醫病共享決策改善術後疼痛與康復

Shared Decision Making Improves Pain and Recovery after Operation

醫病共享決策（shared decision-making, SDM）是一個溝通合作的過程，考量患者的偏好和最佳實證資料，使患者和臨床醫師共同參與醫療決定。SDM是以病人為中心，將實證醫學落實到臨床運用，改變傳統醫療決策的方式。在引導患者參與的同時對於促進醫病關係、提升病人滿意度已有明確證據。自衛生福利部於民國105年推行以來，許多醫療次專科已經有許多發展與應用SDM與決策輔助工具，然而在麻醉領域及圍術期照護，則仍有進步空間。SDM是改善患者預後與術後加速恢復的重要因素，獲得充分資訊且深思熟慮後的決定，使患者對醫療計畫更具認同與遵從度，有助於提升自我健康效能。術後疼痛可能導致身心不良副作用，延遲術後恢復、甚至變成慢性疼痛。然疼痛乃一主觀感受，對緩痛的期待因人而異，止痛方式、可能副作用與健保給付與否，也可能影響患者的選擇。本文以醫病共享決策在術後止痛的應用為題，探討現行做法、遭遇之困難與可能的解決方式。

Shared decision-making (SDM) approach involves both patients and clinicians in decision-making about possible treatment options, using patients’ preferences and best available evidence. SDM is the delivery of patient-centered care, the practice of evidence-based medicine, and changes the traditional medical decision-making process. It is associated with increased patient satisfaction, involvement, and confidence with healthcare decisions. A nationwide SDM program has been implemented in different medical subspecialties under the support of the Ministry of Health and Welfare since 2016, incorporating multiple approaches such as developing patient decision aids (PDAs). There is still room for improvement in anesthesia and perioperative care. Shared decision-making is an important component of improved patient outcomes and enhanced recovery after surgery (ERAS). Poor management of postoperative acute pain can contribute to medical complications, hinder postoperative recovery, and lead to chronic pain. As pain is subjective, the expectation of analgesia is diverse among individuals. The decision of pain management options may be influenced by the route of analgesics administration, potential side effects, and health insurance coverage. This article reviewed the application of SDM in postoperative pain management, discussed current strategies, common difficulties, and potential clinical solutions.