醫病共享輔助工具應用在人工關節置換

Patient Decision Aids for Shared Decision Making in Joint Arthroplasty

醫病共享決策（shared decision making, SDM）可以讓醫師和病人共同討論，了解疾病資訊與治療內容，針對醫療模式選項之優缺點並列比較，讓病人根據自己的價值觀與喜好進行決策，這醫病共享決策模式的流程中，需要運用一項很重要工具即：醫病共享輔助工具（patient decision aid, PDA）。在此以骨科常見的人工關節置換手術分享，本文討論設計過程及運用經驗，比較醫療選項的差異、醫療決策病人在意的項目及程度、確認病人對醫療選項的認知狀況、確認病人能執行醫療決策的狀況，並提出部分醫病共享輔助工具使用的經驗與建議，並討論應用時的一些常見問題。若能在適當的時間，選擇適當的病人，運用適當的醫病共享輔助工具，則能增強醫病間的有效溝通，提升病人滿意度。

Shared decision making (SDM) is a process in which patients and clinicians can discuss and work together to clarify the disease information and options of optimal treatment. During the process, the pros and cons of treatment options are clearly provided with evidence. The patients can make decisions according to their values, desires, and preferences. Patient decision aid (PDA) is a useful tool to share medical information and make the conversation more efficient. In the present article, we shared our experience of applying SDM to total joint arthroplasty surgery. This article included designing process and application experience, comparing the differences of medical options, explanation of the advantages and disadvantages, the items and degrees that patients caring about, confirming the patient’s awareness of medical options and their ability to make medical decisions. We also provide some experience and suggestions about the use of PDA and common problems during executing such an approach. If an PDA can be used in an appropriate timing and the right patient, it can effectively increase communication between clinicians and patients, and improving their satisfaction.