健康照護服務對個人生活品質有直接重大的影響，是學者長久以來關注的研究議題。醫病共享決策模式主張病患參與決策討論，顛覆傳統由醫師主導決策的醫病關係。過去醫療服務研究鮮少探討醫病關係以外的其他利害關係人，例如家屬在共同決策過程中的角色。此外，醫病互動內容主要是期望病患遵守醫療照護的基本要求，而非參與醫療決策活動。然而家屬是個人最重要的社會支持來源，尤其是在台灣，個人對家屬具有共同義務感。個人進行重大決策時也常以家人意見為依歸，家屬是個人重要的決策夥伴。故，本研究從醫病共享決策之理論觀點，以台灣活體肝臟移植個案為情境，探索家屬參與共同決策的歷程，並詮釋蘊含於經驗現象中的意義。
本研究採回溯性病歷回顧法收集活體肝臟移植之捐贈者與受贈者病歷資料，以主題分析法進行質性資料分析，分析結果顯示台灣的活體肝臟移植決策是以家庭為單位的共同決策歷程。首先，家屬參與動機可依據親屬關係類型分為「同為家人」與「情同家人」兩種模式。同為家庭內的捐贈動機往往夾雜著複雜的情感因素，積極因素有拯救家人、改善健康、當仁不讓三個次主題，消極因素則是基於血緣關係的無可奈何。跨三等親以上之捐贈動機則是出於捐贈者與受贈者的關係緊密「情同家人」，反而顯現出毫不猶豫的態度。其次，臨床上除了醫師，還有家屬或主要照顧者來開啟共同決策對話，顯示家屬在決策歷程中是主動積極的角色。第三，在商議過程中，先由家庭內部權衡多重因素後，篩選出有意願的捐贈者，再由醫療服務供給者基於醫療考量選出最適的捐贈者。第四，從篩選「捐贈候選人」到選出「最佳捐贈者」，再到精神醫學與社會心理評估的過程是遞迴前進的過程，而這過程是由移植協調師作為醫病之間的服務協作者，來協助推動商議過程的進行。
本研究增進現有醫病共享決策模型的認知，拓展醫病二元關係，提出醫師-病患-家屬三方共享決策模式。在方法上的新應用，增進了我們對於家屬捐贈動機的認識。此外，還發現家屬於決策過程具多重角色。商議過程中，家庭內部溝通與醫病溝通是兩階段前後各自進行，臨床上卻又存在主要照顧者代理醫病溝通的現象，服務邊界模糊的特色可作為臨床上醫療服務流程修正的參考依據。

Decision-making shared between a physician and patient emphasizes patient participation in decision-making and discussion. This alters the traditional physician-patient relationship in which physicians dominate decision-making. However, few previous studies on medical services examine stakeholders (e.g., family members) in the relationship other than the physician and patient. In addition, the primary content of physician-patient interactions is the expectation that the patient should cooperate with basic healthcare requirements. However, there are few discussions on how to participate in medical decision-making. In this study, we analyzed living liver transplant donors in Taiwan using the existing physician-patient shared decision-making model as a basis. To this, we also included family members to further explore the process of family participation in shared decision-making and interpret the significance of this empirical phenomenon. The study found that the decision-making of living liver transplant donors in Taiwan is a process shared with the family as a unit. Family members play many roles in the decision-making process. Within-family communication and physician-patient communication were carried out separately, and medical service coordinators did not participate in decision-making within the family. However, in practice, the caregiver is allowed to act as a proxy for physician-patient communication. This phenomenon demonstrates the blurred boundaries in medical services in Taiwan.

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