糖尿病患認知之溝通

Communication of Illness Perception with Diabetic Patients

糖尿病爲二十一世紀初，全世界愈加盛行也日漸重要的慢性病。其治療與控制，有賴病患在日常生活中不斷調整自我照顧行爲。因此，如何適當地與病患溝通，促使遵行醫囑，是醫護人員重要的診療工作。事實上，糖尿病可視爲新世紀典型之慢性疾病，醫病之間對相關病情之溝通過程，可爲照顧其他病患參考。本文旨在闡述臨床上與病患溝通病情認知之取向，並以實證資料爲基礎，以糖尿病爲例，說明與病患進行認知溝通之重點。「溝通」爲「生物醫療技術」外，重要之診療手段。近來學者發現，病患對其病情所持不同觀點，常爲治療者忽略而致遵行醫囑不良，影響病情，因而提出 「以病患爲中心」的臨床方法，強調了解病患生活、治療期望、對疾病認知、經驗及情緒等，希望以協商找出共識解決問題。其中，病患對其病情之認知常有錯誤，而對健康行爲有重大影響。並且當其面對專業人員的意見，會先與原有「認知解釋模式」比較，決定整合或去留。因此，一味地灌輸新知，不如尋找病患的誤解概念，予以澄清，較爲事半功倍。爲求了解本土糖尿病患之認知與自我照顧行爲，進而探討如何促進病患遵行醫囑，作者在中部某鄉鎭以質性研究之深度訪談與焦點團體蒐集一手資料，發現若干病患認知中常見而重要的誤解，並建議醫護人員在臨床上，應掌握病患「疾病認知模式」重要內容，並且：一、說服病患，建立全面而個別化的治療目標，注意並遵行「控制糖份」以外的治療措施：二、在飮食上，告訴病患「糖份飮食固應加以注意，減少脂肪的攝取更易爲一般病患所忽略」；三、澄清「流汗不等同於運動，只流汗的活動，可能不具運動的好處」，考慮自行減藥前，仍應以專業醫療人員之建議爲依據；四、澄清「高血糖對腎臟的傷害，也許更甚於藥物」，以說服病患遵行藥物醫囑。

Type 2 diabetes is becoming more prevalent in the whole world. To maximize the benefits of medical treatment, health professionals need effective communicative strategies to improve their patients' adherence and daily self-care. The aim of this article is to delineate the rationality of focusing cognitive perception in doctor-patient communication and illuminate patients' key cognitive misunderstandings found in my field study. Clinical communication is an important measure for chronic patient care. Researchers have noticed, recently, that patients' different perspectives to illnesses from doctors are important aetiologies of poor adherence and proposed the 'patientcentred clinical method', arguing the importance of understanding patients' living experience, cognitive perception and emotional responses to their illnesses. Recognition of cognitive misunderstandings, which may lead to health misconduct and need clarification, is the central task in this new clinical method. In order to better understand diabetic patients' perception and self-care behaviors, I performed a qualitative research with in-depth and focus-group interviews in central Taiwan. I found three main misunderstandings and recommended health professionals to convince their patients: 1. to develop a comprehensive managing program with strategies beyond sugar-control, 2. Cutting fatty food is, at least, as important as sugary food, 3. activities with sweating rather than consuming energy may not be as beneficial, 4. high blood sugar may be more toxic to kidneys than hypoglycaemic drugs.