影響醫療人員參與和發展醫病共享決策工具之相關因素探討

Factors Influencing Medical Staff Engagement in Shared Decision- Making and tool Development

目的
隨著網路普及、資訊流通，病患知識增長與充權，促使病患就醫自主性提升。2015年醫策會將醫病共享決策的概念及作法引進台灣，衛生福利部則更將其納入醫療品質及病人安全年度工作目標，並鼓勵各醫療機構落實。本研究希望找出影響醫療團隊投入醫病共享決策與聯合發展決策輔助工具之關鍵因素，提供各醫療機構在推行時之參考。
方法
本研究以南部某區域教學醫院為研究場域，藉由問卷調查收集資料與運用層級分析法萃取影響醫護同仁參與醫病共享決策暨聯合發展決策輔助工具的相關因素。結構化問卷包含「SDM推動者意向」、「工作環境轉變」、「獎酬誘因」及「團隊因素」四大構面，個案醫院中參與醫病共享決策計畫的醫護同仁為研究對象，共發放問卷100份。
結果
分析結果呈現，主要影響投入因素為：一、符合主管期待；二、提升醫護團隊自我成就；三、營造友善醫病環境；四、提升醫病溝通效率；五、團隊成員互動狀態。各醫療專科跨領域團隊的組成和合作，有助於發展出合適臨床現場推動醫病共享決策輔助的工具，實質的促進醫護同仁參與的意願並增進病人的信任與提升醫病互動。
結論
個案醫院擬持續將五大影響醫護同仁投入的因子納入年度SDM政策推動之重點對策，持續提高醫療團隊之參與意願。

Purposes
With the advance of medical technology, and patients have been requesting more autonomy in treatment decisions. In 2015, the medical policy meeting introduced the concept and practice of“shared decision-making between doctors and patients”to Taiwan. The Ministry of Health and Welfare incorporates SDM into its annual healthcare quality and patient safety goals.The goal of this research is to find out the key factors that affect the medical team’s input into shared decision-making and joint development of decision-making aids, and to provide reference for other medical institutions to promote.
Methods
This study takes teaching hospitals as the research field, collects data through questionnaires and uses AHP to extract the relevant factors that affect the participation of medical and nursing colleagues in shared decision-making and joint development of decision-making aids. The structured questionnaire includes four dimensions:“SDM promoter's intention”,“work environment change”,“reward incentive”and“team factor”. 100 questionnaires were distributed.
Results
After the analysis results, the main factors affecting the input (1) meeting supervisors’expectations (2) improving self-achievement (3) creating friendly relationships (4) improving communication efficiency (5) team member interaction status. Through the formation and cooperation of cross-disciplinary teams of medical specialists, it is helpful to develop suitable clinical tools to promote shared decision-making assistance between doctors and patients, substantially promote the willingness of medical colleagues to participate, and enhance the trust of patients and enhance the interaction between doctors and patients.
Conclusions
The case hospital plans to continue to include five factors that affect the investment of medical and nursing colleagues into the annual SDM policy promotion focus, and continue to increase the willingness of the medical team to participate.