaster T: Pharmacological interventions for smoking cessation: an overview and network metaanalysis. Cochrane Database Syst Rev 2013; 2013: CD009329.