運用醫病共享決策輔助工具降低決策引導員引導困難

Applying Patient Decision Aids to Improve the Guidance Effects of Shared Decision-Making in Doctor-Patient Relationships

在醫病雙方具備知識、溝通和尊重之基礎下，共享醫療資訊過程中一旦引導不良常導致病人無法有效做決策。透過品管圈的運作方式與結構式書面訪談調查得知醫病共享決策引導員口語引導決策之困難程度高達5.66 分，以特性要因圖分析口語引導醫病共享決策成效不佳之三大要因為(1) 僅以口語引導病人無法冷靜權衡、(2) 僅以口語引導太抽象及(3) 病人得知的訊息和病人轉述給其家屬的有出入。經由專案小組擬定解決方案包括建立結構式書面訪談調查表、依據調查結果安排引導員課程、協助製作醫病共享輔助工具及加強團隊間溝通。執行改善策略後，運用決策輔助工具降低決策引導員之引導困難程度，加上決策引導教育課程，降低醫病共享決策引導之困難程度至3.66 分的目標值，促進醫病雙向溝通。

On the basis of knowledge, communication, and respect between medical personnel and patients, if the process of sharing medical information is not ideal, such sharing of information often leads to poor guidance and the inability of patients to make effective decisions. Through the operational modes of the quality control circle and a structured written interview questionnaire, we find that there is a high degree of difficulty (reaching up to 5.66 points) when decision-making is derived from spoken guidance. This study uses a cause-andeffect analysis chart to display the three main reasons as to why spoken guidance by medical personnel sharing medical information leads to less-than-ideal decision-making results: (1) the strict use of spoken guidance renders the patient incapable of calmly weighing decision factors, (2) the strict use of spoken guidance leads to too abstract of a decision-making process for the patient to understand their medical condition and (3) the medical information the patient gains knowledge of and the information that the patient then relays to their family members differs. This study’s solutions developed through the project team include the establishment of a structured written interview questionnaire, the arrangement of instructor courses based on the results of the questionnaire, assistance in the production of medical sharing aids, and enhanced team-to-team communication. After implementation of the improvement strategies, decision-assisted tools are then used to strengthen the guidance effect of the decision-maker, and the facilitation of the educational curriculum and community promotion activities reduces the difficulty of sharing decision-making guidance to a target value of 3.66, promoting two-way communication between medical personnel and patients.