精神醫學與社區照護之醫病共享決策

Shared Decision-Making in Psychiatry and Community Care

本研究以系統性文獻回顧，探討醫病共享決策（shared decision-making，SDM）於精神醫學與社區照護的理論基礎、實務應用與文化挑戰。分析2010年至2025年間國內外研究與政策文件，依PRISMA原則呈現篩選流程。結果顯示，SDM可促進病人參與與復元導向照護，強化醫病夥伴關係，但仍面臨病人決策能力受限、家庭角色模糊及制度支持不足等挑戰。本文進一步提出「家庭導向共享決策」（family-centered decision making，FCDM）之本土化架構，並結合我國長照2.0至3.0政策脈絡，說明SDM於跨專業整合與社區復健中的應用潛力。最後建議未來研究應深化文化調適與決策支持策略，以平衡病人自主與安全，推動精神醫療體系邁向以人為本之轉型。

This study explores the theoretical foundations, practical applications, and cultural challenges of Shared Decision-Making (SDM) in psychiatry and community care. A systematic literature review was conducted to analyze research and policy documents published between 2010 and 2025, following the PRISMA guidelines. Findings indicate that SDM enhances patient engagement, recovery-oriented care, and collaborative doctor–patient relationships. However, challenges persist, including patients’limited decision-making capacity, ambiguous family roles, and insufficient institutional support. To address these issues, this paper proposes a culturally adaptive framework of Family-Centered Decision Making (FCDM) and links it to Taiwan’s policy transition from Long-Term Care 2.0 to 3.0, highlighting SDM’s potential to strengthen interdisciplinary collaboration and community-based psychiatric rehabilitation. Future research should further develop culturally sensitive strategies and supported decision-making mechanisms to balance patient autonomy and clinical safety, thereby advancing a person-centered and sustainable transformation of Taiwan’s mental health care system.