以病人為中心照護對臨床的成效

Clinical Outcomes: The Impact of Patient-Centered Care

以病人為中心議題在三十年前首被提出，目前已成為當前醫療服務的潮流。然而此概念一直以來未被具體界定，許多質量性研究從瞭解「醫師與病人的關係」開始去抽絲剝繭釐清這個概念，並探討醫師與病人的關係型態對病人滿意度、醫療健康行為順從性及健康狀態的影響。一直到2000年Mead和Bower回顧過去實證性與理論性文章，才初步將此概念具體化。可惜的是，該文章並未涵蓋護理所提的概念與研究結果，而以病人為中心的理念其實一直都是護理服務的本質之一，因此，缺乏護理對此概念的詮釋可能欠缺完整，故本文除整合文獻對此概念的詮釋外，也嘗試以系統性文獻回顧，深入探討與護理相關之「以病人為中心」的介入措施成效。文獻搜尋至2011年2月，資料庫包括：Cochrane Controlled TrialsRegister、JBI（The Joanna Briggs Institute）、MEDLINE、CINAHL、Pubmed、ProQuest、PsycInfo及CEPS等，共計納入13篇文獻，結果顯示「以病人為中心」之護理措施對疾病的改善仍有限，但對病人的自我照顧知識與技巧，及滿意度都能有效提升。而分析納入的研究對於「以病人為中心」的定義仍依據傳統的定義，未能涵蓋Mead和Bower的所有概念。此外，因各篇研究異質性高，且欠缺本土性研究，故本文縱整相關「以病人為中心」的成果指標，希望藉此提供國內護理研究及臨床實務之參考，亦期望護理可以順著這波時代趨勢，發揮護理專業之長處，領導及整合醫療環境的品質提升。

An extensive body of literature advocating a ”patient-centered” approach to medical care has emerged over the past three decades. This approach is now a mainstream trend in healthcare. Despite its popularity, there remains little consensus regarding the content or definition of patient-centered care. Various quantitative and qualitative research studies have extracted core meanings from ”doctor-patient relationship” perspectives and investigated the relationships of these meanings with patient satisfaction, compliance with health promoting behavior, and health status. Mead and Bower’s review of the conceptual and empirical literature represented the first attempt to develop a model of the doctorpatient relationship that considered the multiple aspects embraced by the ”patient-centered” approach. However, any interpretation of the ”patient-centered” concept that fails to consider the perspective of nursing is likely incomplete, as patient-centered care is the essence of nursing. This paper reviewed the concept of ”patient-centered care”, conducted a systematic review of randomized control trials to explore the effectiveness of patient-centered care, and integrated nursing-related studies that focused on patient-centered care. Our search covered articles published through the end of February 2011 in the Cochrane Controlled Trials Register, JBI, MEDLINE, CINAHL, Pubmed, ProQuest, PsycInfo, and CEPS, with 13 relevant articles identified. The majority of trials addressed by these studies demonstrated a positive ”patient-centered care” effect on self-care knowledge and skills but a limited / insignificant effect on disease improvement. The reviewed studies used traditional definitions of ”patientcentered care” that were inconsistent with the concepts defined by Mead and Bower. Heterogeneities exist between reviewed studies and the lack of related research in Taiwan. We thus integrated outcome indicators related to ”patient-centered care”. This study may be referenced by nursing research and clinical care professionals responsible to improve and integrate medical care quality.