運用共享決策於戒菸服務成效之研究

Abstract

背景：戒菸是減少菸害最主要的策略，鑒於戒菸強調個人決策及自我效能的重要性，故運用共享決策了解吸菸者偏好，使其可以有自主的決策權利。目的：探討介入共享決策與現有的戒菸服務後，戒菸自我效能的變化、戒菸成功率及實驗組對於共享決策戒菸服務的感受。方法：採準實驗性研究設計及方便取樣，2020年8月至2021年4月於北部某醫療網二個院區胸腔科門診及住院吸菸病人進行收案，隨機分配個案至實驗組（n = 48）或對照組（n = 44）。兩組個案於同意後填寫研究問卷，之後實驗組接受決策指導員說明及使用決策輔助工具做戒菸決策後，再給予戒菸衛教；對照組則接受常規戒菸衛教。兩組在介入後第三個月與第六個月各填寫一次戒菸自我效能量表，同時研究者以電話追蹤所有個案戒菸狀態。。結果：無論介入何種方式，戒菸自我效能及戒菸成功率均提升。兩組個案的戒菸自我效能隨著時間增加，自我效能的提高呈顯著差異；且自我效能分數每增加1分，戒菸成功率在3個月與6個月是不成功的1.89倍和2.11倍。而戒菸成功率皆提高，3個月為45.7%、6個月為41.4%。結論：現行國家推動的常規戒菸服務成效顯著，而共享決策則是提供給目前吸菸者另一個選擇，尤其適用於不知選擇何種戒菸服務的吸菸者，可以讓其了解各種戒菸服務後，依自己的偏好做戒菸決策，以提高戒菸成功率。

Background: Smoking cessation is the primary strategy for reducing smoking-related health problems. Because independent decision making and self-efficacy are key to the quitting process, we used a shared decision making strategy to understand the preferences of smokers and reinforce their right to independent decision making.Objective: To compare the effectiveness of the current intervention and the shared decision making strategy in promoting smoking-cessation self-efficacy and success in adult smokers.Methods: We used a quasi-experimental design and convenience sampling. We recruited smokers from August 2020 to April 2021 from the inpatient and outpatient units of the thoracic departments of two hospitals that form part of a northern Taiwan medical facility. The patients were randomly assigned to the experimental group (n = 48) or the control group (n = 44). They filled out a research questionnaire upon providing their consent. The experimental group received instructions from coachs on how to use decision aids to help quit smoking, and later they received health education on smoking cessation. The control group received the conventional smoking-cessation health education. The participants filled out a smoking-cessation self-efficacy scale three and six months after the initiation of the intervention. At the same timepoints, the researchers followed up on the participants’ smoking status by telephone.Results: Smoking-cessation self-efficacy and success increased regardless of the intervention. The improvement in self-efficacy over time differed significantly between the two groups, however. For each one-point increase in self-efficacy, the success rate of smoking cessation at three and six months was 1.89 and 2.11 times, respectively, higher than the rate of failure. In addition, the smoking-cessation success rate was 45.7% at three months and 41.4% at six months.Conclusion: The current conventional smoking cessation intervention yielded excellent results. The shared decision making method provided an additional option for current smokers, especially those who did not know which smoking cessation intervention to choose. The options allowed the smokers to understand all the interventions and choose one according to their preference, and this may improve the smoking cessation success rate.