運用共享決策於一位十二指腸癌末期個案之護理經驗

本文為照顧一位印尼藉留學生，於十二指腸腺癌疾病惡化時的抉擇困境照護。筆者運用醫病共享決策模式，協助個案面對留在台灣或返回印尼、持續化學治療或緩和治療之間做最適合的抉擇。護理期間自2019年11月04日至11月13日，透過身體評估、觀察、會談及傾聽技巧，運用生理、心理、靈性、社會層面整體性評估，確立健康問題有：營養少於身體所需、抉擇衝突、家庭因應能力增進的準備度。以醫病共享決策會議進行雙向溝通，協助釐清疑問與決策困境，提昇個案對決策的自信，並整合團隊醫療照護資訊、加強腸造瘻傷口護理及管灌營養概念等予出院準備，以減輕個案及家屬照護的緊張感，最終讓個案圓夢返鄉與家人團聚。期望藉此護理經驗，提供臨床護理人員參考。

關鍵字

十二指腸腺癌；跨團隊照護；醫病共享決策

並列摘要

This article describes an experience of an Indonesian student who was in a dilemma when the disease of duodenal adenocarcinoma caused physical deterioration. The author used the sharing decision-making model to assist the patient in making the most suitable choice between staying in Taiwan or returning to Indonesia, continuing chemotherapy or palliative treatment. During the nursing period from November 04 to November 13 2019, information was collected by means of physical examination, observation, conversation and listening skills. We used physical, psychological, spiritual, and social holistic assessments to collect subjective and objective data with health problems of imbalanced nutrition imbalanced to promote family preparedness for discharge care response capacity, and conflict decision-making. Two-way communication with shared decision-making meetings to help clarify questions and decision-making difficulties enhanced the confidence of the patient in personal decision-making. We promoted family preparedness for discharge care response capacity to reduce nervousness by integrating team medical care information, thereby strengthening the concept of intestinal ostomy wound care and feeding nutrition. Finally, the patient returned to Indonesia and reunited with his family. We hope this nursing experience can help clinical nursing staff in similar cases.

並列關鍵字

Duodenal adenocarcinoma ； Interprofessional practice ； Shared Decision Making

參考文獻

陳思穎、陳玠伊、彭靖舒、楊淑君、方基存、周宏學、唐婉如(2018)．醫病共享決策—以Three talk model為例．臨床醫學月刊，81(6)，342-347。 https://doi.org/10.6666/ClinMed.201806_81(6).0063

黃郁珊、黃淑鶴(2017)．台灣居家安寧療護面臨困境之探討．安寧療護雜誌，22(2)，180-191。DOI:10.6537/TJHPC.2017.22(2).4

蘇僅涵、蔣立琦(2017)．以系統性文獻綜整減輕癌症家庭照顧者焦慮及憂鬱之組合式護理措施．源遠護理，11(1)，5-11。DOI:10.6530/YYN/2017.5.1

Chukwuneke, F. N. (2015). Ethics of palliative care in late-stage cancer management and end-of life issues in a depressed economy. Nigerian Journal of Clinical Practice, 18 (7), 15-19. https://doi.org/10.4103/1119-3077.170824

Cloyd, J. M., George, E., & Visser, B. C. (2016). Duodenal adenocarcinoma: Advances in diagnosis and surgical management. World Journal Gastrointest Surgery, 8(3), 212-221. https://doi.org/10.4240/wjgs.v8.i3.212

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