個案管理過程中運用PRECEDE模式探討癌症病人中斷治療影響因素

The Factors Association with Interruption of Treatment in Case Management by Using the PRECEDE Model

周淑嵐(Shu-Lan Chou) ； 林梅香(Mei-Hsiang Lin) ； 林玉芬(Yu-Fen Lin) ； 姜亭妤(Ting-Yu Chiang) ； 王靜婷(Ching-Ting Wang) ； 王昭慧(Chao-Hui Wang)

《腫瘤護理雜誌》 15卷1期 (2015/06) Pp. 39-46

https://doi.org/10.3966/168395442015061501005

摘要

隨著癌症治療的進步，癌症病人的存活率大為提升；癌症病患從診斷、治療、甚至追蹤的各個時期，都必須面臨種種的不安與壓力，治療過程中的不適往往會降低病患完成治療的意願造成治療中斷，中斷治療的結果會影響治療的預後，造成疾病復發和轉移機率增加，且耗費社會醫療成本。本文就個案管理過程中，應用PRECEDE模式為架構，探討癌症病人中斷治療因素，分析前傾因素（對疾病的認知、對治療的態度、對疾病預後的了解程度和對治療的信心不足等）、增強因素方面（病患的社會支持系統、醫病關係、家人對治療的態度等）及使能因素方面（病患就診的便利性、治療的可行性，接受治療時的身體狀況、及疾病進展等）。個案管理師藉由主動追蹤，適時了解病患需求及整合資源，試圖解決或改善無法完成治療的原因，可避免因中斷治療造成癌症復發或轉移，幫助增加病人治癒的機會。

關鍵字

個案管理 ； PRECEDE模式 ； 中斷治療

並列摘要

Cancer patients have to deal with different forms of restlessness and stress during diagnosis, treatment, and follow up. Treatment related discomfort sometimes reduces the willingness to complete treatment resulting in treatment interruption, which then in turn affects the prognosis of treatment leading to increased risk of recurrence and metastasis, not to mention the additional costs to the society. Herein, the PRECEDE model was used by the case management as a framework to explore the factors that caused cancer patients to discontinue treatment during. Predisposing factors (awareness of the disorder, attitude towards treatment, level of understanding of the disease prognosis, and confidence in treatment), reinforcing factors (patients’ social support system, the Physician-Patient Relationship, family’s attitudes towards treatment), and enabling factors (availability of treatment facilities, feasibility of the treatment, physical condition when receiving treatment, and disease progression) were also analyzed. Through active tracking, timely understanding of patient needs, and integration of resources, the case managers could try to clear or ameliorate the conditions that may cause the patient to discontinue treatment. This could lower the risks of cancer recurrence and metastasis caused by treatment interruption and thus increases the patients' chances of cure.

並列關鍵字

case management ； PRECEDE Model ； interruption of treatment

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