應用醫病共享決策平台改善碘131病人治療品質

Application of a Shared Decision Making platform to improve patient care quality in Iodine-131 therapy

陳瑞仁(Jui-Jen Chen) ； 賴鈺婷(Yu-Ting Lai)

《健康科技期刊》 6卷1期 (2019/09) Pp. 6-15

https://doi.org/10.6979/TJHS.201909_6(1).0003

摘要

目的：2018-2019年度醫院醫療品質及病人安全年度工作目標八，鼓勵病人及其家屬參與病人安全工作執行策略為推行醫病共享決策（Shared Decision Making, SDM），本研究目的是提供甲狀腺癌病人術後放射碘131治療流程的評估與衛教，導入資訊技術輔助醫師與病人雙向互動的有效溝通中獲得最適化的治療。方法：應用實證醫學及共享決策兩大觀念，由醫師分析建置放射碘131治療準則，電腦師架構核子醫學科碘131決策資源共享平台，以病人隱私為主軸採不記名操作模式與扁平化極簡排版設計理念，運用活潑的色彩配置、說明文字粗體放大以及百分比個數圖片輔助。結果：核子醫學科於2017年9月至2018年5月進行SDM問卷滿意度調查，其未使用SDM平均值落在1.3，使用後大幅提升至4.89，滿意度提升確實解答了病人對放射性碘131治療的相關疑慮與恐懼，使每位病人獲得個人化及最適化的治療方式。結論：平台以結構化的步驟引導病人及其家屬說出重要考量，經過醫病雙方共同討論，降低彼此認知落差，同時讓主治醫師以做中學方法帶著住院醫師與實習醫學生真實的面對病人，讓住院醫師得到最完整及最實務的SDM。

關鍵字

醫病共享決策 ； 病人安全 ； 醫療品質 ； 核子醫學

並列摘要

Purposes: 2018-2019 Hospital Patient Safety Annual Goal No. 8 encourages patients and their family members to participate in strategy implementation regarding patient safety issues, and to thus implement Shared Decision Making (SDM). This study provided evaluation and health education regarding the Iodine-131 radiotherapy process to postoperative thyroid cancer patients. The study introduced information technology to help doctors engage in two-way communication with patients and thus obtain optimal therapy. Methods: This study applied two major concepts: evidence-based medicine (EBM) and SDM. Doctors analyzed and put in place standards for Iodine-131 radiotherapy. Computer engineers then created a department of nuclear medicine Iodine-131 SDM platform. The platform uses an anonymous operation method (based on the core principle of protecting patient privacy) and a simple flat design. This is supplemented by a vivid color scheme; large, bold explanatory text; and percentage-based images. Results: The department of nuclear medicine implemented an SDM satisfaction survey from September, 2017 to May, 2018. The pre-SDM value was at 1.3; after using SDM, satisfaction increased greatly, to 4.89. The increase in satisfaction shows that SDM indeed resolved patient doubts and fears about Iodine-131 radiotherapy, and helped each patient receive the most personalized, optimal form of therapy. Conclusions: The platform's structured steps guide patients and their family members through important considerations. Through two-way doctor-patient communication, differences in understanding are reduced. This helps attending physicians bring residents and interns face-to-face with patients through a learn-while-doing process, while also helping doctors obtain the most robust and practical SDM possible.

並列關鍵字

Doctor-patient Shared Decision Making ； patient safety ； healthcare quality ； nuclear medicine

參考文獻

蔡姈砡、林秋菊 (2015)。運用共享決策於一位腎癌併皮下轉移病人之照護經驗。[Using Shared Decision-Making on a Patient with Renal Cell Carcinoma and Subcutaneous Metastasis: A Care Experience]。護理雜誌，62 (3)，89-94。doi: 10.6224/jn.62.3.89

Bunn, Frances, Goodman, Claire, Manthorpe, Jill, Durand, Marie-Anne, Hodkinson, Isabel, Rait, Greta, Wilson, Patricia. (2017). Supporting shared decision-maki-ng for older people with multiple health and social care needs: a protocol for a realist synthesis to inform integrated care models. BMJ Open, 7 (2). doi: 10.1136/bmjopen-2016-014026

Coylewright, M., O'Neill, E.S., Dick, S., & Grande, S.W. (2017). PCI Choice: Cardiovascular clinicians' perceptions of shared decision making instable coronary artery disease. Patient Educ Couns, 100 (6), 1136-1143. doi: 10.1016/j.pec.2017.01.010

Wilton, Stephen B., & Lyons, Kristin J. (2017). The Challenge of Measuring Adherence With Implantable Cardioverter Defibrillator Referral Guidelines in the Era of Shared Decision-Making. Canadian Journal of Cardiology, 33 (4), 420-421. doi: 10.1016/j.cjca.2016.11.008

Yek, J. L. J., Lee, A. K. Y., Tan, J. A. D., Lin, G. Y., Thamotharampillai, T., & Abdullah, H. R. (2017). Defining reasonable patient standard and preference for shared decision making among patients undergoing anaesthesia in Singapore. BMC Medical Ethics, 18, 6 . doi : 10.1186/s12910-017-0172-2