建立淺白的醫病共享決策輔助工具──以拍痰治療的選擇為例

Development of Easy-to-Understand Patient Decision Aid: Chest Physical Therapy (CPT)

"隨著資訊爆發的新時代，醫療資訊的取得顯得更加容易，這也使得醫病型態由病人被動式的接受到現在已漸漸轉向於病人或家屬主動的參與。近年來，衛生福利部病人安全工作的目標八設定為，鼓勵病人及家屬參與病人安全工作，其中導入醫病共享決策概念，期待病人與家屬能夠共同參與醫療決策，以維護醫療自主權、促進更有效的醫療、降低醫療浪費並減少醫療糾紛。在醫病共享決策中，決策工具的使用是必要的，病人、家屬與醫療團隊共同決定的過程，必須讓病人與家屬充分瞭解病情及治療選項，透過工具內容的使用，包含：實證醫學數據、病人家屬在意因素的引導、疾病與治療選項認知評估等，在提供這些資訊下，應有助於醫病溝通與共同決策之事半功倍。故，開發病人看得懂、聽得懂的決策輔助工具就極為重要，本研究以開發當我或我的家人無法自行咳痰時，有什麼治療方式的選擇，說明如何與病人及家屬參與共同開發較白話之決策工具。本研究以國際決策輔助工具開發步驟(The International Patient Decision Aid Standards, IPDAS)，參考Ottawa 在2013 年提出「Decisional Needs Assessment in Populations」使用結構化工具，開發決策輔助工具，並運用在臨床上。"

"In the age of information explosion, collecting medical information is rather easy. As a result, the physician-patient relationship has been transforming from patients passively accepting to patients/families actively participating. In the recent years, the Ministry of Health and Welfare has set the #8 Taiwan Patient Safety Goal as encouraging patients and their families to participate in patient safety related work and integrated the idea of physicianpatient shared decision-making, in hopes that patients and their families can participate in medical decisions related to them, to assert patient right to autonomy, to facilitate more efficient medical treatments, and to reduce waste in the healthcare system and medical malpractice claims. In physician-patient shared decision-making, having a decision support tool is essential. In the process of shared decision-making by a patient, his families, and the medical team responsible for his treatment, it is necessary to help the patient and his families fully understand his condition and available treatment options through the content provided by the tool, including: empirical medical data, guidance related to factors that the families care about, and cognitive appraisal. With this information provided, physicianpatient communication and shared decision-making can be done more efficiently. Therefore, it is important to develop a decision support tool that provides information patients can understand. This study used treatment options for people who or whose families have trouble coughing up sputum as an example to illustrate how to get patients and their families involved in developing an easy-to-understand decision support tool. This study adopted the International Patient Decision Aid Standards (IPDAS) and referred to the 'Decisional Needs Assessment in Populations' proposed by Ottawa in 2013 to develop a decision support tool using structured tools and then applied it clinically."