醫病共享決策對病人的憂慮程度與選擇治療方式之影響

Effect of Shared Decision-Making on Patient Anxiety and Treatment Choice

楊佳怡(Jia-Yi Yang) ； 鍾信成(Hsin-Cheng Chung) ； 周思源(Szu-Yuan Chou) ； 葉德豐(Te-Feng Yeh) ； 陳慶霖(Ching-Lin Chen)

《澄清醫護管理雜誌》 15卷3期 (2019/07) Pp. 16-23

摘要

目的：探討醫病共享決策是否能降低病人的憂慮程度與改變治療方式的選擇。方法：以結構式問卷進行調查，針對中部某區域教學醫院之病人為研究對象，並以立意抽樣的方式抽取痔瘡38份與乳癌24份，將所得資料以IBM SPSS 21.0進行描述性統計和推論性統計。結果：使用輔助工具後對醫療決策的經驗和看法同意程度僅有六、七成；在決策幫助性方面，有九成的病人認為在決策過程是有幫助的，且在SDM介入後決策後憂慮程度有明顯下降的趨勢；決策差異方面，乳癌病人比痔瘡病人較為顯著；在使用輔助工具後對醫療決策的經驗和看法同意程度中，除少數項目以外，對乳癌病人的影響顯著高於痔瘡病人。結論：在使用輔助工具後對醫療決策的經驗和看法同意程度、決策幫助皆達到有效的幫助，且SDM有助於降低憂慮程度。對於病情複雜、嚴重性疾病之病人而言，SDM更具有效果性，建議相關單位從這類型病人著手，積極推廣SDM，讓病人在此過程中獲得最佳的醫療資訊與判斷能力，做出最佳的決策。

關鍵字

共享決策 ； 病人參與 ； 決策輔助工具

並列摘要

Purposes: To explore whether shared decision-making can reduce the anxiety of patients and change treatment choices. Methods: A structured questionnaire was used to investigate the patients in a regional teaching hospital in central Taiwan. A total of 38 hemorrhoid patients and 24 breast cancer patients were selected using purposive sampling. Descriptive and inferential statistics were employed on the data using IBM SPSS 21.0. Results: After using the patient decision aid, only 60%-70% patients agreed with the experience of and favorable opinions regarding medical decision-making and 90% patients believed that the decision-making process was helpful. In addition, the anxiety about decision-making significantly declined after the shared decision making (SDM) intervention. Breast cancer patients had more significant changes in decision-making than hemorrhoid patients had. The influence of using patient decision aid on the agreement with the experience of and opinions on medical decision-making was higher among breast cancer than hemorrhoid patients. Conclusions: Using patient decision aid had positive effects on the experience of and opinions on medical decision-making, and helped in decision-making. In addition, SDM helped to reduce the degree of anxiety. SDM is more effective in patients with complex and serious illnesses. It is recommended that relevant institutions start assisting breast cancer and hemorrhoid patients actively promote SDM, so that patients can get the best medical information and judgment ability in the process of making the best decisions.

並列關鍵字

Shared decision-making ； Patient participation ； Patient decision aid