醫用營養之醫病共享決策

Shared Decision Making for Medical Nutrition

營養不良影響癌症治療也增高手術併發症的發生率，體重、體重變化、身體質量指數等體位測量常作為營養不良指標，然而，肌肉質量、手術前後體肌肉質量變化、肌少症的評估更貼切用於定義營養不良。臨床上受限於使用體肌肉測量工具，生物電阻分析提供了較佳的評估工具及精準數據，但受限於自費選項及測量不普及，需要營養師對病人甚至其他醫護團隊介入專業說明；藉由醫病共享決策過程，提高病人及醫療團隊對營養不良風險的及早認知，提供營養師規劃個別化的營養介入策略，及早計劃蛋白質、熱量供應到位，有助於改善營養支持品質，並提高整體醫療滿意度。

Malnutrition influences cancer treatment and increases the complication rates after operation. Measurements of anthropometric body composition such as body weight, weight change, and body mass index are often used to assess malnutrition. However, muscle mass, changes of muscle mass before and after surgery, and sarcopenia are more properly used to define malnutrition. The assessment of muscle mass is limited in clinical practice, the bioelectrical impedance analysis (BIA) provides a better evaluation to reach accurate results, but it is not covered by medical insurance and is not widely used. Therefore, a professional intervention and explanation by dietitian is needed. Using a shared decision-making process, the dietitian can communicate with the patients and medical team, early detection of malnutrition and individualized nutritional intervention strategies, including supplement of adequate amount of protein and energy. Thus, they will improve the quality of nutrition support and optimize the overall medical satisfaction.