探討醫病共享下影響病人決策之相關因素

研究背景：「醫病共享決策」（Shared Decision Making，SDM）這個名詞最早是1982年美國以病人為中心，為促進醫病之間相互尊重與溝通而提出。透過醫病共享讓病人與家屬對治療方式有足夠的醫療觀念，提升自我照護的能力，並在家人與朋友的協助下降低焦慮不安的心情，讓病人有堅持接受治療的動力，增加醫病之間的信賴感使治療更加順利，因此如何讓病人在接受治療的過程中同時維持生活品質，並且經由專業醫療團隊的照護下使身體、心靈、社會層面都能得到支持是非常重要的。研究目的：本研究目的為利用醫病共享輔助評估表以及影片播放讓肺癌晚期病人及家屬獲得醫療知識，探討醫病共享下影響病人決策之相關因素。研究方法：以問卷收集的方式，經醫師診斷為晚期非小細胞肺癌病人或家屬並且尚未接受治療者進行填寫，問卷內容包含基本資料、對治療方式的認知、態度、行為、決策過程中受尊重情形、醫病之間信賴關係程度、決策前後治療方式的選擇，共七大面向，進行統計分析。結果：人口學特質對治療方式與疾病相關認知，在年齡（p=0.020）與疾病相關認知分數達顯著，35-44歲認知的程度比65-74歲較好。輔助評估表對病人與家屬是有幫助的，醫病關係的信賴對認知、態度、行為、尊重有顯著關係。結論：建議實習醫師與專科護理師也能加入SDM執行，如此實習醫師也能夠與病人或者家屬互動，以增進醫學生於臨床進行醫病溝通過程發揮其專業溝通能力及專業倫理認知。此外專科護理師若也能夠加入，對病人來說更有安心感受，因為專科護理師更了解每位病人的狀況。讓團隊內成員充分發揮功能，提供連續醫療照護。病人參與醫病共享決策，提高整體滿意度以落實醫病溝通行為。

關鍵字

醫病共享決策；非小細胞肺癌；醫病關係

並列摘要

Research Background: The term ‘Shared Decision Making’ (SDM) was first introduced in the United States in 1982 as a patient-centered approach to promote mutual respect and communication between doctors and patients. Through the sharing of doctors and patients, patients and their families will have enough medical ideas about treatment methods to improve their ability to care for themselves, and reduce anxiety. Also, with the help of family members and friends, patients have the motivation to adhere to treatment and increase the sense of trust between the patients and doctors which will make the treatment more smooth. Therefore, it is very important to enable the patients to maintain the quality of life while receiving treatment and to get support to their bodies, minds and society levels through the care of a professional medical team. Research purposes: The purpose of this study was to use Shared Decision Making Aided Assessment Questionnaires and video playback to allow patients with advanced lung cancer and their families to obtain medical knowledge, and to explore the factors of patients’ judgements under the impact（influence）of shared decision making. Research methods: Questionnaires were collected by doctors who diagnosed patients with advanced non-small cell lung cancer or their families and had not yet received treatment. The questionnaire contained basic data, knowledge of the treatment modalities, attitudes, behaviors, and respect in the decision-making process. The degree of trust relationship between doctors and patients, and the choice of treatment methods before and after the decision-making. A total of seven major aspects were included for statistical analysis. Result: Demographic characteristics of the treatment and disease-related cognition, age-related (p=0.020) and disease-related cognitive scores are significant. Patients and their family members at the age of 35-44 shows higher score in the treatment of attitude statistics than at the age of 65-74. The result indicates that this Shared Decision Making Aided Assessment Form is helpful for patients and their families and trust in relationship between doctors and patients has a significant relationship to cognition, attitude, behavior, and respect. Conclusion: It is recommended that interns and nurse practitioners can also participate in the SDM so that interns can also interact with patients or their families to enhance interns’ professional communication skills and professional ethics cognition during the clinical process. If any nurse practitioners can also join, the patients will feel more comfortable, because the nurse practitioners understands the condition of each patient better. The members of the team can fully bring out their innate qualities, and provides continuous Medical care. In the mean time, the patients can participate in the SDM that may improve overall satisfaction to implement the communication between doctors and patients.