腦瘤病患之治療決策衝突及其相關影響因素

Abstract

中文摘要 研究目的：本研究旨在探討腦瘤病患面臨治療決策時感受到的衝突程度以及相關因素，進一步以醫病互動角色偏好與實際參與決策的角色，探討角色期望落差情形對決策衝突程度的影響。 研究方法：屬於橫斷式描述性研究，採立意取樣，以台灣北部某醫學中心神經外科病房及門診18歲以上初次診斷腦瘤的病人為研究對象。以結構式問卷為研究工具，資料收集期間由2010年5月1日至6月25日，共有61位研究對象。 研究結果： 多數（40.9％）研究對象偏好主動角色參與決策，其次為被動角色（39.4％），與醫師採取合作角色者最少（19.7％）。期望能自己做決定者，以年輕、女性或未婚的病人居多；反而，教育程度大專以上、惡性腦瘤、未曾有自己或家人罹病經驗者，欲將治療決策授權給醫師。整體而言，本研究對象存在決策衝突。衝突的來源包含對於治療決策的不確定感、疾病與治療資訊不足，以及缺乏支持感。社會人口學變項之中，僅有年齡因素對衝突程度的影響達統計上顯著差異（p=0.018）。高達92.3％的研究對象，其家人曾一同參與治療決策，家人參與程度愈高者，反而衝突程度愈高（p=0.007）。60.7％的研究對象擁有期待中與實際上相符的參與角色，其感受到的衝突程度明顯低於存在角色期望落差的病人。針對存在角色期望落差者而言，感到較多主控力的病人比感到較少主控力者具有較高衝突程度。 研究結論：以具備高度專業性的醫療領域而言，執行治療決策的確會對病人造成複雜而困難的衝突情形。既然病人非醫療專業人士，期待能有更多的決策參與或者能在協助之下做決定，是無可厚非之事。醫師傾全力使病人獲得治療資訊時，需兼顧病人的意願以及家屬的參與情形，臨床護理師將會是居中協助溝通的重要橋樑，可以拉近專業代溝的距離，避免產生參與治療的角色期望落差，甚至醫病互動隔閡，盡可能降低病人在治療決策上的衝突程度。

Abstract Purposes: This study explored medical decisional conflict of treatment in patients with brain tumor and factors associated with the match between actual and preferred role of involvement in this decision. Methods: This is a cross-sectional descriptive study. A purposive sampling of neurosurgery patients with age 18 years at least and newly diagnosed brain tumor from one medical center in northern Taiwan was recruited. Data were collected from May 1st 2010 to June 25th 2010 with Control Preference Scale and Decision Conflict Scale. A total of 61 participants were distributed. Results: The majority (40.9%) preferred active role in decision making, the next is passive role (39.4%), and the minority is collaborative role (19.7%). Most of women, younger or unmarried clients desired to decide on their own; however, ones with educational level in college, malignant tumor or without experience of illness wanted to delegate the decision to their doctors. Participants in this study had decisional conflict. The conflict was composed of three dimensions, including state of uncertainty, lack of information, and insufficient support. The level of decisional conflict significantly correlated with age statistically (p=0.018). The older ones had the higher level of decisional conflict. 92.3% of all participants invited their families to involve this decision even if they made the final decision by themselves. Participants with more involvement of families had higher decisional conflict (p=0.007). 60.7% of patients met their preferred role of involvement and had lower level of decisional conflict than those with expectation gap in the role of involvement. Participants who perceived more control than preferred had more decisional conflict. Conclusions: In critically clinical professional situation, making medical decisions for patients result in complex and difficult conflict. Patients are not professionals in medical, thus they expect to be involved more in decision-making and make a decision with someone’s help. Physicians should give consideration to wills of patients and the participation of families. Nurses could be coordinators between physicians, patients and families to make communication lines open and meet expectations. The objective is to eliminate barriers between patients and medical teams and to diminish the level of the conflict for patients in medical decision-making.