末期醫療抉擇的家庭會議溝通模式之回溯性分析

Family conference communication patterns for end-stage patients

目標：家庭會議是促進醫療端與病家端的重要開放性溝通方式，藉此確認病人的意願，整合家屬意見，討論共識出適切的醫療抉擇。本研究目的為了解末期醫療抉擇的家庭會議中醫療端與病家端間的溝通模式。方法：以台灣南部一區域教學醫院，收集2009-2014年108位病人共125份的癌末醫療抉擇的家庭會議紀錄，進行病歷之回溯性分析。採內容分析歸納臨床上進行末期醫療抉擇家庭會議的常見溝通模式。結果：發現召開的家庭會議中，雖然有部分討論到以病人的意願與自主為最重要之考量，但實際上有病人參與共同討論的家庭會議為數不多，甚至有的會議家屬拒絕病人參與決策。質性分析歸納出家庭會議溝通模式包括了三主題九大類別： 1.病主──尊重依循病人的自主決定；2.家主──由家屬代表發聲並代做決定；3.醫主──希望以醫師的經驗與建議為之。結論：期能以此研究結果為基礎，發展符合文化民情但具有效能的末期醫療抉擇與家庭會議溝通模式，進而深耕推動未來更尊重病人自主的醫病共享決策模式。（台灣衛誌 2022；41（2）：226-233）

Objectives: Family conferences constitute a vital medium for facilitating open communication between a medical team, a patient, and the patient’s family. Confirming the patient’s wishes and incorporating their family’s views during the formulation of decisions for end-stage medical care are crucial. The objective of this study was to determine the communication patterns arising between the health-care team, the patient, and the patient’s family during a family conference for making decisions about end-stage medical care. Methods: This 5-year retrospective analysis reviewed charts for 125 family conference minutes concerning decisions for end-stage medical care; the charts were sourced from 108 patients residing in a regional teaching hospital in Southern Taiwan between 2009 and 2014. Content analysis was conducted to observe the common communication patterns during these family conferences. Results: Although some family conferences reached an agreement that patient willingness and autonomy should be prioritized, few conferences actually involved the patients. Some conferences were even held on the condition of no patient involvement. Our qualitative research identified several family conference communication patterns as follows: (a) patient-oriented patterns, where the patient’s thoughts were considered to deliberate the medical decisions; (b) family-oriented patterns, where family members made decisions on behalf of the patient; and (c) medical-oriented patterns, where physicians were trusted to make decisions. Conclusions: The results of this study can serve as a reference for developing effective family conference communication patterns in which patient autonomy in making decisions concerning end-stage medical care is respected, thus promoting shared decision-making. (Taiwan J Public Health. 2022;41(2):226-233)