從病人的觀點探討醫病共同決策的價值

Value of Shared Decision Making from Patients' Perspective

譚家偉(Ka-Wai Tam) ； 陳可欣(Kee-Hsin Chen) ； 張秀如(Hsiu-Ju Chang) ； 黃珮玲(Pei-Ling Huang) ； 鄭思敏(Ssu-Min Cheng) ； 李佳穗(Chia-Sui Li) ； 陳作孝(Tso-Hsiao Chen) ； 劉秋芬(Chiu-Fen Liu) ； 周昀昀(Yun-Yun Chou) ； 薛曉筑(Hsiao-Chu Hsueh) ； 李惠蘭(Hui-Lan Lee) ； 賈淑麗(Shu-Li Chia) ； 王英偉(Ying-Wei Wang)

《醫療品質雜誌》 14卷1期 (2020/01) Pp. 36-41

https://doi.org/10.3966/199457952020011401008

摘要

醫病共同決策（Shared Decision Making，SDM）自引進臺灣以來，全國紛紛投入SDM的推動，並大量製作決策輔助工具（Patient Decision Aid，PDA），惟SDM執行成效仍有待評估。本研究透過焦點團體訪談，從病人及家屬的角度探討SDM的價值。我們於北部某醫學中心，邀請慢性腎臟病病人及家屬進行訪談，以探求病人對健康促進之需求，藉以優化SDM過程。我們發現，病人對洗腎有南轅北轍的認知；而醫療決策因無迫切性，進入決策的時間點較難掌握；且決策多為醫師主導，缺乏對話機制。因此，建議未來推動SDM應多思考以下面向：（1）回歸SDM核心價值；（2）提升民眾的健康識能；（3）SDM的過程需要因病制宜；（4）PDA的選項需符合病人需求；（5）鼓勵病友團體的介入。希望未來能有更多更符合病人需求的SDM與PDA，促進醫療品質的提升。

關鍵字

醫病共同決策 ； 決策輔助工具 ； 慢性腎臟病 ； 焦點團體訪談 ； 健康識能 ； 病人觀點

並列摘要

Shared decision making (SDM) has been advocated in Taiwan since 2016, and medical institutions have begun to engage in SDM promotion and patient decision aid (PDA) implementation. However, the effectiveness of SDM implementation has not yet to be systematically assessed. We conducted a focus group interview with patients with chronic kidney disease and their families in an academic medical center, and the oral content obtained was transcribed into a verbatim draft for further analysis. We determined five main suggestions as follows: (1) everything should be based on the core value of SDM; (2) the health literacy of the general public should be elevated; (3) SDM processes should be designed in accordance with the disease characteristics; (4) PDAs' options should meet patients' demands; and (5) the involvement of patient organizations should be encouraged. Based on the aforementioned suggestions, better designed SDM systems and PDAs meeting the patients needs can be developed.

並列關鍵字

shared decision making ； patient decision aids ； chronic kidney disease ； focus group ； health literacy ； patients' perspective