「生育保護醫病共享決策輔助工具」互動式網頁發展與使用測試

本研究目的為發展「生育保護醫病共享決策輔助工具」互動式網頁，並了解其對於癌症病人生育保護決策之成效。發展過程共有兩階段：（1）互動式網頁設計，並進行專家效度與合適性評估；（2）使用決策困擾量表進行成效測試。第一階段邀請本院7位腫瘤照護專家及3位病友志工，針對內容合適性、敘述理解性、與圖文清晰性提供檢定，結果平均有4分以上（1-5分）。第二階段自2020年5月至2021年3月，共邀請17位24至44歲處於生育年齡，診斷乳癌、淋巴癌及血液癌症，預計進行化學治療且有生育功能保護需求的婦女納入本研究；介入前後之決策困擾量表得分以Wilcoxon's signed-rank進行檢定，結果顯示介入後整體得分顯著下降（P＜0.001），表示決策衝突有改善。本工具可幫助癌症病人，在化學治療前做出個人化生育保護決策，值得臨床推廣使用。

關鍵字

生育保護；醫病共享決策；決策困擾量表；化學治療

並列摘要

The objectives of this study are to program an interactive web-based fertility preservation patient decision aid. There are two phases in the development process: (1) interactive web design and conduct expert validity and suitability test and (2) the decision conflict scores for effectiveness evaluation. In phase 1, the content suitability, readability and graphics clarity of the interactive web-based fertility preservation patient decision aid was evaluated by 7 oncology experts and 3 senior patient volunteers. The results have an average of 4 points or more (1-5 points). In phase 2, during the period from May 2020 to March 2021, seventeen women in reproductive age ranging from 24 to 44 years old diagnosed with breast, lymphoma or hematologic malignancies, who have undergone chemotherapy and have fertility function protection demands were included in this study. A Wilcoxon's signed-rank test was conducted to determine the difference in the decision conflict scores before and after intervention. The results showed that significantly less decision conflict score (p＜ .001) after intervention, which means that the decision-making conflict has been improved. Our web-based decision aid can help women make individualized fertility preservation decisions before chemotherapy and is worthy of clinical use.

並列關鍵字

fertility preservation ； shared decision making ； decisional conflict scale ； chemotherapy

參考文獻

Poorvu PD, Frazier AL, Feraco AM, et al. Cancer treatment-related infertility: A critical review of the evidence. JNCI Cancer Spectr 2019;3:kz008. doi: 10.1093/jncics/pkz008

Oktay K, Harvey BE, Partridge AH, et al. Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol 2018;36:1994-2001. doi: 10.1200/JCO.2018.78.1914

Cakmak H, Rosen MP. Ovarian stimulation in cancer patients. Fertil Steril 2013;99:1476-84. doi: 10.1016/j.fertnstert.2013.03.029

Bedoschi G, Navarro PA, Oktay K. Chemotherapy-induced damage to ovary: mechanisms and clinical impact. Future Oncol 2016;12:2333-44. doi: 10.2217/fon-2016-0176

Okanami Y, Ito Y, Watanabe C, et al. Incidence of chemotherapy-induced amenorrhea in premenopausal patients with breast cancer following adjuvant anthracycline and taxane. Breast Cancer 2011;18:182-8. doi: 10.1007/s12282-011-0256-7

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「生育保護醫病共享決策輔助工具」互動式網頁發展與使用測試

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