醫療共享決策加入重症肌無力全人醫療照護

Applying Share-Decision-Making to The Holistic Care for Patients with Myasthenia Gravis

10.6320/FJM.202409_28(5).0001

莊淑婷(Shu-Ting Zhuang)；葉建宏(Jiann-Horng Yeh)

肌無力症 ； 醫療共享決策 ； 全人醫療照護 ； myasthenia gravis ； shared decision making ； holistic care

台灣醫學

28卷5期（2024 / 09 / 25）

507 - 513

繁體中文;英文

本研究企圖找尋有效降緩病人焦慮程度的策略，且能夠實踐全人醫療照護態度的作法。所以運用醫療共享決策作法中的三層次對話模式，設計研究會談訪綱，從取得的各項溝通階段中，分析能促成有效的焦慮因應策略之相關因素。總計8名肌無力症門診病人參與研究，發現若單純地將復發是來自於對疾病本身，勢必帶來偏誤的壓力判斷與引發自尊和生活掌握感危機，尤其不同心理社會發展都有獨特成長任務，然而三層次對話模式溝通風格，可以帶來較全面的壓力評估與友善的溝通氛圍，因為評估方式改變伴隨著自尊感與生活掌握感提升，也增加了自主參與因應焦慮策略的討論行動。所以要實踐全人醫療照護態度的另一執行方向，可以著力在營造讓病人感受到自我感被友善照護的溝通氛圍的態度，進而培養自主能力。

The study attempted to identify effective strategies for reducing patient anxiety levels while implementing an approach of holistic medical care. Therefore, the interview outline was designed using the Three-Talk-Model from shared decision-making practices, analyzing factors that can promote effective anxiety coping strategies from various communication stages. A total of 8 patients with myasthenia gravis participated in the study. It was found that simply attributing relapses solely to the disease itself inevitably leads to biased stress judgments and triggers crises of self-esteem and perceived control over life. Especially, different psychosocial developments entail unique growth tasks. However, the communication style of the Three-Talk-Model can provide a more comprehensive stress assessment and a friendly communication atmosphere. As the assessment method changes, there is an increase in self-esteem and perceived control over life, which also enhances the discussion and action of autonomously participating in coping with anxiety strategies. Therefore, to implement another direction of holistic medical care attitude, efforts can be focused on cultivating attitudes and abilities that create a communication atmosphere where patients feel their sense of self is kindly cared for.