探討乳癌存活者的就醫經驗與後續追蹤間的相關性

Exploring the Relationship Between Patient Experiences of Breast Cancer Survivors and Follow-up Care

黃子馨(Tzu-Hsin Huang)

指導教授 ： 鍾國彪

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2015年)

https://doi.org/10.6342/NTU.2015.01944

摘要

目的：乳癌五年存活率提升，使得乳癌存活者增加，對癌症追蹤的需求也增加；過去少有研究收集由病人報告的乳癌存活者就醫經驗、癌症追蹤情形。由乳癌存活者觀點出發，藉由調查臺灣乳癌存活者就醫經驗與癌症追蹤情形，以NCCN乳癌追蹤指引符合情形，及以病人觀點探討乳癌存活者，對癌症追蹤照護品質的感受及看法。
方法：本研究問卷整合英國國民保健制度(NHS)的Cancer Patient Experience Survey 2014，以及自美國國家癌症研究院(NCI)的Follow-up Care Use Among Survivors (FOCUS) Survey: SECTION B. Follow-Up Care After Cancer選取13題。收案期間自2015年3月14日至6月30日，與乳癌病友協會以及全台12家醫院合作，以郵寄問卷的方式回收405份癌症病人就醫經驗和癌症追蹤情形。
結果：癌症病人就醫經驗問卷中的「以病人為中心的照護」、「共同決策與治療計畫」兩構面之就醫經驗越正向，與符合NCCN乳癌追蹤指引建議頻率有負向關係；癌症病人就醫經驗問卷中的「以病人為中心的照護」、「及時轉診與治療」、「醫病溝通」、「病程資訊提供」、「心理支持」、「共同決策與治療計畫」、「連續性照護」、「社會福利資訊」以上7個構面之正向經驗，與病人主觀認為的癌症追蹤品質癌症追蹤品質有正向關係。
結論：乳癌存活者多數都有進行癌症追蹤，因此合適的癌症追蹤，對於促進乳癌存活者的健康照護品質相當重要，理想的狀況是能夠由乳癌專科護理師，利用乳癌追蹤指引為每一位乳癌存活者，制定最適化的癌症追蹤，其中包括癌症追蹤頻率。71.27％乳癌存活者主觀認為過去2年的癌症追蹤品質為好，顯示台灣的癌症追蹤照護品質普遍良好。癌症病人就醫經驗問卷中的7個構面，為影響癌症追蹤品質的重要因素；以病人為中心的照護，將有助於提升乳癌存活者的癌症追蹤照護品質。

關鍵字

乳癌 ； 乳癌存活者 ； 就醫經驗 ； 癌症追蹤

並列摘要

Objective: The five-year survival rate for female breast cancer patients in Taiwan has increased to more than 86% in recent years. Appropriate follow-up care is important for improving the future health of breast cancer survivors (BCSs). This research focuses on findings related to the cancer patients experience survey, the general compliance of breast cancer follow-ups with the NCCN Breast Cancer Guidelines for follow-up care, and BCSs’ perspectives on the quality of their own follow-up care.
Methods: This research used the questionnaire from the Cancer Patient Experience Survey (CPES) 2014, a national postal survey of patients with cancer treated in England and section B of the Follow-up Care Use among Survivors (FOCUS) Survey. The survey questionnaire included evaluative questions that covered patient experience along the care pathway of patients with cancer, encompassing experience of presentation, diagnostic testing, treatment decisions, doctor and nurse communication, informational integration between hospital and community services after discharge, experience of chemotherapy and radiotherapy treatment, and outpatient follow-up care. Also, this research was a result of cooperation with both the Taiwan Breast Cancer Association and 12 hospitals in Taiwan. Data was gathered from March 14th to June 30th, 2015, and 405 responses were received by mail.
Results: The CPES included two dimension: patient-centered care and shared decision-making and care planning. The more positive these two dimensions were in terms of seeking medical treatments, the lower the likelihood that the treatment met the NCCN breast cancer follow-up frequency guidelines. The seven dimensions of patient-centered care, timely diagnosis and treatment, communication, information and support, emotional support, shared decision-making and care planning, continuity of care and financial and work support also had a positive correlation with the objective quality of the BCSs’ follow-up care.
Conclusion: Because most BCSs have cancer follow-up care, providing appropriate follow-up care tailored specifically for each patient and ensuring the frequency of follow-up care are important for improving health outcomes in BCSs. Overall, 71.27% of breast cancer survivors said that their follow-up care was excellent or very good over the past two years, which demonstrates that Taiwan's cancer follow-up care quality is generally good. The CPES 7 dimensions all are important qualities which affect the standard of follow-up care; thus, a more patient-centered approach will be helpful in improving the overall quality of BCS’s follow-up care.

並列關鍵字

Breast cancer ； breast cancer survivors ； frequency of breast cancer surveillance ； follow-up care

參考文獻

彭台光, 高月慈, & 林鉦棽. (2006). 管理研究中的共同方法變異: 問題本質, 影響, 測試和補救. 管理學報, 23(1), 77-98.

林耀盛, & 胡至家. (2011). 乳癌術後婦女身體意象衡鑑量表之研發. [Constructing the Body Image Scale of the Postmastectomy Breast Cancer Women]. 臨床心理學刊, 5(2), 37-46.

Abel, G. A., Saunders, C. L., & Lyratzopoulos, G. (2013). Cancer patient experience, hospital performance and case mix: evidence from England. Future Oncology(0), 1-10.

Absolom, K., Eiser, C., Michel, G., Walters, S. J., Hancock, B. W., Coleman, R. E., . . . Greenfield, D. M. (2009). Follow-up care for cancer survivors: views of the younger adult. Br J Cancer, 101(4), 561-567.

Aebi, S., Davidson, T., Gruber, G., Cardoso, F., & Group, E. G. W. (2011). Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology, 22(suppl 6), vi12-vi24.