從腎臟照護出發：醫病共享決策之臨床導入與優化

Advance Care Planning and Shared Decision Making for Patient with Chronic Kidney Disease

「醫病共享決策」(Shared Decision Making，SDM)是慢性腎臟病病人面臨腎臟替代療法選擇時，能否接受疾 病並良好適應的重要關鍵。本文為腎臟替代療法臨床導入醫療決策進而優化的實務經驗。實施方法包含： 事先建立團隊共識、培訓引導員和強化回覆示教技巧、開發決策輔助工具和多元應用、導入照護模式並優 化流程。共161位病人參與SDM，由啟動SDM至確認透析治療選項並建立管路平均天數為76.8 ± 87.1天， 病人、家屬及醫療人員均滿意SDM執行過程。建議醫療團隊預期病人透析治療前三至六個月啟動SDM，提供足夠思考時間；開發結合實證醫學與病人需求的決策輔助工具，如簡易文字、圖像、影片、座談會、模擬演練等，並配合資訊科技的運用，可使SDM充分發揮效益，幫助病人做出符合自身期望的決定。

 

Shared decision making (SDM) has been considered as an important element of well adopted to disease status and renal replacement therapy in patients with chronic kidney disease (CKD). This article shares our clinical practical experience of initiating and optimizing an SDM program for renal replace therapy. The steps of this program include team consensus development,facilitators cultivation, teach-back method enhancement, decision support tools with multiple applications development, care model adoption, and care process optimization. Among 161 patients with CKD enrolled in the SDM program, the average duration from the time of initiation of SDM to the date of vascular access creation is 76.8 ± 87.1 days, and all medical staffs, patient families, and patients within this program were satisfied with the whole processes. Our successful experience suggests that patients with CKD should start SDM program in 3 to 6 months before dialysis. Developing patient-friendly decision support tool based on current medical evidence such as plain text, figure, movie, forum, scenario practice combining with informative technology can enlarge the efficiency of SDM and assist patient to make a more suitable decision.