從共享決策SDM談落實癌症病人的善終

癌症是潛在威脅性命的重大疾病，癌症診療團隊雖然不斷精進治療方法，但治療成效仍然有很多不確定性。特別是在反覆復發或進展至末期階段時，該持續抗癌治療或是轉換為安寧緩和醫療，並沒有絕對的評估標準。「共享決策」是透過醫病互動溝通的過程，彼此分享醫學實證治療經驗與病人個人的生命價值觀，達成符合雙方共識的治療計畫。最後的醫療決定沒有絕對的好壞或對錯。本文除了介紹共享決策（shared decision making, SDM）模式外，也針對癌症病人經常要面對抉擇的心肺復甦術與維生醫療、安寧緩和醫療照護、以及病人自主權利法規範的維持生命治療、人工營養及流體餵養等善終議題進行探討。

關鍵字

共享決策；癌症；善終；病情告知；溝通模式

並列摘要

Cancer is a life threatening illness. Despite the advances of anticancer treatments, there has still been many uncertainties in prognosis. During a recurrence or terminal progression, patients may face the dilemma of holding on to the aggressive anticancer treatments or switching to hospice palliative care. Shared decision-making (SDM) is a process in which both the patients and clinicians contribute to the medical decision-making process. While the clinicians bring their expertise on treatment and management options as well as the benefits and risks, the patients are the ones who know the best of their own condition and attitudes, values and preferences. Patients can participate in decision making actively and choose the treatment option that best aligns with their unique cultural and personal beliefs. Embedding SDM in medical decision process can lessen the stress on the patients, improve knowledge of the options and the satisfaction with care, and lead to better quality decision. However, SDM process remains scarce regarding the good dying issues for cancer patients. This article introduces SDM process, development of patient decision aids, and communication strategies and discusses topics on end-of- life care, including resuscitation, life sustaining treatment, palliative care, artificial nutrition and tubal feeding.

並列關鍵字

shared decision making ； cancer ； good dying ； truth telling ； communicationmodel

參考文獻

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郭舒亞（2022）。一位肝癌末期病人之加護護理經驗。長庚護理，33(4)，84-93。https://doi.org/10.6386/CGN.202212_33(4).0008

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陳姿廷、林嬿妮、陳韻安（2020）。提升南部某教學醫院癌症末期病人不施行心肺復甦術簽署率之改善方案。長期照護雜誌，24(2)，161-174。https://doi.org/10.6317/LTC.202008_24(2).0007

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從共享決策SDM談落實癌症病人的善終

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