醫病共享決策之實踐：早期肝癌，我該選擇何種治療方式？

Shared Decision-Making Implementation for Treatment Options in Early-Stage Liver Cancer

10.6142/VGHN.202206_39(2).0002

塗勝翔(Sheng-Hsiang Tu)；連靜雯(Ching-Wen Lien)；溫明寰(Ming-Huan Wen)；黃惠美(Hui-Mei Huang)；黃宇黛(Yu-Tai Huang)；林宜演(I-Yen Lin)；陳怡岑(Yi-Tzen Chen)；林小玲(Shirling Lin)

醫病共享決策 ； 早期肝癌 ； 病人決策輔助工具 ； 決策引導 ； shared decision-making ； early-stage liver cancer ； patient decision aid ； coaching

榮總護理

39卷2期（2022 / 06 / 01）

135 - 145

繁體中文

早期肝癌係指依據巴塞隆納臨床肝癌分類分期為0-A期，臺北榮總早期肝癌治療效果，五年存活率超過64%。醫療團隊於早期肝癌病人治療計畫解釋和說明時，主要建議手術、熱射頻腫瘤滅除術、微波消融術為積極治療的選項。當病人確診為早期肝癌時，病人與家人常可能因為擔憂不同治療方式的優缺點、效果、併發症、醫療費用、復發率與存活率及治療後的生活照護等問題，難以抉擇治療方式，需要更詳細的說明和充足時間考慮。本團隊藉優化決策輔助工具、運用決策引導（coaching）方法，經由醫病共享決策實踐，促使醫護團隊於治療前與病人及家屬充分溝通說明，讓病人選擇最符合自身考量的醫療決策並完成治療。不僅協助病人表達其決策考量、理解與信心程度，進而提升病人對醫療照護滿意度與建立良好醫護病關係。

According to the Barcelona Clinic Liver Cancer Classification, stages 0-A indicate early-stage liver cancer. The 5-year survival rate for patients with early-stage liver cancer is more than 64% in Taipei Veterans General Hospital. When explaining treatment plans for early-stage liver cancer, medical teams mainly suggest surgery, radiofrequency ablation, or microwave ablation. Upon diagnosis of early-stage liver cancer, patients and their families often have difficulty selecting treatments because of concerns regarding advantages, disadvantages, effects, complications, medical expenses, recurrence, survival rates, and posttreatment care; these decisions require information and ample time. Optimizing decision-making aids for patients, coaching nurses, and implementing shared decision-making practices for health-care teams and patients help nursing teams communicate with patients and their families before treatment, enabling them to select the most suitable treatment option. These strategies also help patients express their decision-making considerations and level of understanding confidence, ensures their satisfaction with health care, and creates strong relationships between patients and health-care teams.

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