全人工關節置換手術病人共享決策及相關因素初探

Shared Decision Making and Its Associated Factors for the Patients of Total Joint Replacement Surgery:A Preliminary Study

林雅惠(Ya-Hui Lin)

指導教授 ： 楊麗玉

共同指導教授 ： 金繼春 ； 黃炫迪(Hsuan-Ti Huang)

高雄醫學大學/護理學院/護理學系碩士班/碩士(2018年)

摘要

本研究旨在探討行全人工關節置換手術病人在參與共享決策相關因素調查，研究目的為：(1)了解病人的人口學變項、家人支持與決策控制偏好之情況；(2)了解病人參與共享決策及決策感受之情況；(3) 探討人口學變項、家人支持及決策控制偏好與共享決策之關係為何。(4) 探討共享決策與決策感受之關係為何。採橫斷式相關性研究設計，方便取樣，以結構式問卷收集資料，問卷內容包含人口學變項、共享決策量表、決策滿意度及決策反悔量表。收案地點於南部一家醫學中心及二家區域教學醫院骨科病房，選取年滿20歲初次接受全人工關節置換手術者為研究對象，共95人，所得資料以IBM SPSS Statistics 20.0版進行統計分析。研究結果發現：(1)決策控制偏好中被動角色佔40%，合作角色佔30.5%，主動角色佔29.5%；(2)共享決策量表平均得分為88.03分，共享決策程度屬中上程度；(3)性別、教育程度、有無配偶與決策控制偏好為影響共享決策的相關因素；(4)全人工關節置換手術病人其共享決策的重要預測因子為「教育程度」及「決策控制偏好」，共可解釋21.1%之總變異量。本研究結果可提供專業照護人員了解全人工關節置換手術病人於共享決策執行情況，也可提供未來護理實務及教育的參考依據，以提升病人參與共享決策。

關鍵字

全人工關節置換手術 ； 決策控制偏好 ； 共享決策

並列摘要

This research investigated the shared decision making (SDM) and associated factors for total joint replacement surgery. The purpose of this study were to: (1) understand about demographic characteristics, decision control preference and family support; (2) understand SDM and decision-making experience; (3) explore the relationship among demographic characteristics, family support, decision control preference and SDM; (4) explore the relationship between SDM and decision-making experience in patients with total joint replacement. A cross-sectional and correlation research design was used. Structured questionnaires, including demographic data, SDM-Q-9, SWD and DRS, were used to collect data. A convenience sampling of 95 patient aged 20 years or above and initial total joint replacement surgery was recruited from one medical center and two regional hospital in the southern Taiwan. The collected data were analyzed by IBM SPSS Statistics 20.0 software.
The results of this study showed that (1) the majority preferred passive role(40%) in decision making, the next is collaborative role(30.5%), and the minority is active role(29.5%); (2) index score of SDM was 88.03, an upper intermediate level; (3) factors associated with SDM the most investigated were gender, educational level, spouse, and decision control preference in SDM; (4) education level and decision control preference were the important predictors of SDM, explaining 21.1% of the total variances in SDM. The results of this study may help health professionals in understanding the SDM and the related factors of patient with total joint replacement surgery. It could also provide evidence-based data for practice and education in nursing to improve SDM of patient with total joint replacement surgery.

並列關鍵字

total joint replacement surgery ； decision control preference ； shared decision making

參考文獻

林美伶、葉莉莉、陳清惠（2009）．影響病人參與醫療決策之論述．護理雜誌，56（3），83-87。

簡靜慧、莊正鏗、劉冠麟、劉雪娥（2008）．前列腺癌病患參與治療決策過程的決策困難及其影響因素之探討．長庚護理，19（1），1-13。

Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Social Science & Medicine, 44(5), 681-692.

中文文獻

衛生福利部統計處(2017，10月)．104年度全民健康保險醫療統計年報．取自https://dep.mohw.gov.tw/DOS/np-1920-113.html