大腸直腸癌病患口服化學治療服藥遵從性之初探性研究

The Adherence to Oral Chemotherapy in Colorectal Cancer Patients: A Pilot Study

胡懷文(Huai-Wen Hu) ； 陳美伶(Mei-Ling Chen) ； 廖玟君(Wen-Chun Liao)

《中山醫學雜誌》 19卷2期 (2008/12) Pp. 159-173

https://doi.org/10.30096/CSMJ.200812.0003

摘要

本研究為瞭解大腸癌病患口服化學治療之服藥遵從性之初探性研究，並檢測四項可修正的因子包括化學治療的認知程度、化療副作用的症狀困擾程度、服藥自我效能及醫病關係品質對服藥遵從性的影響，以UFUR作為口服化學治療之34位大腸直腸癌門診病患，自收案日起(T0)每隔四週追蹤訪談一次(T1, T2)，共收集三次資料。測量工具包括服藥日誌與「服藥遵從性」、「化學治療知識」、「副作用之症狀困擾程度」、「服藥自我效能」及「醫病關係品質」等結構式問卷。研究發現T1與T2之回診率分別為85.3%與46.7%，服藥日誌所測得之服藥遵從率為93.1~94%。T0服藥遵從性與化學治療知識、服藥自我效能和醫病信任關係呈顯著正相關，T1服藥遵從性則與化學治療知識呈顯著正相關，T2服藥遵從性與個案得病月數呈顯著負相關。個案疾病狀態與基本屬性均不影響其服藥遵從性或回診次數。在GEE模式分析中，時間對服藥遵從性無顯著影響，但「化學治療知識」得分愈高則服藥遵從性愈好。故在臨床護理應用上，建議每位病患在接受化學治療前，必須給予完整治療計畫說明與持續相關衛教追蹤，以利提升服藥遵從性。

關鍵字

口服化學治療 ； 服藥遵從性 ； 回診率

並列摘要

The purpose of this study was to explore patient adherence to oral chemotherapy regimen and the influence of four modifiable factors-knowledge about oral chemotherapy, symptom distress related to chemotherapy side-effects, self-efficacy on medication, and patient-physician relationships-on adherence to chemotherapy by colorectal cancer patients. We enrolled 34 subjects who were taking oral UFUR as their single chemotherapy agent. Each subject was interviewed at the enrollment (T0), 4 weeks (T1) and 8 weeks after oral chemotherapy was started (T2). Data collected using a medication diary and structured questionnaires, including the ”Self-Reported Medication-Taking Scale,” ”Knowledge of Oral Chemotherapy Scale,” ”Symptom Distress of Chemotherapy Side-effects Scale,” ”Self-Efficacy on Medication Scale,” and ”Patient-Physician Relationship Scale.” Appointment return rate was 85.3% at T1 and 46.7% at T2. Compliance with prescriptions ranged 93~94%. Knowledge about oral chemotherapy, self-efficacy on medication, and patient-physician relationship were positively associated with adherence to medications at T0. Only knowledge about oral chemotherapy at T1 and diagnosis duration at T2 were associated with adherence. Disease status or demographic variables were not associated with adherence to medication regimens or appointment compliance. Time per se had no impact on the adherence to oral chemotherapy in the GEE analysis. However, knowledge about oral chemotherapy significantly predicted patients' adherence. Therefore, nurses should provide enough appropriate information about oral chemotherapy and follow patients up during clinical visits to improve their adherence to oral chemotherapy.

並列關鍵字

oral chemotherapy ； medication adherence ； appointment return rate