癌症疼痛的醫病共享決策

Shared Decision Making for Cancer Pain

疼痛是癌症病患最常見的症狀之一，也是影響患者預後與生活品質的重大臨床挑戰。突發性疼痛（breakthrough pain）與頑固性癌痛（refractory cancer pain）尤其因難，疼痛控制不足，固然會造成患者身心負擔，然而類鴉片藥物的不當使用，亦可能打擊醫病之間的互信基礎，因此納入以病人為中心醫病共享決策（shared decision-making, SDM），邀請患者共同參與藥物調控的目標，或適時引進多種微創技術的進階區域疼痛治療，才是根本解決之道。在SDM模式下，照護者提供實證資訊，病患考量自身偏好與價值觀，醫病互相尊重溝通，通過賦權（patient empowerment）提升自我健康效能，積極應對癌症疼痛，改善疼痛管理。SDM與賦權使患者對癌症治療計畫更具認同與遵從度，醫護患者之間密切溝通，表達疼痛與疼痛控制狀況，從而打破癌症疼痛治療兩難困境，同時達到對抗癌症疼痛，改善生活品質的終極目標。

Cancer-related pain is the most distressing symptom for cancer patients. Refractory pain due to inadequate opioid dosage clearly threatens both anti-neoplastic outcome and quality of life. Meanwhile, opioid-induced side effect remains a psychosocial burden throughout patients' terminal stage. To solve this dilemma, we propose that minimal invasive treatment could serve as a perfect remedy to help optimize opioid medications through shared decision-making (SDM). Unlike the traditional medical decision-making process, SDM is a powerful tool that delivers a most update patient-centered care from evidence-based medicine. This review discussed barriers and patient empowerment in cancer pain management and useful SDM options to help patients' adherence to minimal invasive procedure. In conclusion, SDM approach involves both patients and clinicians in decision-making about possible treatment options based on patients' preferences and best available evidence.