運用醫病共享決策於初診斷乳癌病人的決策衝突

本文主要描述護理師運用醫病共享決策，來降低一位初次診斷乳癌病人決策衝突的照護經驗。護理期間為2019年8月20日至10月14日。筆者紀錄與個案互動過程，將病人醫療決策過程歸納成三階段：擔憂罹癌後身體心像的轉變、缺乏決策相關訊息、擔心手術成效不合乎預期。依據以上三階段，藉由門診護理師及個管師所擔任的決策引導員，運用「醫病共享決策」及「醫病共享決策輔助工具」，傾聽及有系統的評估病人相關疾病照護知識、價值觀及決策衝突後，找出合適的醫療治療決策達到醫病雙贏的局面。

關鍵字

醫病共享決策；乳癌決策衝突；醫病共享決策輔助工具

並列摘要

This article describes the successful application of shared decision making for a newly diagnosed breast cancer patient with decision making conflict. The nursing process started from Aug 22, 2019 to Oct. 14 2019. Based on the records from nurses' interactions with the patient, the decision making process were identified with three major stages: 1. worrying about impact of body image disturbance from the breast cancer; 2. decision making conflict because of insufficient information about treatment decision; and 3. decision making conflict because of concerns in the effectiveness of treatment. Decision coach conducted shared decision making and patient decision aids with listening and systemic evaluation for the patient to understand the disease. We also investigated the personal value and decision conflict of the patient. Through listening and showing, an appropriate treatment decision was reached for the best interest of the patient and for the healthcare team to provide the best possible care.

並列關鍵字

shared decision-making ； breast cancer decision conflict ； patient decision aids

參考文獻

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