探討智能輔助衛教對初次心導管檢查患者焦慮及醫病共享決策之成效

研究背景：心臟疾病為台灣十大死因第二位，其中冠狀動脈疾病占大多數，而心導管檢查是最常執行的侵入性、診斷性檢查及治療。當患者面臨此類檢查或治療時，常因醫療專業資訊獲取之限制，在決策選擇的過程產生焦慮感，而於術前給予相關衛教資訊，是減輕焦慮的有效措施。運用智能模式提供衛教可滿足衛教個別性與提供互動諮詢，並根據病患個人需求選擇學習次數與主題，其緩解焦慮之效果是否優於常規護理及傳統多媒體衛教有待進一步研究。研究目的：探討智能決策輔助衛教對緩解初次接受心導管檢查患者焦慮及醫病共享決策之成效研究方法：本研究為介入性研究設計、採方便取樣，隨機分為介入組及對照組，兩組樣本數各35位。研究場所在中部某醫學中心心臟科病房，選取初次接受心導管檢查患者為研究對象。研究工具包括智能衛教方案，情境-焦慮量表及醫病共享決策輔助評估表。對照組給予傳統常規衛教單張並說明；介入組則以病房智能照護系統提供心導管檢查智能決策輔助衛教影片及互動教學。兩組於衛教介入前、後，進行情境焦慮量表之測量。收案期間從2021年11月至2022年05月，為期六個月，研究資料以SPSS 22.0版進行統計分析，以描述性統計及無母數檢定分析進行兩組間之差異比較。研究結果：介入組之焦慮後測分數（32.9 ± 2.6分）顯著低於對照組的（46.7 ± 8.9分）（P<0.05），顯示智能決策輔助衛教方案介入後降低焦慮的程度有顯著差異；兩組在接受衛教後，醫病共享決策評估表的完成率皆有大幅提升，另外在認知總分上有達顯著差異（P <0.05），其中支架內再狹窄認知方面未達顯著差異（P = 0.096），在經濟及健保給付認知方面有顯著差異（P <0.05），在支架置放術可能發生之副作用與合併症認知方面有達顯著差異（P = 0.047），在後續藥物治療認知方面未有顯著差異（P = 1.000）。結論：智能衛教的普及和方便性，智能衛教結合床邊照護系統已運用於臨床實務中，可有效降低患者及家屬的焦慮感與提高醫病共享決策的完成率。臨床醫護人員可運用智能衛教方式提供即時衛教資訊，並可依照個別性選擇專屬的衛教內容，提供QR Code持續留存，透過持續學習反饋及持續追蹤，雙向溝通回饋讓病人更有參與感，提供更好的照護品質。

關鍵字

心導管檢查；醫病共享決策；智能衛教；焦慮

並列摘要

Background: Cardiovascular disease is the second leading cause of death in Taiwan; coronary artery disease accounts for the majority. Cardiac catheterization is the most commonly performed invasive diagnostic test and treatment. When patients face those examinations or treatments, they experience anxiety during decision-making due to limited access to medical professional information. Giving relevant health education information before surgery is an effective measure to reduce anxiety. Intelligent mode to provide health education can meet individualized health education and provide interactive consultation. Objective: To explore the effect of intelligent decision-making aided health education on alleviating the anxiety of patients undergoing cardiac catheterization for the first time and the effectiveness of medical and patient-sharing decisions. Research method: This study is an interventional research design, adopts convenient sampling and is divided into an intervention group and a control group, which 35 persons in each group. The research site is in the cardiology ward of a medical center in central China, and patients who underwent cardiac catheterization for the first time were selected as the research objects. The research tools include an intelligent health education program, a situation-anxiety scale, and a shared decision-making aid assessment form. The control group was given standard health education leaflets and explanations; the intervention group provided intelligent decision-making auxiliary health education videos and interactive teaching for cardiac catheterization with the ward competent care system. Both groups were measured with the Situational Anxiety Scale before and after health education intervention. The case acceptance period is six months, from November 2021 to May 2022. The research data is statistically analyzed with SPSS version 22.0, and the difference between the two groups is compared using descriptive statistics and no-matrix test analysis. Research results: The anxiety score of the intervention group (32.9 ± 2.6 points) was significantly lower than that of the control group (46.7 ± 8.9 points) (P<0.05), showing that the intervention of the intelligent decision-making aided health education program significantly reduced anxiety levels. The difference in the change of the total cognitive score was significantly different in the total cognitive score (P <0.05), and there was no significant difference in the aspect of in-stent restenosis (P = 0.096). However, there was a significant difference in the aspect of economy and health insurance payment (P <0.05), and there was a significant difference in the possible side effects and complications of stent placement (P = 0.047). However, there was no significant difference in subsequent drug treatment (P = 1.000). Conclusion: Due to the popularization and convenience of intelligent health education in recent years, the combination of intelligent health education and bedside care system has been applied in clinical practice. Doctor-patient sharing decision-making can guide effective communication between doctors and patients, improve patients' understanding of treatment information and Communication between doctors and patients can effectively reduce the anxiety of patients and their families. Clinical medical staff can use smart health education methods to provide real-time health education information. During hospitalization, patients can obtain relevant information from the bedside care system, and can choose exclusive health education content according to individuality, and provide QR Code for continuous retention, which can not only improve Patients' understanding of disease knowledge, through continuous learning feedback and continuous tracking, and two-way communication and feedback make patients more involved and provide patients with better quality of care.