醫病共享決策應用在骨腫瘤檢查

Shared Decision Making in Bone Tumor Assessment

在病患主觀意識抬頭的現代，面對各種新技術的龐大醫療資訊，醫病如何一同決定出最合適的治療選項，成為一項重大挑戰。「共享決策（shared decision making, SDM）」因應而生，透過臨床工作人員首先向病人和家屬說明疾病、處置方案選項，並提供關於治療方案的各程比較資訊，然後在與病人和家屬的實地討論過程中，利用醫病共享決策輔助工具（patient decision aids，PDAs）了解病人對治療方案的偏好和價值觀，分析方案的優缺點，最後支持病人依其價值觀進行醫療決策。醫療不確定性比重越大，越重大、複雜的疾病，越適合採用醫病共享決策。由於病人和家屬通常對骨腫瘤較為陌生，一旦被臆斷為骨腫瘤時，而且常常是在意料之外的情境下被診斷，常常會對病情和預後感到非常焦慮，即使想要從網路得到的資訊，相關內容也相對較少，更加重對疾病預後的恐慌感。在施行治療骨腫瘤前，需進行完整的檢查，判定腫瘤分期和確定腫瘤的種類，這些檢查項目不少，經由SDM的溝通和說明，可以有助於讓病人和家屬瞭解和配合，也可提出其偏好和價值觀給醫療團隊，讓醫病雙方都可更良好的溝通，得到共識和決定，展開醫療的流程。

Patient's autonomy is more emphasized in the modern age. In the face of huge amounts of medical information and various new technologies, it is a big challenge to reach the most suitable treatment options through discussion. ''Shared decision making (SDM)'' has been developed timely. Clinical staffs first explain the situations of disorders and treatment options to the patient and family, as well as provide comparative information about each treatment option. During the discussion with the patient/family on the real focus issues, patient decision aids (PDAs) are used to understand the patient's preference and values about treatment options, analysis of the advantages and disadvantages of the options. The patient's preference and values are supported in making medical decisions. The greater degree of medical uncertainty, the more serious and complexity of diseases, the more is needed to adopt shared medical decision making. Patients and family members are usually relatively unfamiliar with bone tumors. Once the possibility of bone tumors has been mentioned, often in an unexpected situation, they are often very anxious about the condition and prognosis. Even if they want to get information from the Internet, the relevant content is relatively scarce. Therefore, they often worry about the prognosis of the disease. Before the treatment of bone tumors, a complete set of assessment is required to determine the oncological stage and the type of bone tumor. There are many assessment items. Through the communication and explanation of SDM, it can enable patients and their families to understand and cooperate. They also can propose their preferences and values to the medical team. Thus, both doctor and patient/family can reach a better communication, consensus and decisions, and start the treatment process.