請用此 Handle URI 來引用此文件：
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/80297完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 陳端容(Duan-Rung Chen) | |
| dc.contributor.author | Pi-Yu Wu | en |
| dc.contributor.author | 吳丕玉 | zh_TW |
| dc.date.accessioned | 2022-11-24T03:04:02Z | - |
| dc.date.available | 2022-02-16 | |
| dc.date.available | 2022-11-24T03:04:02Z | - |
| dc.date.copyright | 2022-02-16 | |
| dc.date.issued | 2022 | |
| dc.date.submitted | 2022-01-24 | |
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/80297 | - |
| dc.description.abstract | "研究背景 肝臟疾病為我國重要公共衛生議題，慢性肝臟疾病進程到末期的病人而言，肝臟移植是救命的最後希望。我國大體捐贈來源的器官有限，肝臟移植以活體肝臟移植（Living donor liver transplantation,LDLT）為主。LDLT的決策涉及捐贈者、受贈者及家庭中其他關係人的想法，捐贈者是否適合亦需要醫療人員嚴謹的評估，故其決策非僅限於捐贈當事人，是一個需要共享決策（Shared decision making，SDM）的議題。就目前已發表的研究，尚未有以協助活體肝臟潛在捐贈者做出符合個人價值觀知情決定的決策輔助工具(Patient decision aid，PDA)。 研究目的與方法 本研究參照國際病人決策支援標準協會(the International Patient Decision Aid Standards ,IPDAS，以下簡稱IPDAS)，經過界定範圍、組成指導小組、需求評估、決定工具形式及應用計畫、實證綜整等過程產出PDA的原型，再經過初步測試(Alpha test)及臨床應用測試(Beta test)發展出輔助LDLT潛在捐贈者作捐贈決策的PDA。PDA的Beta test係針對接受活體肝臟捐贈評估第二階段住院評估的捐贈者，在其住院評估出院前實施問卷測量，以比較PDA介入組及對照組的潛在捐贈者在與LDLT相關知識、捐贈矛盾、決策衝突、決策滿意度及捐贈意向等結果變項。另因需求評估的對象涵蓋LDLT醫療團隊的各職類人員、有過LDLT評估或實際捐贈經驗的捐贈者，以及接受過LDLT的受贈者，故分析需求評估的質性資料，歸納出影響LDLT潛在捐贈者的決策因素及醫療人員在LDLT中扮演的角色。 研究結果 參照IPDAS發展出的PDA，經自評可符合IPDAS4.0的合格類別、認證類別及大部分的品質類別指標，且在Alpha test階段醫療人員及曾經有過捐贈經驗的捐贈者或正在接受捐贈評估的潛在捐贈者均對PDA有正面的評價。Beta test (對照組27人、介入組26人)，並未發現PDA介入組在捐贈矛盾、決策衝突雖較對照組為低、決策滿意度較對照組為高，但兩組在各結果變項均未達到統計上的顯著差異。透過在PDA需求評估階段對醫療人員、捐贈者及受贈者的需求訪談內容所作的質性分析，可歸納出影響活體肝臟捐贈者決策的影響因素可分為「內在動機」、「決策過程」、「外在脈絡」三個層次，在「內在動機」的層次，可歸納出「責任與義務」、「愛與不愛」及「自我實現」三個主題；在「決策過程」的層次，歸納出「拉扯」、「偕同」及「承擔」三個主題；在「外在脈絡」層次，可歸納出「器捐文化」、「資源拉扯」及「醫療主導」三個主題。醫療團隊在LDLT的角色，扮演受贈者的「支持者」、捐贈者的「保護者」並在LDLT過程間擔任「領航員」。 研究結論與建議 從質性研究的結果可知影響活體肝臟潛在捐贈者的決策因素相當多元，且涉及捐贈者、受贈者及其他關係人的身心社會條件與想法，醫療人員亦扮演相當重要的角色，應全面的考量活體肝臟捐贈者的身心社會條件，及其對個人意願或捐贈決定後果的影響。本研究發展的PDA符合IPDAS建議的發展步驟並符合多數IPDAS建議的PDA品質指標，可考量於臨床進一步的推廣應用，且介入時機可考量提早在受贈者接受移植評估時，或至遲於捐贈者接受第一階段捐贈評估時即介入，以更即時讓潛在捐贈者能了解活體肝臟移植及腦死捐贈者肝臟移植的差異，以及個人捐贈或不捐贈的好處與壞處，及早確認個人的價值觀與意願，作出符合個人意願及知情同意精神的決定。" | zh_TW |
| dc.description.provenance | Made available in DSpace on 2022-11-24T03:04:02Z (GMT). No. of bitstreams: 1 U0001-1701202218294000.pdf: 10494485 bytes, checksum: dd72aa6768cee9660724d6e547dc39e9 (MD5) Previous issue date: 2022 | en |
| dc.description.tableofcontents | "第一章 緒論 1 第一節 研究背景 1 第二節 研究目的與重要性 5 第一項 研究目的 5 第二項 研究重要性 6 第二章 文獻回顧 8 第一節 醫病共享決策 8 第一項 醫病共享決策的定義 8 第二項 醫病共享決策的測量 11 第二節 決策輔助工具 12 第一項 決策輔助工具的理論概念架構 12 第二項 決策輔助工具與醫病共享決策 15 第三項 決策輔助工具之發展程序-IPDAS 16 第四項 決策輔助工具的效果測量 20 第五項 本土決策輔助工具開發與應用效果之相關研究 22 第三節 活體肝臟移植 26 第一項 活體肝臟移植捐贈者之條件 26 第二項 活體肝臟捐贈者之評估 30 第三項 活體肝臟移植對受贈者的效果與風險 36 第四項 活體肝臟移植捐贈者的風險 37 第五項 活體肝臟移植的倫理議題與知情同意 40 第四節 活體肝臟移植之相關質性研究 44 第一項 捐贈動機 44 第二項 捐贈者的決策類型及對對捐贈風險認知的態度 46 第三項 活體肝臟捐贈決策的家庭議題 47 第四項 活體肝臟捐贈者術後恢復的影響因素 48 第五項 活體肝臟捐贈者對決策所需的資訊需求 48 第五節 器官移植或肝臟疾病決策輔助工具之發展與醫病共享決策之應用現況 49 第一項 iChoose Kidney 49 第二項 肺囊纖維症病人是否要採取肺臟移植的PDA 49 第三項 肝臟移植相關的PDA 50 第六節 小結 50 第三章 研究方法 52 第一節 研究場域 52 第二節 研究步驟與研究對象 53 第一項 研究步驟 53 第二項 研究對象 54 第三節 決策輔助工具(Patient Deicion Aid, PDA)的發展 54 第一項 範圍標定(Scoping) 55 第二項 指導小組(Steering group) 55 第三項 決策需求評估(Assess decisional needs) 56 第四項 工具形式與應用計畫(Determine format and distribution plan) 56 第五項 文獻回顧與實證綜整(Literature review and synthesis evidence) 56 第六項 決策輔助工具原型產出(DA prototype) 57 第七項 前測試(Alpha testing) 57 第八項 臨床應用測試(Beta testing) 58 第四節 Beta test研究工具 59 第一項 決策控制：控制期待量表(Control Preferences Scale) 60 第二項 活體肝臟捐贈者的矛盾：矛盾量表 61 第三項 活體肝臟捐贈的相關知識：捐贈者知情同意評估工具(Evaluation of Donor Informed Consent Tool，EDICT) 62 第四項 決策衝突：決策衝突量表(Decisional Conflict Scale) 67 第五項 決策滿意度：決策滿意度量表（The Satisfaction with Decision Scale） 69 第六項 其他變項 69 第五節 研究工具的信效度檢定 70 第六節 資料分析 70 第一項 質性分析 70 第二項 PDA前測試(alpha test)的量性統計 71 第三項 PDA臨床應用測試(beta test)的量性統計 71 第四章 研究結果 73 第一節 活體肝臟捐贈PDA研發 73 第一項 範圍標定(Scoping) 73 第二項 指導小組 73 第三項 決策需求評估 74 第四項 工具形式與應用計畫 86 第五項 文獻回顧與實證綜整 87 第六項 決策輔助工具原型產出 88 第七項 Alpha test 93 第二節 活體肝臟捐贈PDA的導入效果 95 第一項 Beta test樣本基本資料描述性統計 95 第二項 與捐贈決策相關的變項比較 101 第三項 介入組對PDA的看法 112 第四項 小結 114 第三節 利害關係人對捐贈決策的影響 114 第一項 活體肝臟移植潛在捐贈者的捐贈決策決定因素 115 第二項 醫療團隊在活體肝臟捐贈與移植醫療中扮演的角色 134 第三項 小結 143 第五章 研究討論與研究限制 144 第一節 PDA的開發 144 第二節 PDA Beta test分析結果 152 第三節 質性研究結果 159 第一項 質性研究結果輔助PDA發展的關聯 159 第二項 捐贈決策決定因素 161 第三項 醫療團隊在活體肝臟移植扮演的角色 163 第四節 研究限制 165 第一項 單一機構發展PDA及收樣具結果外推之限制性 165 第二項 基於考量研究執行可行性衍生的研究限制 165 第三項 質性資料蒐集的研究限制 166 第四項 PDA使用的相關資訊未納入研究蒐集的資訊 167 第五項 活體肝臟捐贈是否為醫病共享決策適當議題的限制性 168 第六項 PDA取代醫病互動的限制性 168 第六章 研究結論與建議 169 第一節 研究結論 169 第二節 研究貢獻與臨床應用建議 170 第一項 研究貢獻 170 第二項 臨床應用建議 171 第三節 對未來研究之建議 172 第一項 電子版本的PDA與潛在捐贈者對PDA回覆內容的收集 172 第二項 運用RCT的研究設計並至少做兩個以上時間點的測量 172 第三項 PDA與研究工具的精進 173 第四項 進行本國多中心及其他語言版本的跨國研究 173 參考文獻 174 附錄 186" | |
| dc.language.iso | zh-TW | |
| dc.subject | 醫病共享決策 | zh_TW |
| dc.subject | 決策輔助工具 | zh_TW |
| dc.subject | 活體肝臟移植 | zh_TW |
| dc.subject | 活體捐贈者 | zh_TW |
| dc.subject | 決策衝突 | zh_TW |
| dc.subject | 矛盾 | zh_TW |
| dc.subject | Ambivalence | en |
| dc.subject | Shared decision making | en |
| dc.subject | SDM | en |
| dc.subject | Patient decion aid | en |
| dc.subject | PDA | en |
| dc.subject | Living donor liver transplantation | en |
| dc.subject | LDLT | en |
| dc.subject | living donor | en |
| dc.subject | Decisional conflict | en |
| dc.title | 發展活體肝臟捐贈決策輔助工具及其效益評估 | zh_TW |
| dc.title | The development of the decision aid for potential donor of living donor liver transplantation and to appraise its effect | en |
| dc.date.schoolyear | 110-1 | |
| dc.description.degree | 博士 | |
| dc.contributor.oralexamcommittee | 鍾國彪(Chiung-Pin Liu),邱秀渝(Sheng-Feng Hung),胡瑞恆,陳彥元,邱玉蟬 | |
| dc.subject.keyword | 醫病共享決策,決策輔助工具,活體肝臟移植,活體捐贈者,決策衝突,矛盾, | zh_TW |
| dc.subject.keyword | Shared decision making,SDM,Patient decion aid,PDA,Living donor liver transplantation,LDLT,living donor,Decisional conflict,Ambivalence, | en |
| dc.relation.page | 230 | |
| dc.identifier.doi | 10.6342/NTU202200085 | |
| dc.rights.note | 同意授權(限校園內公開) | |
| dc.date.accepted | 2022-01-24 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
文件中的檔案：
| 檔案 | 大小 | 格式 | |
|---|---|---|---|
| U0001-1701202218294000.pdf 授權僅限NTU校內IP使用（校園外請利用VPN校外連線服務） | 10.25 MB | Adobe PDF |
系統中的文件，除了特別指名其著作權條款之外，均受到著作權保護，並且保留所有的權利。