腰椎退化病人醫病共享決策過程與結果之影響因子

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題名:	腰椎退化病人醫病共享決策過程與結果之影響因子 The Influencing Factors of Shared Decision Making Process and Outcomes in Patients With Lumbar Degenerative Disease
作者:	莊心怡 Chuang, Hsin-Yi
貢獻者:	長期照護碩士學位學程侯文萱
關鍵詞:	醫病共享決策;腰椎退化疾病;決策決定因子;決策結果 Shared decision making;lumbar degenerative disease;decision antecedents;decision outcomes
日期:	2019-06-04
上傳時間:	2020-02-10 13:54:30 (UTC+8)
摘要:	背景：隨著世界人口老化，腰椎退化疾病所引起的下背痛造成最大的失能照護負擔，因其治療是多重選擇的，包括藥物、物理治療和手術等多種選項，治療成敗的關鍵在於病人是否與醫師有良好的溝通，並且醫病共同決定符合其自身偏好及價值觀的治療方式。然而，目前國內尚缺乏有關腰椎退化病人在醫病共享決策過程及結果中的影響因子之研究。目的：本研究根據醫病共享決策概念架構，分析病人的個人因素對於決策決定因子之影響，以及決策決定因子對決策過程品質及結果之影響。方法：本研究為橫斷面研究，採連續取樣，進行問卷訪查20歲以上因腰椎退化疾病至新北市某準醫學中心就診的病人。以決策參與期待量表、自我效能決策量表、決策準備量表和個人因素測量決策決定因子，分析其對病人版共享決策問卷的決策過程品質之影響，以及決策決定因子和決策過程品質對決策結果的影響(包括決策衝突量表及決策滿意度量表)。統計分析方式包括獨立樣本t檢定、單因子變異數分析、卡方檢定、多變項線性迴歸分析以及階層線性迴歸分析。結果：本研究總共招募132位平均年齡61歲的病人參與，結果顯示在調整相關個人因素的多變項線性迴歸中，決策決定因子中的決策自我效能及決策準備程度是顯著( p < 0.05)影響決策過程品質的因子；決策準備程度及決策過程品質對於決策衝突有顯著( p < 0.05)影響；女性、決策準備程度及決策過程品質對於決策滿意度有顯著( p < 0.05)影響。結論：本研究結果顯示病人對於治療決策有較高的準備程度與決策自我效能，對於促進醫病共享決策溝通過程的品質十分重要。未來臨床上當醫師面對自我效能較低或尚未做好決策準備的病人，可以適時地介入加強醫病溝通互動關係，透過醫病共享決策的模式幫助病人了解並選擇最適合他的治療方式，使其降低對於選擇治療方式的衝突感及提升對於治療決策的滿意度。 Background: Shared decision making (SDM) is a patient-centered physician-patient communication for clinical decision making. In Taiwan, 4 million people seek medical assistance for lumbar degenerative diseases (LDD) each year which causes a burden of disability care. The treatment of LDD has multiple choices, including medication, physical therapy, and surgery. The key to the success of treatment is whether the patient has a good communication with the physician, and work together to make the most appropriate treatment option based on the patients’ preferences and values. Objectives: Based on the SDM conceptual framework, this study analyzed the impact of the patient's personal factors on decision antecedents and the impact of influencing factors of decision process quality and outcomes among patients with LDD. Methods: This cross-sectional study used continuous sampling method to administer the questionnaire survey for adult outpatients with LDD in the Taipei Medical University affiliated hospital. Multiple linear regression was used to assess associations between the personal factors and decision antecedents including Control Preference Scale(CPS), Decision Self-Efficacy Scale(DSES), Preparation for Decision Making scale (PrepDM), and decision-making process of 9-item SDM Questionnaire(SDM-Q-9). Hierarchical linear regression was used to assess associations between personal factors and decision antecedents, SDM-Q-9, and decision outcomes including Decisional Conflict Scale(DCS), and Satisfaction with Decision Instrument(SWD). Results: A total of 132 patients with a mean age of 61 years were enrolled in the study. The results showed that in the multiple linear regression with adjustments of relevant individual factors, DSES and PrepDM w significantly predicted SDM-Q-9 (p < 0.05). PrepDM and SDM-Q-9 had significant (p < 0.05) impact on DCS. Female, PrepDM and SDM-Q-9 had significant (p < 0.05) impact on SWD. Conclusions: The results of this study showed that the level of readiness of patients to make decisions and the degree of decision self-efficacy were important to promote the quality of the decision-making process. In the future, when a doctor faces a patient with low decision self-efficacy or is not ready for decision-making, he or she can timely intervene to strengthen the interaction between doctors and patients, and help patients understand and choose the treatment that suits them best through the SDM. It reduces uncertainty about the choice of treatment and increases satisfaction with treatment decisions.
描述:	碩士指導教授：侯文萱委員：梁蕙雯委員：邱曉彥
資料類型:	thesis
顯示於類別:	[長期照護碩士學位學程] 博碩士論文

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