探討醫病共享決策影響孕產婦施打減痛分娩意願之成效

隨著醫療水平提升，溫柔生產的概念漸受重視，孕產婦趨於積極參與醫療決策，以增加在分娩過程中的自主權。本研究運用「醫病共享決策」模式，提升孕產婦對生產時疼痛控制的認知，比較在醫病共享決策前後，施打減痛分娩意願的變化，及探討孕產婦對決策輔助工具的評價及其就醫心理感受與施打意願之相關性。本研究採用問卷調查法，針對於台中市某區域醫院婦產科門診及待產室參與醫病共享決策的病人及其家屬作為研究對象，依臨床現況設計施打減痛分娩與否的決策輔助工具，增加孕婦認知，協助釐清疑慮，使其做出達成醫病雙方共識的醫療決策，研究目的為探討在醫病共享決策前後施打意願及焦慮感受的變化，另以「PrepDM量表」及「CollaboRATE問卷」評估孕產婦對決策輔助工具的評價、就醫心理感受，及其對施打意願的影響。回收有效問卷共174份，以SPSS 27.0進行統計分析。本次研究對象以30-39歲(60.9%)、初產婦(60.3%)為多數，由分析結果歸納結論，在醫病共享決策下，孕婦施打減痛分娩的意願有所提升，焦慮程度則顯著下降，然而，孕產婦對決策輔助工具的評價及其就醫心理感受對施打減痛分娩的意願皆無顯著相關。此外，在人口統計變項中，胎次及教育程度與施打意願具相關性，年齡及共同決策對象則與施打意願無顯著差異，期望此研究經驗提供醫療機構作為未來執行醫病共享決策實務規劃之參考。

As medical standards improve, the concept of gentle delivery is increasingly valued. Pregnant women tend to actively participate in medical decision-making to increase their autonomy during delivery. The main purpose of this study is to use the "shared decision making" model to improve pregnant women's awareness of pain control during delivery, compare the willingness of using epidural labor analgesia changes between participated in shared decision making. Explore whether the willingness is related to the assesment of patient decision aids and their psychological feelings about medical treatment.This study adopted a questionnaire survey. the research objects were those pregnant wowen and their families who participated in shared decision making in the outpatient clinic or labor room of a regional hospital in Taichung City. The patient decision aids designed based on the currtent clinical situation. It can increase pregnant women's understanding of pain relief and help them clarify doubts to make the decisions that reach a consensus between doctors and patients. The purpose of the study is to explore the changes in willingness of using epidural labor analgesia and the feelings of anxiety between shared decision making. Also, this study used the "PrepDM Scale" and "CollaboRATE" questionnaires to evaluate pregnant women's assessment of patient decision aids and their psychological feelings about medical treatment. The study total collects174 valid questionnaires and statistical analyzed by SPSS 27.0The majority of the subjects in this study were 30-39 years old (60.9%) and most were primiparous women (60.3%).The study results show that the willingness of pregnant women using epidural labor analgesia has increased, and their anxiety levels have decreased after they participated in shared decision making.However, the willingness of pregnant wowen using epidural labor analgesia is no significant related to their assesment of patient dicision aids and psychological feelings about medical treatment. In addition, among the demographic variables, parity and education level are related to the willingness of using epidural labor analgesia, but age and joint decision-making partners are not significantly different from the willingness to using epidural labor analgesia. Hope this research can provide medical institutions as a reference for practical implementation plan on shared decision making in the future.