決策輔助工具在骨盆腔器官脫垂婦女醫病共享決策之應用成效

Applying a Patient Decision Aid to Facilitate Decision Making in Women with Pelvic Organ Prolapse

10.6142/VGHN.201912_36(4).0003

張紫婷(Tzu-Ting Chang)；陳尹甄(Yin-Chen Chen)；郭素真(Shu-Chen Kuo)

骨盆腔器官脫垂 ； 醫病共享決策 ； 決策輔助工具 ； pelvic organ prolapse ； sharing decision making ； patient decision aid

榮總護理

36卷4期（2019 / 12 / 01）

353 - 360

繁體中文

骨盆腔器官脫垂常造成婦女焦慮、憂鬱及緊張等情緒困擾，影響生活品質甚鉅。臨床處置方式包括生活方式調整、藥物、子宮托與手術等，婦女在選擇治療方式時常會產生決策衝突，基於實證證據的決策輔助工具提供個別化訊息，讓婦女依循偏好，選擇最適合自己的治療方法，更能澄清婦女對資訊的疑慮，達到醫病共享決策的目標。本文目的為建構骨盆腔器官脫垂治療與處置之決策輔助工具，並檢視成效，結果發現婦女的焦慮程度由使用骨盆腔器官脫垂決策輔助工具前的57.1%降到使用後的28.6%；在骨盆腔器官脫垂治療與處置方面，經由醫師解說溝通後，原準備採手術療法由57.1%降為28.6%、使用子宮托比率由14.3%增加至42.8%；醫療成員認為使用決策輔助工具後，有助於提升婦女健康識能及促進醫病關係及溝通。本文藉由充分且透明化資訊，提供不同選擇，讓婦女重新審視醫療選項，依據其在意的項目選擇，實踐以病人為中心之照護理念，驗證醫病共享決策是優質輔助工具，值得廣泛推廣與應用，共同促進醫療品質。

The uterus, ovary, bladder, rectum, and other organs in the pelvic cavity are supported by and fixed to the pelvic floor muscles and ligament fascia. When the pelvic floor muscles loosen or the ligament fascia breaks, the organs in the pelvic cavity can no longer be supported, which may cause prolapse or protrusion of the uterus, namely pelvic organ prolapse. It is a common benign disease in women, which often contributes to anxiety, depression, and nervousness-thus affecting the women's quality of life. This article discusses the development of decision aids through the sharing of relevant information with women with pelvic organ prolapse. By inviting these women to discuss the problems they face, the details they need, and the methods they choose, patient-centered care can be provided with greater facility. In this study, a decision aid for the treatment decisions of women with pelvic organ prolapse was constructed. The results demonstrated that the women's degree of anxiety decreased from 57.6% to 28.6%. After fully explaining and communicating relevant information, the surgery rate decreased from 57.1% to 28.6% and that of pessary use increased from 14.3% to 42.8%. This shared decision-making process may enhance women's health literacy and promote doctor-patient relationship and communication. The development process provided in this article may provide an example for other health care staff to develop additional medical decision-making aids, which can consequently improve care quality and increase patient benefit.

1. AHRQ. (2014). The SHARE Approach-Essential Steps of Shared Decision making: Quick Reference Guide. Retrieved from https://www.ahrq.gov/health-literacy/curriculumtools/shareddecisionmaking/tools/tool-2/ index.html
2. Bø, K.(2012).Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction.World Journal of Urology,30(4),437-443.
3. Bugge, C.,Adams, E. J.,Gopinath, D.,Reid, F.(2013).Pessaries (mechanical devices) for pelvic organ prolapse in women.Cochrane Database of Systematic Reviews,2
4. Coulter, A.,Stilwell, D.,Kryworuchko, J.,Mullen, P. D.,Ng, C. J.,van der Weijden, T.(2013).A systematic development process for patient decision aids.BMC Medical Informatics and Decision Making,13(Suppl 2),S2.
5. Culligan, P. J.,Scherer, J.,Dyer, K.,Priestley, J. L.,Guingon-White, G.,Delvecchio, D.,Vangeli, M.(2010).A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength.International Urogynecology Journal,21(4),401-408.
6. Davis, K.,Kumar, D.(2003).Pelvic floor dysfunction: A conceptual framework for collaborative patient-centred care.Journal of Advanced Nursing,43(6),555-568.
7. de Albuquerque Coelho, S. C.,de Castro, E. B.,Juliato, C. R. T.(2016).Female pelvic organ prolapse using pessaries: Systematic review.International urogynecology journal,27(12),1797-1803.
8. Elwyn, G.,Laitner, S.,Coulter, A.,Walker, E.,Watson, P.,Thomson, R.(2010).Implementing shared decision making in the NHS.British Medical Journal,341,c5146.
9. Frosch, D. L.,Kaplan, R. M.(1999).Shared decision making in clinical medicine: Past research and future directions.American Journal of Preventive Medicine,17(4),285-294.
10. Hallock, J. L.,Handa, V. L.(2016).The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update.Obstetrics and gynecology clinics of North America,43(1),1-13.
11. Hawary, A.,Sinclair, A.,Pearce, I.(2010).The origin of information: Are IUGA-specific patient information leaflets the answer?.International Urogynecology Journal,21(8),1001-1004.
12. Howard, F.,Steggall, M.(2010).Urinary incontinence in women: Quality of life and help-seeking.British Journal of Nursing,19(12),742+744+746+748-749.
13. Iglesia, C. B.,Smithling, K. R.(2017).Pelvic Organ Prolapse.American Family Physician,96(3),179-185.
14. Kennedy, A. D.,Sculpher, M. J.,Coulter, A.,Dwyer, N.,Rees, M.,Abrams, K. R.,Stirrat, G.(2002).Effects of decision aids for menorrhagia on treatment choices, health outcomes, and costs: A randomized controlled trial.The Journal of the American Medical Association,288(21),2701-2708.
15. O'Connor, A. M.,Bennett, C. L.,Stacey, D.,Barry, M.,Col, N. F.,Eden, K. B.,Rovner, D.(2003).Decision aids for people facing health treatment or screening decisions.Cochrane Database of Systematic Reviews,2,Cd001431.
16. Ronda, G.,Grispen, J. E.,Ickenroth, M. H.,Dinant, G. J.,De Vries, N. K.,Van der Weijden, T.(2014).The effects of a web-based decision aid on the intention to diagnostic self-testing for cholesterol and diabetes: A randomized controlled trial.BMC Public Health,14,921.
17. Sung, V. W.,Raker, C. A.,Myers, D. L.,Clark, M. A.(2010).Treatment decision-making and information-seeking preferences in women with pelvic floor disorders.International Urogynecology Journal,21(9),1071-1078.
18. The American College of Obstetricians and Gynecologists(2017).Practice bulletin No. 185: Pelvic organ prolapse.Obstetrics & Gynecology,130(5),234-250.
19. 王英偉(2016)。醫病共享決策─ 決策輔助工具與臨床運用。醫療品質雜誌，10(4)，15-24。
20. 許維邦、張瑞月、呂美君、周明智、蕭培靜(2015)。共同決策於臨床醫學之應用。澄清醫護管理雜誌，11(2)，24-29。

1. 戴雯緣,蔡春敏,林慧萍,周佳正,古立亭(2021)。多媒體電子書為醫病共享決策輔助工具之成效－以乳癌病患為例。醫務管理期刊，22(3)，220-231。