| 摘要: | 醫病共享決策(Shared Decision-Making, SDM)是以病人為中心的臨床醫療決策的過程，其目的是讓醫療人員和病人在進行醫療決策前，能共享現有的實證醫學結果，結合病人本身的偏好與價值來達成醫療決策共識，並支持病人做出符合其偏好的醫療選擇。病人決策輔助工具(Patient Decision Aids, PDAs)旨在幫助病人在SDM過程中提供醫療的選項，讓病人做出具體的醫療選擇。儘管實務界強調SDM為醫院提昇病患安全的解決方案，但整體採用率仍偏低。回顧過去相關文獻主要探討SDM的採用和使用，但這些研究主要以案例報告、科技或健康照護利用的觀點，而無法充分解釋健康照護提供者及消費者對SDM共享行為。因此，本研究基於個人採用的觀點發展兩個整合模型，探討醫療人員(健康照護提供者)及民眾(健康照護消費者)的行為模型。本研究採實證研究的方式，第一階段採用衛生福利部所公告之醫院評鑑合格名單為樣本來源，以醫療人員為研究對象進行問卷調查，回收有效問卷421份，有效回收率為93.14%，並以結構方程模式進行資料分析，其實證結果顯示：社會網路、社會信任、知覺有用性、相容性、結果展示性以及形象對SDM行為意圖有正向顯著影響；再者社會網路及共同目標對社會信任有正向顯著影響；此外，社會網路對共同目標具正向顯著影響以及知覺易用性對知覺有用性具正向顯著影響；第二階段以20歲以上民眾為研究對象，透過網路巿調進行問卷調查，回收有效問卷2,513份，有效回收率為83.76%，並以結構方程模式進行資料分析，其實證結果顯示：資訊支持、情感支持、尊重支持以及e-健康識能對健康自我效能具正向顯著影響；再者健康自我效能、e-健康識能、功能價值、社會價值以及情感價值對民眾參與SDM行為意圖具正向顯著影響。因此，本研究成果可作為醫院、政府單位與系統開發者對SDM的推廣以及管理策略之參考，並增益學術界對於個人採用SDM之相關研究。
Shared decision-making (SDM) is a process that respects the rights of patients to be fully involved in decisions about their health care. By evaluating all available care options and weighing patients’ values and preferences against evidence-based medicine, patients and medical personnel can make health-related decisions together, as partners. Patient decision aids (PDAs) have been designed to help patients participate in making specific choices among care options in shared decision-making. Even though some practitioners and academics have emphasized the improved patient safety that SDM offers to hospitals, its overall adoption by medical personnel and patients remains low. Several prior studies have focused on identifying the factors that impact the adoption and use of SDM; however, these studies have concentrated on case reports, the impact of tech-nology, and health care utilization aspects. They are therefore insufficient for fully explaining the SDM be-haviors of health care providers and receivers. Based on the concept of individual adoption, this study has de-veloped two integrated models to explain medical personnel’s (health care providers) and citizens’ (health care consumers) intentions to use the SDM. A sample source was achieved by using the roster of the Ministry of Health and Welfare. A series of surveys were conducted to empirically test the individual adoption research model for medical personnel in the first stage. The resulting 421 valid questionnaires constituted a response rate of 93.14%. The results indicate that social network, social trust, perceived usefulness (PU), compatibility, result demonstrability, and image have positive effects on medical personnel’s intention to the share the SDM. The results also show that both social network and shared goals have positive influence social trust. Social network show has a positive effect on shared goals and perceived ease of use (PEOU) has a positive effect on PU. Next, this theoretical model was empirically validated via online survey data from Taiwanese citizens of at least 20 years of age, and the structural equation model was used to examine the data. The resulting 2,513 val-id questionnaires constituted a response rate of 83.76%. The results present that information support, emotional support, esteem support, and e-health literacy have positive influences on health self-efficacy. The results also indicate that health self-efficacy, e-health literacy, functional value, social value, and emotional value have positive effects on citizen’s intention to the participate the SDM. The research results of this study offer constructive suggestions to researchers, hospitals, and the government to increase the likelihood of SDM adoption. The results provide useful insights that can not only help hospital managers choose an appropriate promotion strategy but also enable system developers and government agencies to develop and appropriate their own administrative strategies for the future. |
