醫病溝通與共享價值觀對醫病共享決策成效影響之研究-以退化性膝關節炎病患為例

Research on the Effects of Physician-Patient Communication and Shared Value on Shared Decision Making Effectiveness – an Example of Degenerative Knee Osteoarthritis Pateints

蔡宜珊(YI-SHAN TSAI)

指導教授 ： 張馨云

中臺科技大學/管理學院/醫療暨健康產業管理系碩士班/碩士(2020年)

摘要

前言：醫病共享決策(SDM)是目前衛生福利部以及醫策會為強化醫病溝通及病人安全下，積極推動的重點主題，主要是協助醫療人員與病人之間更有效的互動，以共享價值觀的基礎下建立互信與彼此承諾。衛生福利部南投醫院於2018年導入退化性膝關節炎之SDM輔助工具，此項輔助措施在國內各醫療機構新倡導實行，其影響因素仍處於探索階段，藉由SDM輔助工具介入，探討醫病溝通及共享價值觀兩大變數對於醫病共享決策之成效影響。
方法：以衛生福利部南投醫院就診診斷為退化性膝關節炎，未接受膝關節置換之病人與家屬為研究對象，於109年1至3月期間，在接受SDM輔助工具後與就診後，實際訪談回收有效問卷95位，問卷所得資料以SPSS 22.0版統計軟體進行統計分析。
結果：研究顯示，在不同決策參與者當中的配偶對於醫病溝通的差異性大於病人本身（p <0.05）；皮爾森相關係數為醫病溝通與SDM成效之間及共享價值觀與SDM成效之間各構面變數皆達顯著水準(p <0.01)，於迴歸分析中顯示，醫病溝通對SDM成效有47.6%解釋力(p <0.001)，共享價值觀對SDM成效有49.4%解釋力(p <0.001)。經此驗證由醫病共享決策(SDM)輔助工具介入措施，可提升醫病雙方的醫病溝通及共享價值觀，也藉此提升醫病共享決策成效。
結論：因地緣人口特性關係，建議配偶適時的參與共享決策，可提升共享決策之成效；SDM輔助工具介入對於醫病互動是一個良好的的溝通媒介，建議醫療機構可設計及推廣至其他醫療領域，以提升醫病關係品質，創造醫病雙贏。

關鍵字

退化性膝關節炎 ； 醫病共享決策 ； 醫病溝通 ； 共享價值觀

並列摘要

Foreword: Shared Decision Making (SDM) is currently the key theme actively promoted by the Ministry of Health and Welfare and the Joint Commission of Taiwan, with the aim of strengthening physician-patient communication and patient safety. The main goal is to assist medical personnel and patients to interact more effectively and to establish mutual trust and commitment based on shared values. The Nantou Hospital of the Ministry of Health and Welfare introduced the Patient Decision Aid(PDA) for degenerative knee osteoarthritis in 2018. This auxiliary measure was newly advocated and implemented in various medical institutions. Its impact still needs to be explored. This study discusses the impact of two major variables, physician-patient communication and shared values on the effectiveness of SDM through the PDA.

Methods: The patients who were diagnosed with degenerative knee osteoarthritis and have not been treated with knee replacement at the Nantou Hospital of the Ministry of Health and Welfare, and their families, were selected as subjects. From January to March of 2020, after using PDA and medical examination, 95 valid questionnaires were collected. The data obtained from the questionnaires were statistically analyzed using the statistical software SPSS 22.0.

Results: The study shows that among different participants in decision-making, there is a higher level of differentiation between spouses than between patients in terms of physician-patient communication (p < 0.05). Pearson’s correlation coefficient values between phycisian-patient communication and SDM effectiveness, and between shared values and SDM effectiveness both reached a significant level (p < 0.01). Regression analysis shows that physician-patient communication had 47.6% explanatory power for SDM effectiveness (p < 0.001), and shared values had 49.4% explanatory power for SDM effectiveness (p < 0.001). Therefore, it is verified that interventions by the PDA can improve physician-patient communication and shared value, and thereby improve the effectiveness of SDM between physicians and patients.

Conclusion: Due to geographical and demographic characteristics, it is recommended that patients’ spouses participate in SDM in a moderate and timely manner, so that the effectiveness of SDM can be improved. The intervention of PDA is a good communication medium for the physician-patient relationship. It is recommended that medical institutions should design and promote them to other medical fields in order to improve the quality of the physician-patient relationship and create a win-win situation for physicians and patients.

Keywords: degenerative knee osteoarthritis, Shared Decision Making, physician-patient communication, shared values

並列關鍵字

degenerative knee osteoarthritis ； Shared Decision Making ； physician-patient communication ； shared values

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