由於疾病類型已從前期的急性醫療逐漸轉變成慢性疾病，因此醫病關係可能已經由短期照護轉變成一種長期照護之關係，在醫療環境的改變以及長期醫病資訊不對等的情況下，醫療共享決策在近日被認為是醫療中較理想的治療決策模式之一。本研究計畫以知識態度行為模型為主，探討民眾以及探討醫護人員對於醫病共享決策的接受度與其知識、態度與行為，並探討醫護人員執行該政策上之看法或障礙等。
本研究以南台灣一般民眾與醫療院所之醫療人員作為研究對象，採用紙本及網路問卷方式施測，一般民眾問卷以網路方式發放後共回收500份問卷，且樣本皆為有效問卷；醫護人員問卷以紙本及網路方式發放問卷，共回收422份問卷，共計400份有效問卷，本研究以SPSS 24.0版與R語言3.5.2版之統計軟體進行資料處理與分析，其分析包含描述性統計、皮爾森相關分析、獨立樣本T檢定、單因子變異數分析、卡方檢定與迴歸分析進行資料處理，所得一般民眾結果如下：（一）民眾對於醫病共享決策之知識、態度、行為之間有顯著正相關；（二）對於是否聽過及接受過醫病共享決策正向影響民眾對於醫病共享決策之知識態度行為；以及（三）民眾之教育程度正向影響民眾對於醫病共享決策之知識態度行為。醫護人員結果如下：（一）醫護人員對於醫病共享決策之知識、態度、行為之間有顯著正相關；（二）是否擔任主管職務、就職醫院一年內是否即將或已通過醫院評鑑、是否曾經製作決策輔助工具以及是否曾經使用決策輔助工具正向影響醫護人員對於醫病共享決策之知識態度行為；（三）醫護人員在實行醫病共享決策時最常遭遇之困難依序為：缺乏執行時間、知識不足、製作決策輔助工具困難與缺乏決策輔助工具等因素；以及（四）71%的醫護人員表示願意將醫病共享決策納入臨床實踐，並認為醫病共享決策可以為病患提供最好的健康照護、帶來良好的醫療結果與符合患者和社會的期望。

Disease category has moved gradually from acute to chronic. The relationship between doctors and patients may have been changed from short-term care to long-term. Due to medical encounter changes and information asymmetry, the shared decision-making model has been considered as one of the most suitable ones. This study adopts the model of Knowledge Attitude Behavior (KAB) as its framework to explore how each construct in this model impacts Shared decision making (SDM), and it reveals the factors that affect behavior intention and actual use behavior via the use of moderators.
This study targets the general public and medical staff in south Taiwan as its object and utilizes an online or paper questionnaire to survey the opinions. For general public, a total of 500 questionnaires were completed and received, among all have been recognized as valid. For medical staff, a total of 422 questionnaires were completed and received, among which 400 have been recognized as valid. Furthermore, descriptive statistics, Pearson correlation analysis, independent sample T test, one way ANOVA analysis, Chi-square test and linear regression analysis were leveraged for data processing by SPSS version 24.0 and R Language version 3.5.2. Finally, the results of general public include as follows: 1) The knowledge, attitude and behavior toward SDM are positively correlated. 2) Regarding whether or not general public heard or accepted SDM are positively correlated with their knowledge, attitude and behavior. 3) Education level of general public are positively correlated with their knowledge, attitude and behavior of SDM. The results of health care providers include as follows: 1) the knowledge, attitude and behavior toward SDM are positively correlated. 2) Whether the health care provider is a supervisor or not, whether they will soon or have already passed hospital accreditation within one year of employment in hospital, and whether they have made PDAs, also, whether they have used PDAs to positively influence the knowledge and attitudes of health care providers on SDM. 3) The most often meet barriers reported were lack of time, lack of knowledge, difficulty of developing patient decision aids, and lack of patient decision aids. 4) 71% respondents who were willing to practice SDM opined that SDM can provide the best health care for patients, can maintain and improve individual clinical expertise, and can meet patient and social expectations.

論文審定書 i
摘要 ii
Abstract iii
目錄 v
圖次 vii
表次 viii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究問題 3
第三節 研究目的 4
第四節 研究流程 5
第二章 文獻探討 6
第一節 醫病共享決策之定義與實行步驟、工具 6
第二節 醫病共享決策與醫病關係之關聯性 14
第三節 臺灣與各國實施醫病共享決策之現況 17
第四節 知識態度行為模型 21
第五節 小結 28
第三章 研究方法 30
第一節 研究架構與假設 30
第二節 問卷設計與資料蒐集方法 31
第三節 研究變項與操作型定義 32
第四節 資料處理與統計分析方法 40
第五節 專家效度與問卷前測結果分析 42
第六節 正式問卷信效度分析 44
第四章 研究結果 51
第一節 資料發放與蒐集 51
第二節 描述性統計分析 52
第三節 推論性統計分析 67
第四節 研究架構與假設檢驗 85
第五章 討論與建議 88
第一節 討論 88
第二節 建議 93
第三節 研究限制 94
第四節 研究貢獻 95
第五節 結論 96
參考文獻 97
附錄一 102
附錄二：決策輔助工具研發報告 103
附錄三：民眾問卷 107
附錄四：醫護人員問卷 110
附錄五：人體研究計畫同意函 114

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