就醫提問單對癌症末期病人的有用性、滿意度及焦慮之成效──統合分析

The Effects of the Question Prompt List on Usefulness, Satisfaction and Anxiety in Patients With Terminal Cancer: A Meta-Analysis

背景：臨床常見癌症末期病人與照顧者或醫療團隊溝通不良導致的困擾及焦慮，引發對於治療的不確定感及產生恐懼等，影響治療的進行及善終的目標。國際研究結果指出醫病共享決策（shared decision making）的就醫提問單（question prompt list）應用過程可改善醫病溝通模式。
目的：有鑑於目前國內臨床尚未普及使用就醫提問單，其是否適合國內癌末病人及家屬溝通使用，迫切需要實證的支持。
方法：本研究以系統性文獻回顧法及統合分析Meta-analysis研究法，應用Cochrane Risk of Bias Tool 2誤差風險工具，以評估文獻品質，依據關鍵字分別搜尋英文資料庫包含PubMed、Cochrane library、Embase、EBSCOhost及MEDLINE；中文資料庫為華藝線上圖書館，共六個資料庫。採用RevMen5.4套裝軟體（北歐Cochrane中心2020年9月版）進行數據分析。
結果：研究結果發現就醫提問單的使用顯著增加發問題數（MD = 2.45, p = .01）及有用性（SMD = 0.25, p = .02）；但對於諮詢時間（MD = 4.49, p = .11）、滿意度（MD = 0.08, p = .91）或焦慮（SMD = 0.06, p = .62）則未呈現顯著的改變。
結論／實務應用：建議將就醫提問單依使用時機精簡化、重點化的運用不同章節及主題提問，於家庭會議時，尊重病人、家屬及家庭需求，選擇重視的焦點，將使會談更加聚焦及有效的建立治療性關係，病人及照顧者確實參與治療計畫。再者，建議未來增設外部溝通指導者，指導病人及照顧者澄清需求及關注點，以增進諮詢期間病人的發問技巧，為其賦能。期待未來能發展本土癌症末期病人之就醫提問單，應用本研究結果做為醫療人員及學生之在職教育內容。

Background: Difficulties and anxiety caused by poor communication between patients with terminal cancer and their caregivers and medical teams are common in clinical practice. This may lead to uncertainty and fear of treatment, affecting the progress of treatment and achievement of hospice-care goals. The results of prior research indicate that using a question prompt list to promote shared decision-making can improve communication between medical care providers and patients.
Purpose: This study was developed to explore the effectiveness of using question prompt lists in communications with terminal cancer patients and their families in clinical settings in Taiwan.
Methods: A systematic review of the literature using a meta-analysis research design was conducted in this study. Cochrane Risk of Bias Tool 2 was used to assess literature quality. The selected keywords were used to search six databases, including the English-language PubMed, Cochrane Library, Embase, EBSCOhost, and MEDLINE databases and the Chinese-language Airiti Library database. RevMen 5.4 software (the latest version released by the Nordic Cochrane Center in September 2020) was used for data analysis.
Results: Applying the question prompt list was found to significantly increase the number of questions asked (MD = 2.45, p = .01) and the usefulness (SMD = 0.25, p = .02). However, no significant changes in consultation time (MD = 4.49, p = .11), satisfaction (MD = 0.08, p = .91), or anxiety (SMD = 0.06, p = .62) were found.
Conclusion/ Implications for Practice: The results support that simplifying and focusing the topics of each chapter and theme of the question prompt list based on time of use may allow the list to be used effectively in combination with family meetings in clinical practice and to be focused based on patient, caregiver, and family needs to facilitate more-productive discussions. This will allow meetings to better facilitate therapeutic relationships and patient and caregiver participation in treatment plans. An external communication coach may be added in the future to help patients and caregivers clarify needs and concerns and improve the effectiveness of consultations. As questioning skills are important to empowering patients, a question prompt list for patients with terminal cancer should be developed. The results of this study may be used to guide the practice of healthcare providers and referenced in caregiver in-service education.