醫病共享決策之推動－以北市某區域教學醫院為例

Promoting Shared Decision Making in a Regional Hospital in Taipei

林淑美(Shu-Mei Lin) ； 蔡志婕(Chih-Chieh Tsai) ； 詹尚易(Shang-Yih Chan) ； 劉建良(Chien-Liang Liu) ； 許文章(Wen-Chang Hsu) ； 張富康(Fu-Kang Chang) ； 程威銘(Wei-Ming Cheng) ； 林政宜(Cheng-Yi Lin) ； 邱家祈(Chia-Chi, Chiu) ； 邱逸淳(Yi-Chun Chiu) ； 萬同軒(Tung-Hsuan Wan) ； 翁林仲(Lin-Chung Woung) ； 黃勝堅(Sheng-Jean Huang)

《北市醫學雜誌》 17卷4期 (2020/12) Pp. 459-481

https://doi.org/10.6200/TCMJ.202012_17(4).0010

摘要

目的：醫療決策是臨床執行醫療的常見過程，2015年世界衛生組織提出以人為中心（people-centered）的醫療照護架構，促進病人參與醫療，成為決策過程的重要思維。2019年國際醫病共享決策會議更具體建議納入病人角度來建構臨床實務上的教育、平權及決策輔助工具（Patient Decision Aid, PDA）。在台灣甫施行病人自主權利法之際，亦促使醫院思考如何實踐以病人為主體的決策。方法：為架構醫病共享決策之推動：首先選定主題並組織工作小組，推廣教育並以PDA開發工作坊訓練臨床人員，及團隊品質提升活動（Quality Control Circle, QCC）程序小規模的探討臨床實踐之可行性。結果：此次推動完成192場宣導、2場工作坊及臨床實踐13個單位。完成11件包括預立醫療照護諮商（Advance Care Planning, ACP）及醫療特色之PDA，醫療團隊成員在認知、態度及意願皆有顯著增強（p＜0.05）。臨床實踐後的滿意度、溝通協調能力及品管工具運用信心亦有增加。病人方面在健康識能、認知、滿意度及參與意願皆為增加。結論：此過程醫療人員學習何謂病人的角度，以為促進病人參與及新的醫病互動關係之準備，並藉此建立持續推動的基礎。

關鍵字

以人為中心 ； 醫病共享決策 ； 決策輔助工具 ； 病人的角度 ； 醫病關係

並列摘要

Objective: Healthcare decision making is a routine process conducted during clinical practice. In 2015, the World Health Organization initiated a framework of person-centered health services that promotes patients' engagement in healthcare decision making. Moreover, the International Shared Decision Making (SDM) Conference (ISDM, 2019) concretely suggested developing education for clinical practice, equality, and patient decision aid (PDA) from patient perspectives. The announcement and implementation of the Patient Autonomy Act in Taiwan have led the hospital administrators to consider how to put the patient-centered decision into practice. Methods: To construct and promote SDM, we first selected topics and organized task forces, conducted promotional educations, held PDA development workshops, and explored its clinical feasibility by small scale quality control circle. Results: During the promotion period, we carried out 192 advocacy activities, two workshops and practically put SDM into practice in 13 units. We developed 11 PDAs to help patients make medical decisions, including advance care planning and PDAs for featured treatment services. The knowledge, attitude, and willingness to use PDA increased significantly among medical team members; the health literacy, knowledge, satisfaction, and willingness to join SDM also increased. Conclusion: The medical professionals learned to see from patient perspectives to be prepared for promoting patient participation and new doctor-patient interaction and use this as the basis of future development.

並列關鍵字

people-centered ； shared decision making ； patient decision aid ； patient-oriented ； physician-patient relationship