台北市中医师公会中医药研究论丛

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241.3 失智症患者针灸治疗知情同意情形与影响因子

TJ TCM.24(1) : 25-38, 2021

DOI : 10.6516/TJTCM.202103_24(1).0003

失智症患者针灸治疗知情同意情形与影响因子

Informed Consent and Influence Factors of Acupuncture Treatment for Patients with

Dementia

黄怀蒂1　林舜谷2,3*

1 国立台湾师范大学研究发展处研究伦理中心

2 台北市立联合医院仁爱区中医科

3 国立阳明大学公共卫生研究所

【摘要】

前言：失智症患者最主要的症状就是认知能力降低，无法正确的辨认、理解问题并据以作出合理的思考及回应，因此在临床治疗中常用的知情同意方法，失智患者大多难以理解，遑论有效的同意。近年有越来越多的失智患者开始接受中医治疗，其中又以针灸为大宗。针灸可以以减少失智患者的认知退化与精神行为症状，但治疗过程中会感到疼痛。如何在患者的医疗自主决定与实证医学疗效中取得平衡，是中医治疗过程中需要面对的难题。

方法：本研究为回溯性横断研究（Retrospective Cross-Sectional Study），属於观察性研究（Observational Research）。利用台北市立联合医院仁爱院区，中医失智症特别门诊於2016 年1 月至2017 年12 月间之失智症患者的病历资料与同意书内容，以研究台湾中医失智症患者行使针灸治疗同意权之情形与可能的影响因子。本研究的研究变项包含有性别、年龄、教育程度、婚姻状况、简易认知量表总分、临床失智评分表总分、日常生活活动力量表总分、简短版神经精神量表总分等变项，并以罗吉斯回归分析（Logistic regression）测试变项间是否有显着的影响差距。

结果：本研究共纳入287 位失智症患者，本研究发现失智症患者接受针灸治疗呈现两极化现象，在疾病严重度较低和较严重的患者，接受针灸的比率较高。从简易心智量表总分与临床失智评估量表分数和同意针灸治疗的分析也可以验证此现象；此外，简短版的神经精神量表可以作为是否接受针灸治疗的良好预测指标，神经精神量表分数越高的患者，接受针灸治疗的倾向越低。我们发现随着简易心智量表总分或日常生活活动能力量表总分下降，或是临床失智评估量表分数上升，则家属代为行使同意权的倾向也显着的上升。换句话说，随着认知退化功能越严重，则家属代为行使同意权的比例越高。

结论：不同退化程度失智症病人，对於针灸的接受度和自己执行知情同意的能力有显着的差异，单一制式化的针灸同意书并无法适用於各种类型的失智症，我们建议应该导入逐级升阶的治疗策略，以及医病共享决策方法，协助医疗同仁更清楚的理解病患和家属的需要，作出更合理且为多方接受的医疗决策。

【关键词】医疗自主权、知情同意、中医、失智症、针灸、医病共享决策

Huai-Ti Huang1Shun-Ku Lin2,3*

1Research Ethics Committee, National Taiwan Normal University, Taiwan

2Department of Chinese Medicine, Taipei City Hospital, Ren-Ai Branch . Department of

Health, Taipei City Government, Taiwan

3Institute of Public Health, National Yang-Ming University, Taiwan

【Summary】

Background: The main symptom of dementia patients is the cognitive decline, so patients can not perform informed consent for medical behavior. Acupuncture treatment can reduce cognitive deterioration and mental behavior symptoms in dementia patients, but the procedure is accompanied by pain. How to let patients correctly understand the side effects of acupuncture and implement valid informed consent is a difficult problem for clinicians.

Method: This study is a Retrospective Cross-Sectional Study. We collected medical records and consents from dementia patients from Taipei City United Hospital from January 2016 to December 2017. The purpose of the study was to analyze the informed consent and possible impact factors of acupuncture in patients with dementia. Research variables included gender, age, education, marital status, Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Activities of daily living (ADL), and Neuropsychiatric Inventory Questionnaire (NPI). We tested whether there were significant differences between variables in Logistic regression.

Result: A total of 287 patients with dementia were included in the study. We found that patients with the lowest and highest disease severity had a higher rate of acupuncture. Besides, NPI is a good predictor of acupuncture treatment. Patients with higher NPI scores have a lower tendency to receive acupuncture treatment. We also found that as the total score of MMSE or ADL decreased, the proportion of family members who agreed to treat patients also increased significantly.

Conclusion: Patients with different degrees of dementia have significant differences in the degree of acceptance and informed consent of acupuncture.

Single-form acupuncture consent does not apply to all types of dementia. We suggest that the decision-sharing making method should be introduced. It can help medical colleagues understand the needs of patients and make more reasonable and multi-acceptable medical decisions.

【Keywords】Patient Autonomy Rights; Informed Consent; Traditional Chinese Medicine; Dementia; Acupuncture; Shared Decision Making

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