運用醫病共享決策輔助策略提升癌症病人不施行心肺復甦術簽署率

Using Shared Decision Making -Assisted Strategy to Improve Patient Do-Not-Resuscitate Signing Rate

10.6537/TJHPC.202006_24(2).04

陳淮羽(Huai-Yu Chen)；吳秀春(Hsiu-Chun Wu)

醫病共享決策 ； 不施行心肺復甦術 ； shared decision making ； do not resuscitate

安寧療護雜誌

24卷2期（2020 / 06 / 01）

137 - 152

繁體中文

末期癌症病人接受急救存活率只有6%，末期臨終時可選擇不接受心肺復甦術，減少侵入性治療，給予舒適及尊嚴。本專案目的旨在運用醫病共享決策輔助策略提升癌症病人不施行心肺復甦術簽署率，經調查發現：本單位不施行心肺復甦術簽署率僅52.6%，經分析偏低原因為「醫護人員DNR溝通技巧不足」、「缺乏談DNR介入決策時機的評估工具」、「病人及家屬對DNR的認知不足」、「缺乏DNR宣導相關輔助工具」，經舉辦在職教育、使用緩和療護身體活動功能評估量表（Palliative performance scale, PPS）作為簽署時機評估工具、製作DNR醫病共享決策（SDM）輔助工具（急救不急救決策輔助表及影片、急救說明娃娃等）。措施介入後DNR簽署率提升至90%，期待能將此些措施推廣至全院各單位，讓醫護團隊及病人家屬能討論出最佳及可行的醫療決策，減少病人不必要的受苦及無效醫療，提升生命末期的照顧品質達到圓滿善終。

The survival rate of terminally-ill cancer patient after CPR is only 6%. Terminal patients are allowed to refuse cardiopulmonary resuscitation in order to reduce invasive treatment and pass away with comfort and dignity. The aim of this project was to explore the impact of shared decision making-assisted strategy on the cancer patient do-not-resuscitate signing rate. According to the investigation, the signing rate of DNR was just only 52.6%. Analysis indicated that was due to the lack of communication skills in medical staff and absence of assessment tools for evaluating the suitable timing of DNR involvement. In addition, the insufficient knowledge of DNR within patient and their family members and the lack of tools for DNR education contribute to the low consent and signing rate of terminally-ill patients. Through Professional training, used of Physical Performance Scale (Palliative performance scale ;PPS) for assessment of DNR intervention timing, and the development of sharing decision making (SDM) tools such as videos explained pros and cons of first aid along with instruction dolls as visuals, the DNR signing rate has increased to 90%. These measures should be promoted and extended to all the department within the hospital, and then the medical team and family members of patients may be able to agree on the most suitable decision for improving end of life care, reduce suffering, and preventing unnecessary medical practice on terminally-ill patients.

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