本文探討專科護理師（Nurse Practitioner, NP）於預立醫療照護諮商（Advance Care Planning, ACP）與醫病共享決策（Shared Decision Making, SDM）流程中的角色挑戰與功能重構。隨著《病人自主權利法》實施與SDM制度推動，NP雖具備醫療專業與照護互動優勢，能深入掌握病人價值觀與偏好，然因現行法規與制度設計侷限，難以正式參與或影響醫療決策。本文統整制度法規現況、臨床實務觀察與倫理分析，指出NP於資訊轉譯、價值澄清與倫理促進等功能具高度介入潛力，可有效補足ACP與SDM推行過程中的溝通落差與實務困境。建議未來應從法規明確化、臨床合作機制與教育訓練等面向強化NP之參與架構，以提升病人為中心的決策品質，並深化ACP與SDM制度於國內臨床場域之落實。

This article explores the role challenges and functional redefinition of Nurse Practitioners (NPs)within the processes of Advance Care Planning (ACP) and Shared Decision Making (SDM). With the implementation of the Patient Right to Autonomy Act and the national promotion of SDM in Taiwan, NPs—equipped with clinical expertise and strong patient-centered communication skills—are well positioned to understand patients’ values and preferences. However, existing legal and institutional constraints often limit their formal participation in medical decision-making. Drawing from policy analysis, clinical practice observations, and ethical reflection, this paper identifies the underutilized yet critical functions NPs can fulfill in ACP and SDM processes, particularly in areas such as medi-cal information interpretation, value clarification, and ethical facilitation. These roles can help bridge communication gaps and address practical barriers that hinder the effective implementation of pa-tient-centered care planning. To enhance the quality and inclusiveness of decision-making, this paper recommends strengthening NP involvement through legal recognition, interprofessional collaboration frameworks, and targeted education and training. Such reforms are essential for advancing ACP and SDM integration in Taiwan’s clinical settings and promoting ethical, value-based care.