醫病共享決策及決策輔助工具之發展－以「失智末期吞嚥困難之進食方式選擇」為例

Development of Shared Decision Making and Patient Decision Aids by Using ＂Guide to Feeding Options for Patients with Advanced Dementia＂ as an Example

10.6142/VGHN.201906_36(2).0007

劉建良(Chien-Liang Liu)；林乃玉(Nai-Yu Lin)

醫病共享決策 ； 決策輔助工具 ； 末期失智症 ； 失智進食問題 ； 失智吞嚥困難 ； shared decision making ； patient decision aids ； advanced dementia ； eating problems ； swallowing difficulties

榮總護理

36卷2期（2019 / 06 / 01）

170 - 177

繁體中文

臨床推行醫病共享決策是將實證醫學獲得的最佳與最適宜的治療方式，藉由醫病雙方透過良好的溝通過程，交換彼此的意見和迷思，一旦病方經由共享決策做出符合其價值觀與偏好的選擇，醫療端必須尊重其醫療決策；而醫病共享決策執行需要以中立的立場去進行，不可引導病方往醫療端所要的方向進行。失智症是緩慢進行疾病，而吞嚥與進食問題影響86%的末期失智者，一旦家屬將之送醫，臨床提供的醫療選項是否符合失智者的價值觀與偏好，或臨床人員確實提供末期失智者所有相關進食選項。我們期待失智者在尚有自我決策能力時，透過醫病共享模式為自己的未來醫療照護做出決策，若失智者已無能力為自己做決策，家屬亦可透過家庭會議的模式進行醫病共享決策，為失智者做出最符合其偏好的醫療照護。

The clinical implementation of shared decision making is the most effective and appropriate approach for communication in daily practice. Doctors, patients, and caregivers can communicate and discuss their understanding regarding the disease and opinions regarding the choice of medical care. Shared decision making involves providing reliable, balanced, and evidence-based information outlining treatment, care or support options, outcomes, and uncertainties considering patients' preferences. Dementia is a slow progressive disease. However, patients with advanced dementia may not have the ability to express their willingness. In advanced dementia, swallowing and eating difficulties are major problems, noted in approximately 86% of the patients. After they undergo emergent medical care owing to swallowing and feeding difficulties, patients with advanced dementia may not have be able to express their willingness to receive appropriate treatment. Therefore, we recommend that patients with early dementia-who still can to select their treatment options-should make decisions regarding their own further medical care plan by using shared decision making. The following are the principles of shared decision making used for resolving swallowing and eating problems: early discussion with the family, regular assessments and rethinking decisions, appropriate measures to prevent swallowing problems, rehabilitation for swallowing problems, and consideration of advanced care planning.

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