運用醫病共享決策提升末期腎臟病病人治療模式選擇之成效

Using Shared Decision Making to Promote the Efficacy of Treatment Modality in Patients with End Stage Renal Disease

本專案旨在提升末期腎臟病病人治療模式選擇成效，當慢性腎臟病的病情進展到末期階段，且末期腎臟病病情進展不可逆，醫療團隊的工作目標是協助病人在專科醫師的建議下，適時完成腎臟取代療法之治療模式選擇。因本院治療模式選擇率持續下降，在2017年1月至5月份僅有44％，因此觸發執行專案改善的動機。本專案團隊確立的主要問題包含：一、醫療團隊部份：（1）治療模式選擇介入時機無共識、（2）個管師衛教內容不一致、（3）業務繁忙、（4）缺乏有效溝通；二、病人與家屬部份：（1）認知不足、（2）主要決策者無法配合就醫、（3）缺乏學習動機；三、設備部份：衛教空間與工具不符合病人期待。本專案旨在提升末期腎臟病病人治療模式選擇成效，並將專案目標設為提升治療模式選擇完成率達70％以上。過程中運用醫病共享決策團隊會議進行，以最新的實證醫學證據，用病人能夠理解的方式進行說明與討論、以QR code推廣多元衛教工具便民瀏覽、衛教空間重整等措施，不僅提升病人對治療模式選擇知能，也藉由專案推動引導病人說出自身焦慮、使病家願意正視疾病進展，最終使治療模式選擇成效提升至81.3％，達專案目標。

This project aimed to promote the efficacy of choosing treatment modality in patients with end stage renal disease to raise the completion rate of treatment modality selection to higher than 70%. However, the ratio of patients who have decided the modality of renal replacement therapy before initiation of dialysis was decreasing progressively in our hospital. Between January 2017 and May 2017 in our hospital, dialysis modality has been decided in only 44% incident dialysis patients on dialysis initiation and temporal vascular access was used increasingly. Most incident dialysis patients were suffering at a loss to decide which treatment modality was the most suitable because of the uncertainty about the optimal timing at which a medical team should involve to help choose treatment modality, ineffective communication between medical teams and major decision makers as well as unsatisfactory space and tools for health education. In this project, we executed shared decision making by team meetings and discussed with patients and their family members colloquially based on evidence-based medicine. QR code was introduced and effectively facilitated diverse health education materials to be approached. Besides, the space for health education was refurbished. Thereafter, up to 81.3% patients have chosen the treatment modality before dialysis was initiated. Through this project, patients became willing to express their concerns and families became willing to face on the progress of chronic renal disease. Finally, patients would embrace the disease and choose treatment modality more effectively.