醫病共享決策在骨科的應用

Shared Decision Making in Orthopaedics

醫病共享決策模式（shared decision making, SDM）是一種病患與醫師共同參與醫療決策的過程，醫師需先向病患說明相關疾病和治療的知識，再納入病患的偏好、價值觀等，共同做出最終的治療決策。SDM已經應用在多項醫療領域，在骨科方面，亦有許多證據指出，此種醫病共享決策模式，可以幫助骨科病患在更少的就診次數中，順利做出醫療決定、提升病患醫療知識、提升整體的病患滿意度，且臨床實務更有效率；除了這些優點以外，也有一些需克服的重大困難挑戰。骨科是主要施行手術的臨床科別，部分手術式採用臨床路徑，加上SDM在骨科手術的應用，具有多種主觀和客觀的限制因素，仍有待發展。此篇文章討論醫病共享決策模式目前在骨科領域的運用，並針對不同面相加以說明。

Shared decision making (SDM) model is a collaborative process between the physician and patient to make a clinical decision. Doctors explain relevant knowledge of disease and treatment options to the patients. The patients' preference and values are well taken for reaching the final medical decision through a consensus way. It has been broadly applied in clinical practice. In orthopaedics, the SDM can improve clinical efficiency, patient knowledge and patient satisfaction, and more efficient in clinical practice. However, there are also some significant challenges to the process of incorporating SDM into orthopaedic practice. Orthopaedics is a main field in surgical practice. Clinical pathways are used for the treatment of some orthopaedics disorders. There are subjective and objective limiting factors for the application of SDM in orthopaedic surgery. It needs to be developed. This article comprehensively reviewed the application of SDM in orthopaedic surgery.