慢性腎臟病患預立醫療自主計畫模擬情境溝通訓練方案之建構

Constructing an ACP Simulation-Situation Communication Training Program for Patients With Chronic Kidney Disease

人口老化及生活型態的改變，導致慢性腎臟疾病風險相對提高，台灣末期腎臟疾病的發生率與盛行率在全球均名列前茅，血液透析病人必須承受共病症的折磨及面臨死亡的不確定性，預立醫療自主計畫（advance care planning, ACP）是保障病人善終最佳的方式。然而病人ACP簽署率仍偏低，分析其關鍵因素乃是醫護人員缺乏ACP教育訓練和溝通能力不足，故本文將以慢性腎臟疾病為例，探討臨床推動ACP的困境，並提出以理論為基礎的ACP模擬情境溝通訓練方案的理論架構，此架構係整合模擬情境模式、PREPARED model及鷹架理論等。期望讀者能利用此架構設計合乎自己實況的ACP模擬情境溝通訓練方案，並進一步測試其在臨床實務的成效及可行性。

The aging population and changing lifestyles have lead to the increased general risk of chronic kidney disease. Taiwan currently has the highest incidence and prevalence of end-stage renal disease (ESRD) of any country or region in the world. Hemodialysis patients must endure comorbidities and face the uncertainties of death. The best way to achieve a good death is for patients to sign advance care planning (ACP). However, the key factors contributing to low ACP signature rates have been the lack of communication skills and related training among medical staffs. This article explores the dilemma of ACP using an example of chronic kidney disease (CKD) and proposes a theory-based approach to develop a theoretical framework for an ACP simulation-situation communication training program that integrates the simulation situation model, PREPARED model, and scaffolding theory. Readers may use this framework to design ACP simulation-situation communication training programs that conform to their own conditions and then test the effectiveness and feasibility of these programs in clinical settings.