| 摘要: | 背景：就醫提問單是透過結構化問題清單，鼓勵病人就醫時向醫療人員提出問題，以獲得切身相關且更清楚的健康或醫療知識，促進醫病溝通。癌症發生率逐年提高，而乳癌已成為全球女性最常見的癌症。然而，面對眾多且複雜的治療方式常使病人感到無所適從，導致醫病溝通不良，產生心理困擾。國外已推行就醫提問單多年，而臺灣目前並沒有針對乳癌病人族群的就醫提問單之相關研究。
目的：本研究透過乳癌就醫提問單介入，探討就醫提問單在乳癌病人族群的決策自我效能、決策參與、醫病溝通、決策衝突與後悔、健康狀況之成效。
方法：本研究採受試者盲性的單盲隨機對照試驗，於臺北某區域教學醫院之乳房外科門診或病房，招募確診乳癌之病人，採塊狀隨機分派方式將病人分為就醫提問單介入組與控制組，評估工具為決策自我效能（決策自我效能量表）、決策參與（病人醫生互動效能量表、決策角色偏好、病人感知參與照護量表、決策準備量表）、醫病溝通（改良版健康照護趨勢量表、collaboRATE醫病共享決策量表）、決策衝突與後悔（SURE測驗量表、決策後悔量表）、健康狀況（情境特質焦慮量表-情境量表、疼痛狀況、自覺健康狀況）。統計分析方式包括皮爾森卡方檢定、獨立樣本T檢定、單因子變異數分析、簡單線性迴歸分析、多變項線性迴歸分析以及廣義估計方程式。
結果：本研究於109年5月至110年5月間，共有240位（介入組120位；控制組120位）的乳癌病人參與研究，進行乳癌就醫提問單介入後，結果顯示介入後7-14天比一般照護模式能顯著提升決策自我效能(p=0.001)、病人醫生互動效能(p=0.02)；而介入後6-8週比一般照護模式能顯著提升決策自我效能(p<0.001)、病人醫生互動效能(p<0.001)；此外決策準備程度介入後7-14天(p<0.001)與介入後6-8週(p<0.001)兩組間達統計上顯著差異；迴歸分析後結果顯示決策自我效能在就醫提問單介入與短期的決策參與及短中期的決策參與及醫病溝通具有中介效果；以廣義估計方程式分析組別與時間交互作用後，結果顯示決策自我效能、病人醫生互動效能量表、改良版健康照護趨勢量表、情境特質焦慮量表-情境量表兩組間達顯著差異。
討論：透過乳癌就醫提問單能有效提升病人決策自我效能，促進病人主動參與醫療決策，有助於改善病人與醫療團隊之間的互動，促進醫病溝通，並與一般衛教模式達顯著差異。預期結果與貢獻：本研究希望透過就醫提問單此工具，提升乳癌病人的決策自我效能、醫病溝通、決策參與、健康狀況，並降低病人的決策衝突與後悔，進而提升乳癌病人之醫療照護品質。
Background: Question Prompt List (QPL) is a list of questions related to illness and treatment that patients may want to ask their physicians during a medical visit, which has been used to encourage patients to participate actively during medical visits. The incidence of cancer is increasing year by year, and breast cancer has become the most common cancer among women in the world. However, faced with numerous and complex treatment methods, patients often feel at a loss, leading to poor communication between doctors and patients, and psychological distress.
Purposes: This study examined the effect of QPL intervention in decision self-efficacy, participation in decision-making, patient-physician communication, decision conflict or regret, and health status compared to the routine care among patients with breast cancer.
Methods: This study was a single-blind (blindness of patients) randomized controlled trial in breast surgery clinics and wards. Pretests and interventions in the form of self-administered questionnaires were used before medical visits, and two posttests in the form of telephone interview were respectively used after 7-14 days and 6-8 weeks. We assessed decision self-efficacy (Decision Self-Efficacy Scale), participation in decision-making (Perceived Efficacy in Patient-Physician Interactions Scale, Control Preference Scale, Patients' Perceived Involvement in Care Scale, Preparation for Decision-Making Scale), patient-physician communication (collaboRATE, modified Health Care Climate Questionnaire), decision conflict and regret (SURE Test, Decision Regret Scale), and health status (State Trait Anxiety Inventory-S, conscious health status, pain status). The statistical analysis methods were Pearson's chi-square test, independent sample T test, analysis of variance, simple linear regression analysis, multivariate linear regression analysis, and generalized estimation equations.
Results: From May 2020 to May 2021, a total of 240 adult outpatients with breast cancer participated our study. After QPL intervention, 7-14days after intervention, the intervention group significantly improved decision self-efficacy (p=0.001), perceived efficacy in patient-physician interactions (p=0.02), and help patients’ decision-making preparation (p<0.001) significantly. 6-8 weeks after intervention, the intervention group improved decision self-efficacy (p<0.001), perceived efficacy in patient-physician interactions (p<0.001), and help patients’ decision-making preparation (p<0.001). GEE results showed that there was group by time interaction effect on Decision Self-Efficacy Scale, Perceived Efficacy in Patient-Physician Interactions Scale, modified Health Care Climate Questionnaire and State Trait Anxiety Inventory-S.
Conclusions: QPL could effectively improve decision self-efficacy, the participation in decision-making, and patient-physician communication among patients with breast cancer.
Clinical Implementation: Our study provided a QPL intervention effectively promoting the patients’ decision self-efficacy, participation in decision-making, patient-physician communication, health status, and decreasing decision conflict or regret compared to the routine care among patients with breast cancer. |
