醫病共享決策之概念與實務

Shared Decision Making: Concept, Development and Practice

李婉菱(Wan-Ling Lee) ； 張慈惠(Tsyr-Huei Chang) ； 黃嗣棻(Szu-Fen Huang)

《臺大護理雜誌》 17卷1期 (2021/01) Pp. 5-13

https://doi.org/10.6740/NTUHJN.202101_17(1).0002

摘要

過去的醫病關係屬父權式，醫師在醫療過程中為主宰者，病人為求治癒，幾乎照單全收醫師提出的建議且代為決定的醫療決策；倘若醫療人員未完全考慮病人立場代下決策，很可能不是最適合病人的選擇，但可能不佳的結果卻須由病人承擔，此狀況將與眾所期待「以病人為中心」的照護概念相悖，故現今全球推行醫病共享決策以促進病人積極參與自己的醫療過程，期望病人在選擇醫療決策前，能透過醫療人員提供的實證資訊及引導，幫助病人審慎的多方考量後，做出符合其價值觀與自身期待之決策；這樣的醫病溝通模式，在現行臺灣臨床仍屬初試階段，為深化且落實於臨床，醫療人員需透過教育訓練後，瞭解醫病共享決策的概念-「醫療端及病人端的考量皆一樣重要，最適合的決定取決於病人最在意的事」，即能有效引導病人參與。倘若大家皆熟悉此種溝通模式後，醫病雙方將培養出互助且互信的合作關係，讓醫病溝通更順暢，也藉此提升醫療照護品質。

關鍵字

醫病共享決策 ； 醫療品質 ； 病人決策輔助工具

並列摘要

In the past, patients hoped to be cured and accepted nearly all medical decisions made by doctors. However, decisions made by medical staff without considering the needs of the patient may not be the most suitable choices for the patient, but the results are entirely borne by the patient. Therefore, the purpose of the global implementation of medical shared decision making (SDM) is to promote active patient participation in their own medical treatment plan. After the patients receive empirical information and guidance, they are expected to be able to make decisions that conform to their values and expectations. To implement the SDM in clinical practice, medical staff need to undergo education and training to understand the important concept that ＂the most suitable decision depends on what the patient cares about most＂. Medical treatment will become a cooperative relationship of mutual assistance and trust, which will also improve the quality of medical care.

並列關鍵字

shared decision making ； patient safety ； health care quality ； patient decision aids