醫病共享決策輔助工具在長效抗精神病藥物的應用

Application of Shared Decision-Making Aids in the Use of Long-Acting Injectable Antipsychotic Medications

思覺失調症病人在長期治療過程中，常面臨依從性不佳的問題，進而增加疾病復發與再住院的風險。長效抗精神病針劑（long-acting injectable antipsychotics, LAIs）已被證實能有效改善依從性，並降低復發率，然而其臨床使用率仍偏低。醫病共用決策（shared decision-making, SDM）強調資訊透明與病人參與，有助於病人對LAIs治療的理解與接受度。本文採文獻回顧方式，探討醫病共用決策輔助工具（patient decision aids, PDAs）於LAIs治療中的應用，包括工具設計原則、臨床推動策略、應用成效與潛在挑戰。綜合研究結果與初步臨床經驗，PDAs有助提升病人知情參與與治療決策能力，惟實務仍面臨診間時間壓力、病識感落差與文化障礙等限制。未來建議結合數位科技、強化跨專業合作機制，持續優化SDM模式，以促進病人中心精神醫療的落實。

Patients with schizophrenia often face challenges with treatment adherence over the long term, increasing the risk of relapse and rehospitalization. Long-acting injectable antipsychotics (LAIs) have been shown to effectively improve adherence and reduce relapse rates; however, their clinical utilization remains relatively low. Shared decision-making (SDM), which emphasizes information transparency and patient involvement, can help enhance patients’understanding and acceptance of LAI treatment. This narrative review explores the application of patient decision aids (PDAs) in the context of LAI treatment, including principles of tool design, clinical implementation strategies, outcomes, and potential challenges. Based on current research and preliminary clinical experience, PDAs can enhance patient engagement and decision-making capacity. Nonetheless, practical implementation faces barriers such as time constraints in clinical settings, disparities in insight, and cultural obstacles. Future recommendations include integrating digital technologies and strengthening interprofessional collaboration to continuously optimize the SDM model and advance patient-centered psychiatric care.