知情同意與術前矛盾之相關聯

Association between Quality of Informed Consent and Pre-operation Ambivalence

10.6145/jme.200503_9(1).0007

廖士程(Shih-Cheng Liao)；李明濱(Ming-Been Lee)；李宇宙(Yue-Joe Lee)；吳佳璇(Chia-Hsuan Wu)；曾美智(Mei-Chih Tseng)

器官移植 ； 器官捐贈 ； 知情同意 ； 術前矛盾 ； 精神科聯合照會 ； informed consent ； pre-operation ambivalence ； organ transplantation ； living related donor ； consultation-liaison psychiatry

Journal of Medical Education

9卷1期（2005 / 03 / 01）

80 - 90

繁體中文

當代之醫學倫理強調尊重病患之自主，而「知情同意」之意義，更在於與病患及家屬，共同分擔醫療之不確定性及結果。活體器官移植決策過程中，捐贈者自主性之展現，是移植評估及臨床倫理探討之重點。本研究旨在驗證過去醫病溝通系列研究之核心議題，亦即「知情同意」之評估模式，針對88名活體器官移植之捐贈者（肝臟67名，腎臟21名），於術前精神科聯合照評估場域，以深度會談及心理計量分析，進行知情同意客觀評估模式以及器官移植捐贈者術前矛盾相關因素之先導研究。本研究發現：外向性格傾向與知情同意程度評估呈現顯著相關，於逐步複迴歸模式中，知情同意程度愈佳、年齡層愈低、家庭關懷程度愈高、以及外向程度愈高者，其術前矛盾程度愈低。未來研究方向，除將知情同意程度評估模式，於其他醫療情境中廣泛驗證外，對於活體器官移植捐贈者之知情同意過程中，亦應考慮捐贈者性格傾向與醫病溝通效能兩者之關係，以及年齡和家庭支持度對於術前矛盾之影響。

Respecting patient's autonomy is a substantial topic in contemporary medical ethics and informed consent is one of the key ways to achieve this principle. When considering living related organ donation, confirmation of the donor's autonomy is also an extremely important part of the pre-operation evaluation. This study examined the relationships between the quality of informed consent and the pre-operation ambivalence of living related donors, which has been shown to influence the donors' psycho social well being after transplantation. A total of 88 living related donors (liver=67; kidney=21) who had gone through the routine psychiatric assessment before transplantation were recruited to this study. In addition to an in-depth psychiatric interview, we applied the Maudsley Personality Inventory the Pre-operation Ambivalence Scale and the Family APGAR as well as carrying out an objective assessment by a psychiatrist of the informed consent and provided as a detailed psychometric evaluation. In the final stepwise multiple linear regression model, age, extroversion, family APGAR, and quality of informed consent were significantly associated with pre-operation ambivalence. As the quality of the informed consent improved, the donor's feeling of ambivalence became less. This study may be able to serve as a preliminary validity study for an objective assessment model of informed consent and also as an explorative study of the factors associated with pre-donation ambivalence. The generalization of this assessment model for other medical conditions and the investigation of the personality traits influencing physician-patient communication are also worthy of further study.

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