2018-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/655218摘要：由於醫療科技的突飛猛進，人類的生命逐步延長，老化結果加上環境不佳導致器官衰竭的可能性大幅增加，因此，全世界先進國家都面臨了器官來源缺乏，且完全趕不上醫療上對於器官的迫切需求，不僅是美國或歐洲等等先進國家如此，採取「預設不同意」器官捐贈政策的台灣更顯得器官缺乏的嚴重。所以，不僅僅是美國或歐洲等等先進國家，台灣也因此努力透過各種方式，想要增加器官來源，比如，最近幾位學者試圖透過政府單位提出了倫理爭議極大的無心跳器官捐贈的政策，期待開放末期病人心跳停止後的器官捐贈，以期增加器官來源。然而這樣的開放，可能衝擊許多台灣社會的倫理價值。讓病人或家屬在醫療決策中扮演更積極的角色，透過醫病共享醫療決策的模式，將也助於參與器官勸募的家屬，共容易跨出對器官捐贈的不理解。提升器官捐贈者即其代理決定人的意願，為器官勸募最重要的議題。本計畫將以開發多種決策輔助以協助器官捐贈者及其代理人參與醫療決策的過程，並評估這些不同決策方式的成效，本二年期個人型計畫預計將達成下列目標：第一、探討世界各國對於醫病共享醫療決策的進展第二、瞭解器官捐贈的現況第三、研議協助病人或家屬器官捐贈決策的操作流程第四、開發協助病人或家屬器官捐贈決策的工具第五、測量各個介入方式的使用效益 透過本計畫執行，對醫病共享醫療決策及器官勸募間將有更清楚的輪廓。在未來人造器官出現之前，醫療科技進步足以維持衰竭器官的存續時間，我們幾乎還是將面對人體器官來源不足，等待器官人數持續增加，等待器官時間持續增長。透過PDA、短片、標準化作業流程檢核，提升家屬在器官勸募過程中的醫病共享醫療決策，以期提升家屬代理決定增加器官捐贈的意願，在避免可發生的倫理爭議下提升器官來源，以提升器官衰竭病患的生活品質，可以預期將減少醫療資源的浪費，舒緩健保支出的壓力。<br> Abstract: Due to the advance of medical technology，longevity is dramatically increasing. Aging and poor environmental conditions result in the increasing probability of chronic organ failure. Therefore, countries all over the world are all facing a shortage of organs. The condition in Taiwan is rapidly deteriorating under the policy of “opt-in”. not only in Taiwan, but also other countries all over the world strive very hard to figure a way to effectively increase the number of available organs for those who are suffering from organ failure. Encouraging patient/family members is reported more likely to facilitate patients/family members to make medical decisions. This study aims to develop different tools of decisional aid tools for helping the family members of potential donors to make decision, and also to examine the effectiveness of the different ways of implementing decisional aids in the organ procurement process. The specific aims of this two-year research proposal are as the followings: Specific Aim 1、To explore the literature of Shared Decision MakingSpecific Aim 2、To explore the literature of organ procurement and organ donationSpecific Aim 3、To establish the standard operating procedure for organ procurementSpecific Aim 4、To develop patient decisional aids for organ procurementSpecific Aim 5、To examine the effectiveness of the different ways of implementing decision intervention in organ procurement By conducting this study, we will have a better shape about organ procurement and Shared Decision Making. Before the artificial organs are getting mature and available to the medical community, medical technology is still good enough to sustain human life even if he/she has organ failure, and the total number of patients awaiting a workable organ is still increasing. We expect to encourage Shared Decision Making by implementing Patient Decisional Aids, video showing decision aid information, and standard operating procedures check. By doing so, family members’ willingness to donate their beloved family member’s organ will be increased, and the shortage of organ will be relieved.醫病共享醫療決策器官勸募器官捐贈輔助病人決策工具Shared decision makingorgan procurementorgan donationpatient decision aid