共同決策於臨床醫學之應用

Shared Decision Making in Clinical Practice

醫療決策的品質攸關整體醫療品質和病人的福祉，目前臨床最常見有三種醫療決策模式：（1）父權決策模式，（2）告知決策模式，（3）共同決策模式，其中共同決策模式最能夠凸顯以病人為中心照護之精神。我們先就父權決策模式和告知決策模式，做一個概括性的論述，再深入探討共同決策模式，就其定義、臨床應用、臨床試驗是否適合或必須適用和其執行障礙等面相加以探討。依其定義而言我們主要採用Charles C等學者之定義並增添一項病患在參與共同決策模式時，於資訊交換該階段，和醫師一樣，可提出對醫療計畫之建議。希望本篇文章有助於共同決策模式之推廣，進而提升醫療品質，造福病患，將以病患為中心的照護精神發揚光大。

The quality of medical decision-making affects both quality of medical care and welfare of patients. Paternalistic, informed and shared decision-making models are three of the most adopted medical decision-making models. Among them, the shared decisionmaking model can best reflect the essence of patient-centered care. We first made a general description of paternalistic and informed decision-making. Then detailed descriptions of the definition, applications in clinical trials and obstacles of the shared decision-making were presented. In addition to the definition of Charles C and et al., we added that patients, as doctors, can present medical care options during the stage of information exchange while participating in shared decision-making. The purpose of this study is to promote the application of shared decision-making, improve the quality of medical care, benefit patients’ overall medical experience and highlight the importance of patient-centered care.