题名

從共享決策SDM談落實癌症病人的善終

并列篇名

Embedding Shared Decision Making Process in Good Dying Care for Cancer Patients

DOI

10.3966/168395442017101703003

作者

陳如意(Ru-Yih Chen)

关键词

共享決策 ； 癌症 ； 善終 ； 病情告知 ； 溝通模式 ； shared decision making ； cancer ； good dying ； truth telling ； communicationmodel

期刊名称

腫瘤護理雜誌

卷期/出版年月

17卷增訂刊（2017 / 10 / 01）

页次

27 - 37

内容语文

繁體中文
中文摘要

癌症是潛在威脅性命的重大疾病，癌症診療團隊雖然不斷精進治療方法，但治療成效仍然有很多不確定性。特別是在反覆復發或進展至末期階段時，該持續抗癌治療或是轉換為安寧緩和醫療，並沒有絕對的評估標準。「共享決策」是透過醫病互動溝通的過程，彼此分享醫學實證治療經驗與病人個人的生命價值觀，達成符合雙方共識的治療計畫。最後的醫療決定沒有絕對的好壞或對錯。本文除了介紹共享決策（shared decision making, SDM）模式外，也針對癌症病人經常要面對抉擇的心肺復甦術與維生醫療、安寧緩和醫療照護、以及病人自主權利法規範的維持生命治療、人工營養及流體餵養等善終議題進行探討。
英文摘要

Cancer is a life threatening illness. Despite the advances of anticancer treatments, there has still been many uncertainties in prognosis. During a recurrence or terminal progression, patients may face the dilemma of holding on to the aggressive anticancer treatments or switching to hospice palliative care. Shared decision-making (SDM) is a process in which both the patients and clinicians contribute to the medical decision-making process. While the clinicians bring their expertise on treatment and management options as well as the benefits and risks, the patients are the ones who know the best of their own condition and attitudes, values and preferences. Patients can participate in decision making actively and choose the treatment option that best aligns with their unique cultural and personal beliefs. Embedding SDM in medical decision process can lessen the stress on the patients, improve knowledge of the options and the satisfaction with care, and lead to better quality decision. However, SDM process remains scarce regarding the good dying issues for cancer patients. This article introduces SDM process, development of patient decision aids, and communication strategies and discusses topics on end-of- life care, including resuscitation, life sustaining treatment, palliative care, artificial nutrition and tubal feeding.
主题分类 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 內科
醫藥衛生 > 社會醫學
参考文献
  1. Agency for Healthcare Research and Quality. (2014). The SHARE Approach. Retrieved from http://www. ahrq.gov/professionals/education/curriculum- tools/shareddecisionmaking/index.html
  2. Australian Commission on Safety and Quality in Health Care. (2017). Shared Decision Making. Retrieved from http://www.safetyandquality. gov.au/ourwork/shared-decision-making/
  3. Baile, W. F.,Buckman, R.,Lenzi, R.,Glober, G.,Beale, E. A.,Kudelka, A. P.(2000).SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer.Oncologist,5(4),302-311.
  4. Billingham, V.(1998).Through the Patient s Eyes.Salzburg Seminar, Session 356
  5. Brock, D. W.,Wartman, S. A.(1990).When competent patients make irrational choices.New England Journal of Medicine,322(31),1595-1599.
  6. Brody, D. S.,Miller, S. M.,Lerman, C. E.,Smith, D. G.,Caputo, G. C.(1989).Patient perception of involvement in medical care: Relationship to illness attitudes and outcomes.Journal of General Internal Medicine,4(6),506-511.
  7. Buchanan, A.(1978).Medical paternalism.Philosophy & Public Affairs,7(4),370-390.
  8. Charles, C.,Gafni, A.,Whelan, T.(1997).Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango).Social Science & Medicine,44(5),681-692.
  9. Elwy, G. (2016). Chapter 13 The three talk model of shared decision making. In Glyn Elwyn, A. E., & Rachel Thompson (Eds), Shared Decision Making in Health Care: Achieving evidence- based patient choice. Retrieved from http:// www.oxfordscholarship.com/view/10.1093/ acprof:oso/9780198723448.001.0001/acprof- 9780198723448-chapter-13
  10. Elwyn, G.,Tsulukidze, M.,Edwards, A.,Legare, F.,Newcombe, R.(2013).Using a talk model of shared decision making to propose an observation-based measure: Observer OPTION 5 Item.Patient Education & Counseling,93(2),265-271.
  11. Irwin, K. E.,Greer, J. A.,Khatib, J.,Temel, J. S.,Pirl, W. F.(2013).Early palliative care and metastatic non-small cell lung cancer: Potential mechanisms of prolonged survival.Chronic Respiratory Disease,10(1),35-47.
  12. Legare, F.,O Connor, A. M.,Graham, I. D.,Wells, G. A.,Tremblay, S.(2006).Impact of the Ottawa Decision Support Framework on the agreement and the difference between patients and physicians decisional conflict.Medical Decision Making,26(4),373-390.
  13. Lyttle, D. J.,Ryan, A.(2010).Factors influencing older patients participation in care: A review of the literature.International Journal of Older People Nursing,5(4),274-282.
  14. McCormack, L. A.,Treiman, K.,Rupert, D.,Wil- liams-Piehota, P.,Nadler, E.,Arora, N. K.(2011).Measuring patient-centered communication in cancer care: A literature review and the development of a systematic approach.Social Science & Medicine,72(7),1085-1095.
  15. National Health Service. (2010). Equity and excel- lence: Liberating the NHS. Retrieved from https://www.gov.uk/government/news/equi- ty-and-excellence-liberating-the-nhs
  16. Nordby, H.,Nohr, O.(2012).The ethics of resuscitation: how do paramedics experience ethical dilemmas when faced with cancer patients with cardiac arrest?.Prehospital & Disaster Medicine,27(1),64-70.
  17. Politi, M. C.,Lewis, C. L.,Frosch, D. L.(2013).Supporting shared decisions when clinical evidence is low.Medical Care Research & Review,70(1 Suppl),113S-128S.
  18. President s Commission for the Study ofEthical Problems in Medicine andBiomedical and Behavioral Research. (1982). Making Health Care Decisions: A Report on the Ethical and Legal Implications of Informed Consent in the Patient Practitioner Relationship. Retrieved fromhttps://repository.library.georgetown. edu/bitstream/handle/10822/559354/making_ health_care_decisions.pdf?sequence=1&isAl- lowed3y
  19. Price, J.(2016).Informed shared decision-making in planning for the end of life.British Journal of Nursing,25(7),378-383.
  20. Saltbaek, L.,Michelsen, H. M.,Nelausen, K. M.,Gut, R.,Nielsen, D. L.(2013).Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt.Supportive Care in Cancer,21(12),3363-3370.
  21. Stiggelbout, A. M.,Pieterse, A. H.,De Haes, J. C.(2015).Shared decision making: Concepts, evidence, and practice.Patient Education & Counseling,98(10),1172-1179.
  22. Temel, J. S.,Greer, J. A.,Muzikansky, A.,Gallagher, E. R.,Admane, S.,Jackson, V. A.(2010).Early palliative care for patients with metastatic non-small-cell lung cancer.New England Journal of Medicine,363(8),733-742.
  23. The Economist Intelligence Unit. (2015). 2015 Quality of Death Index. Retrieved from http:// www.eiuperspectives.economist.com/health- care/2015-quality-death-index
  24. Veatch, R. M.(1972).Models for ethical medicine in a revolutionary age. What physician-patient roles foster the most ethical realtionship?.The Hastings Center Report,2(3),5-7.
  25. Whitney, S. N.,McGuire, A. L.,McCullough, L. B.(2004).A typology of shared decision making, informed consent, and simple consent.Annals of Internal Medicine,140(1),54-59.
  26. World Health Organization. (2002). National cancer control programmes: Policies and manage- rial guidelines. Retrieved from https://books. google.com.tw/books?hl=zh-TW&lr=&id3D7 VQOD9AAQBAJ&oi=fnd&pg=PR11&dq=N ational+cancer+control+programmes+:+poli cies+and+managerial+guidelines&ots=qfczU jVaZJ&sig=G-ZVtoPTJ3ZousjblZm7gsDjsd Y&redir_esc=y#v=onepage&q=National%20 cancer%20control%20programmes% 20 %3A%20policies%20and%20managerial%20 guidelines&f=false
  27. Yoong, J.,Park, E. R.,Greer, J. A.,Jackson, V. A.,Gallagher, E. R.,Pirl, W. F.(2013).Early palliative care in advanced lung cancer: A qualitative study.JAMAInternal Medicine,173(4),283-290.
  28. Zhang, Z.,Chen, M. L.,Gu, X. L.,Liu, M. H.,Cheng, W. W.(2015).Cultural and ethical considerations for cardiopulmonary resuscitation in chinese patients with cancer at the end of life.American Journal of Hospice & Palliative Medicine,32(2),210-215.
  29. 方俊凱, C. K.(2013)。癌症病人的失志症候群。台灣醫學，17(2)，149-154。
  30. 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。
  31. 台灣病人安全資訊網(2017).2017年醫病共享決策輔助工具競賽辦法,取自http:// www.patientsafety.mohw.gov.tw/content/ ZNewsLetter/Contents.aspx?SiteID=1&MmmI D=17003&MSid=745370575760357022
  32. 立法院(2013).安寧緩和醫療條例,取自http:// law.moj.gov.tw/Law/LawSearchResult.aspx?p =A&t=A1A2E1F1&k1=%E5%AE%89%E5% AF%A7%E7%B7%A9%E5%92%8C%E9%86 %AB%E7%99%82%E6%A2%9D%E4%BE% 8B
  33. 立法院(2016).病人自主權利法,取自http:// law.moj.gov.tw/Law/LawSearchResult.aspx?p =A&t=A1A2E1F1&k1=%E7%97%85%E4%B A%BA%E8%87%AA%E4%B8%BB%E6%A C%8A%E5%88%A9%E6%B3%95
  34. 立法院(2003).癌症防治法.取自http://law. moj.gov.tw/LawClass/LawContent.aspx? PCODE=L0070008
  35. 呂佩佩, P. P.,陳美伶, M.L.,鍾昌宏, C. H.,唐婉如, W. R.(2004)。癌症病患及家屬對不予急救的認知與態度。腫瘤護理雜誌，4(1)，15-22。
  36. 唐婉如, W. R.,方俊凱, C. K.,莊永毓, Y. Y.(2013)。癌症病情告知教育。台灣醫學，17(2)，141-148。
  37. 孫效智, H.C.(2017)。病人自主權利法》評釋。澄清醫護管理雜誌，13(1)，4-7。
  38. 國民健康署癌症防治組 (2016).癌症防治,取自 https://www.hpa.gov.tw/Pages/List.aspx? nodeid=47
  39. 楊鳳凰, F. H.,李素貞, S. C.,王瑞瑤, R. Y.,楊淑寬, S. K,林淑瑜, S. Y.,陳嘉惠, J. H.(2016)。影響重症病人家屬簽署不施行心肺復甦術相關因素探討。澄清醫護管理雜誌，12(1)，30-39。
  40. 廖熏香, H. H.(2017)。淺談醫病共享決策。澄清醫護管理雜誌，13(2)，4-8。
  41. 蔡甫昌, F. C.,郭蕙心, H. H.(2017)。病人自主權利法之倫理觀點與實務挑戰。台灣醫學，21(1)，62-72。
  42. 衛生福利部(2017).醫病共享決策平台:決策輔助工具清單． 取自 http://sdm.patientsafety. mohw.gov.tw/AssistTool/List?sn=24&sType= 16&cid=1131
  43. 衛生福利部(2017).醫病共享決策平台,取自 http://sdm.patientsafety.mohw.gov.tw/Index
  44. 衛生福利部統計處(2017).105年國人死因統計結果．取自http://www.mohw.gov.tw/cp-16- 33598-1.html
被引用次数
  1. 蔡瑋瑋,林玉菁,蔡瑋瑋,林玉菁(2021)。照護一位肝癌末期病人之護理經驗。長庚護理，32(2)，112-123。
  2. 陳俞君,許宜靜(2023)。照護一位大腸癌末期病人面臨醫療決策衝突之護理經驗。彰化護理，30(2)，89-101。
  3. 陳韻安,陳姿廷,林嬿妮(2020).提升南部某教學醫院癌症末期病人不施行心肺復甦術簽署率之改善方案.長期照護雜誌,24(2),161-174.
  4. 林嘉雯,周碧玲(2022)。運用共享決策模式照護一位癌症末期合併呼吸困難病人之護理經驗。安寧療護雜誌，26(2)，178-190。
  5. 馬嘉慧,徐淑芬(2021)。運用醫病共享決策降低加護病房重症末期病人無效醫療比率。領導護理，22(4)，134-150。
  6. 嚴美華,蔡佩勳,陳資錞,胡靜文(2023)。照顧一位末期腎臟病個案選擇安寧緩和療護之護理經驗。新臺北護理期刊，25(2)，130-139。
  7. 鄭方瑜,葉淑惠,李怡慧(2023)。就醫提問單對癌症末期病人的有用性、滿意度及焦慮之成效－統合分析。護理雜誌，70(2)，67-77。
print cancel