醫病共享決策於心肌梗塞後病人戒菸應用初探

Shared Decision Making for Smoking Cessation in Post-Myocardial Infarction Patients: A Preliminary Exploration

吸菸為導致心血管疾病及多種慢性疾病之主要危險因子，對心肌梗塞（mocardial infarction）病人而言，戒菸更為影響長期預後的關鍵。研究顯示，若病人能在心肌梗塞發作後短期內成功戒菸，其未來十年內死亡風險可降低約五成，凸顯戒菸作為次級預防策略之重要性。現行行為與藥物治療等戒菸介入模式已證實具短期成效，然長期維持率不佳，故改善疾病預後效益仍有可精進之處。其中一項主要挑戰在於，戒菸治療決策過程中，病人參與程度有限，導致治療依從性與內在動機不足。
醫病共享決策（Shared Decision Making）強調病人主體性與自主參與，近年來已於青少年及成人族群戒菸介入中展現潛力。藉由提升病人在治療決策中的參與度，使其納入決策團隊一環，可望增進治療配合度與戒菸持續性，進而改善心血管長期預後。特別對經歷重大心血管事件後的吸菸者而言，住院期間乃行為改變契機，若能運用醫病共享決策制訂整合介入計畫，預期可提高戒菸成功率與長期健康效益。
本文綜整心肌梗塞後病人戒菸實證指引，探討臨床介入策略與影響因子，並評估醫病共享決策於戒菸治療中之應用潛力，盼提供實務導向之介入模式，促進臨床推動與研究發展。

Smoking is a major risk factor for cardiovascular disease and various chronic conditions; for patients with myocardial infarction (MI), smoking cessation is especially critical in determining long-term prognosis. Research indicates that patients who successfully quit smoking shortly after an MI can reduce their ten-year mortality risk by approximately 50%, underscoring the importance of smoking cessation as a secondary prevention strategy. While current behavioral and pharmacological interventions for smoking cessation have demonstrated short-term efficacy, long-term abstinence rates remain suboptimal, indicating that further improvement in prognostic outcomes is still needed. One key challenge lies in limited patient involvement in smoking cessation treatment decision-making, resulting in insufficient treatment adherence and intrinsic motivation.
Shared Decision Making (SDM) emphasizes patient autonomy and active participation, and in recent years has demonstrated promise in smoking cessation interventions across adolescents and adult populations. By fostering active patient participation in treatment decision-making, SDM may enhance treatment adherence and sustained smoking abstinence, thereby improving long-term cardiovascular outcomes. For smokers who have experienced major cardiovascular events, hospitalization represents a critical window of opportunity for behavior change. Using SDM to develop an integrated intervention plan during hospitalization can thus be expected to increase smoking cessation success rates and promote long-term health benefits.
Reviewing evidence-based guidelines for post-MI smoking cessation, exploring clinical intervention strategies and associated factors, and evaluating the potential role of SDM in smoking cessation treatment, this article aims to provide a practical, evidence-informed intervention model to facilitate clinical implementation and further research.