| 摘要: | 目的:
血管攝影為診斷血管相關疾病相當重要的黃金標準，執行血管攝
影檢查時醫師通常選擇股動脈穿刺，於結束檢查時將進行止血，在過
去，對於診斷及簡單治療血管攝影，於病情解說時，我們提供傳統文
宣進行提供病患選擇依據，台灣各大醫院普遍都有Vascular Closure
Devices 可供病患選擇，但此設備屬於自費項目(約需自費新台幣
10000~15000 元不等)，因此使用意願較低，另一個導致此止血器不常
被使用的原因為，雖有提供相關資料給病人參考，但這些資料通常充
斥著醫療術語，使病人無法充份理解此止血器所帶來的好處。本研究
目的在探討運用醫病共享決策(Shared Decision Marking)中決策輔助
工具( Patient decision aids)於血管攝影檢查前進行血管止血方式選擇
時，提供病患選擇支持之成效探討。
研究方法:
本研究採用隨機對照實驗(Randomized Controlled Trial，RCT），
研究地點於衛生福利部雙和醫院之血管攝影室病情解說室，收案對象
為進行診斷及簡單治療之血管攝影病人，以亂數表隨機分派將研究對
象分至PDA 組(n=80)與傳統文宣組(n=78)。開發決策輔助工具
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(Dicision Aids)於PDA 組使用。PDA 組使用決策輔助工具於手術前病
情解說，步驟如下(1)解說血管攝影相關風險，隨後解釋術後止血方
式；(2)提供決策輔助工具首先進行止血方式簡介；(3)提供止血方式
各種比較，包含併發症、止血速度、成功率、術後照顧方式、費用等
資訊工病人選擇支持；(4)分析病患需求並引導病患依其偏好及價值觀
進行思考；(5)確認病人資訊認知無誤，支持進行醫療選項選擇。對照
組則進行廠商提供之傳統文宣進行諮詢。
於血管攝影檢查後，病人將依選擇之醫療選項進行止血，病人將
進行至少24 小時之住院觀察，問券將於出院前進行評估，利用SURE
問券調查事項如下:(1)解說前對止血方式了解程度；(2)過程中是否有
得到足夠的資訊或知識；(3)了解止血方式各種優缺點；(4)清楚知道
自己在意的利益及風險；(5)本次手術所選擇之血管攝影止血方式使否
正確；(6)選擇止血方式時有得到足夠的支持及建議，統計完成後將進
行兩組比較之統計分析。
研究結果:
經SURE 問券統計，PDA 組與傳統文宣在獲得足夠資訊或知識方面
的分數為4.64:3.23；在了解止血方式的優缺點方面的分數為
4.71:3.01；在清楚知道利益及風險方面的分數為4.75:3.14；在認為
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自己選擇正確的分數為4.68:3.26；在決策過程中是否得到足夠的支持
或建議分數為4.63:3.07，每一組的p 值皆小於0.01，據統計上顯著
差異，PDA 組分數都較傳統文宣組高，說明在PDA 介入後病患得到較好
的醫療選擇支持。問卷分數顯示，雖然兩組的基準有些許差異，在說
明前是否了解止血選項方面傳統文宣組分數為2.3，高於PDA 組的分數
1.68，p 值小於0.01，但在使用PDA 解說後，分數反而高提升更多，
說明即使一開始PDA 組對於血管攝影止血方式較不了解，但介入後，
PDA 組更能給予病人選擇支持，減少因對選項不了解造成的選擇衝突。
結論:
在決策過程中使用PDA 能提供病患在血管攝影後止血方式足夠的
知識及了解程度，減少病人選擇衝突，希望未來能將此PDA 發展至全
國的血管攝影室使用，供病人選擇止血方式時提供足夠的選擇支持。
Purpose : Angiography is a very important gold standard for the diagnosis
of vascular-related diseases. When performing an angiography examination,
physicians usually choose femoral artery puncture, and hemostasis will be
performed at the end of the examination. In the past, for diagnosis and
simple treatment of angiography, when explaining the condition, we
Provide traditional propaganda to provide basis for patient selection. Major
hospitals in Taiwan generally have Vascular Closure Devices for patients to
choose from. However, this device is a self-funded item (about
NT$10,000~15,000), so the willingness to use is relatively high. Another
reason why this hemostatic device is not often used is that although
relevant materials are provided for patient reference, these materials are
usually filled with medical terminology, which prevents patients from fully
understanding the benefits of this hemostatic device. The purpose of this
study is to explore the effectiveness of providing patient selection support
when using Patient decision aids in Shared Decision Marking to select
vascular hemostasis methods before angiography.
Methods: This study is based on a randomized controlled trial (RCT). The
study site is in the vascular radiography room of the Shuanghe Hospital of
the Ministry of Health and Welfare. The subjects of the case are
angiographic patients undergoing diagnosis and simple treatment. Random
numbers are used to randomize the trial The research objects were divided
into PDA group (n=80) and traditional propaganda group (n=78). Develop
decision aid tools (Dicision Aids) for use in PDA group. The PDA group
used decision-making aids to explain the condition before surgery. The
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steps are as follows: (1) Explain the risks related to angiography, and then
explain the postoperative hemostasis methods; (2) Provide decision-making
aids, first introduce hemostasis methods; (3) Provide various hemostasis
methods Comparison, including information on complications, hemostasis,
success rate, postoperative care methods, costs, and other information to
support patient selection; (4) Analyze patient needs and guide patients to
think based on their preferences and values; (5) Confirm patient
information The cognition is correct and supports the selection of medical
options. In the control group, the traditional propaganda provided by the
manufacturer was used for consultation.
Results: According to the statistics of SURE questionnaires, the scores of
the PDA group and traditional propaganda for obtaining sufficient
information or knowledge are 4.64:3.23; the scores for understanding the
advantages and disadvantages of hemostatic methods are 4.71:3.01; the
scores for clearly knowing the benefits and risks are 4.75:3.14; when you
think you have chosen the correct score is 4.68:3.26; in the
decision-making process whether you get enough support or the
recommended score is 4.63:3.07, the p-value of each group is less than 0.01,
according to statistically significant differences, PDA The scores of the
group were higher than those of the traditional propaganda group,
indicating that patients received better medical choice support after PDA
intervention. The questionnaire scores show that although the benchmarks
of the two groups are slightly different, the number of traditional
propaganda components is 2.3 in terms of whether you understand the
options for hemostasis before explaining, which is higher than the score of
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the PDA group of 1.68, and the p value is less than 0.01, but after using the
PDA to explain, the score is instead The high improvement is more,
indicating that even though the PDA group is less familiar with
angiographic hemostasis methods at the beginning, after the intervention,
the PDA group is more able to give patients the choice support and reduce
the choice conflict caused by the ignorance of the options.
Conclusion: The use of PDA in the decision-making process can provide
patients with sufficient knowledge and understanding of hemostasis
methods after angiography, and reduce patient choice conflicts. It is hoped
that this PDA can be developed for use in vascular photography rooms
across the country in the future for patients to choose hemostasis methods. |
