緩和醫療之醫病共享決策

Shared Decision Making in Palliative Care

緩和醫療的照護對象是面臨生命威脅疾病的病人及其家屬，藉由對於整體苦痛的完善評估與治療，改善病人與其家屬的生活品質。由於末期照顧有許多牽涉個人價值觀或偏好、或者利弊得失不明確的治療選擇，從照顧目標到治療選擇皆有許多可以運用醫病共享決策的地方，例如：善終地點、抗生素使用、及人工營養水分給予等議題。在實際應用方面，醫病共享決策可能遭遇的困境為：時間不足、難以評估成效、某些病人不擅長表達個人想法或是決策能力不足。雖然醫病共享決策的重要性逐漸受到重視，但在緩和醫療領域的應用仍需更多的推廣及研究。如何將家屬納入醫病共享決策、並以緩和醫療的觀點評估其成效，是未來重要的努力方向。

Palliative care improves the quality of life of patients and their families facing life-threatening illness, through ideal assessment and treatment of total suffering. Since end-of-life care involves personal values and preferences as well as the uncertainty of the pros and cons of treatment, shared decision making is an applicable solution in many circumstances. Decisions such as the place of death, antimicrobial use, and artificial nutrition/hydration are issues that can be solved by shared decision making. Barriers of shared decision making in clinical practice include: time constraints, difficulty in evaluating the outcome, patients who are not good at expressing their own opinions or are with limited decision-making capacity. Although the importance of shared decision making becomes more valued, there is still a lack of research on shared decision making in palliative care. Future studies should investigate family members' involvement in the process of shared decision making and evaluate outcomes from the perspective of palliative care.