推動個案管理「癌友導航計畫」提升診斷後治療比率－成大醫院執行現況

The Promotion of Cancer Patient Navigator Program in Case Management to Increase the Seeking Medical Advice after Diagnosis - A Research at National Cheng Kung University Hospital

林貞伶(Chen-Lin Lin) ； 洪彩慈(Tsai-Tzu Hung) ； 劉麗珒(Li-Ching Liu)

《腫瘤護理雜誌》 16卷增訂刊 (2016/10) Pp. 31-41

https://doi.org/10.3966/168395442016101603003

摘要

本文主為介紹本院推廣癌症個案管理模式執行多年以來，如何更精進於初診斷期罹癌病友之介入。本院個案管理模式特色包含：一、於診斷初期與病人建立良好溝通與信任關係，同時提供正確及合適的治療策略；二、以團隊為基礎的個案管理導航模式，提供持續性及完整性的照護管理；三、針對未治療個案持續給予關懷，並提供個案回診追蹤及其他治療選項。文獻指出提升初診斷期的治療率可有效提升癌症治癒率，因此如何善用多專業團隊力量，確實掌握新診斷及初次病情重大變化的癌症病人，建立良好與信任的互信關係與溝通模式，並維持治療性關係讓癌症病人接受治療，在過程中提供相關訊息，協助聯繫相關團隊人員適時給予正向鼓勵，乃個案管理模式未來持續要努力的方向，因此本院初診斷癌症3個月內未治療率由3.96%降低至0.25%，故藉此描述個案管理模式之獨特功能，期能提供國內其他醫療機構此一照護模式之參考。

關鍵字

個案管理 ； 導航 ； 診斷後3個月內治療率

並列摘要

This paper discusses how NCKU hospital improves the medical interventions for patients with newly diagnosed cancer through years of implementing the case management model. The features of current case management model are: 1. early establishment of good communication with and trust from cancer patients in the initial diagnosis period, 2. sure delivery of persistent and comprehensive health care management via the teamwork of case navigator program, and 3. other treatment options, continuous supports, and follow-up for patients refusing the treatment,. According to the literature, timely cancer treatment in earlier diagnosis period is positively correlated to improved recovery rate. Utilizing the teamwork to manage both the new diagnosis period and initial dramatic changes of disease in cancer patients and to build the communication model and mutual trust while maintaining the clinical relations with patients through continuous supply of information and encouragement has always been the direction the case management strives for. As a result, the rate of medical treatment refusal for patients with 3-month newly diagnosed cancer has been lowered from 3.96% to 0.25%. We share the unique features of case management model with hopes that it could be used as reference by other medical organizations.

並列關鍵字

case management ； navigator ； medical treatment rate for patient within 3-month newly diagnosed cancer

參考文獻

張碧容、李鳳屏、蕭華岑、謝秀芳（2015）．治療或不治∼就是問題所在：老年癌症病人照護的倫理議題．腫瘤護理雜誌，15（2），1-18。[Chang, P. R., Lee, F. P. S., Hsiao, H. T., Hsieh, H. F. (2015). To treat or not to treat, that is the question ~ ethical issues related care for elderly cancer patients. The Journal of Oncology Nursing, 15(2), 1-18.]doi: 10.3966/168395442015121502001.

陳淑娟、朱栩萱、陳玨伶、張桂玲、洪敏瑛（2014）．無縫接軌的腫瘤個案管理模式－臺大醫院經驗．源遠護理，8（2），12-18。[Chen, S. C., Ju, S. S., Chen, C. L., Chang, G. L., & Hong, M. Y. L. (2014). The seamless oncology nursing case management model in National Taiwan University Hospital. Yuan-Yuan Nursing, 8(2), 12-18.] doi: 10.6530/yyn.2014.8(2).03.

陳晶晶、吳易霖、陳玉葉、洪彩慈、林貞伶、黃美智（2009）．護理角色的創新與拓展－成大醫院腫瘤個案管理模式介紹．護理雜誌，56（2），11-16。[Chen, C. C., Wu, Y. L., Chen, Y. T., Hung, T. T., Lin, C. L., & Huang, M. C. (2009). Expansion and creativity in nursing: The oncology case management model used at the NCKU hospital. The Journal of Nursing, 56(2), 11-16.] doi: 10.6224/jn.56.2.11.

蔡宜蓁、吳金璇、康琇菱、翁憶萍、羅雅馨、陳淑真、呂佩珍（2014）．腫瘤個案管理師之進階照護角色與功能．長庚護理，25（2)，149-157。[Tsai, Y. T., Wu, C. H., Kang, H. L., Weng, Y. P., Lo, Y. X., Chen, S. C., & Lu, P. C. (2014). Roles and functions of tumor case managers in advanced nursing care. Chang Gung Nursing, 25(2), 149-157.] doi: 10.3966/102673012014062502003.

Bayliss, D., Duff, J., Stricker, P., & Walker, K. (2016). Decision-making in prostate cancer: active surveillance over other treatment options. Urologic Nursing, 36(3), 141-149. doi: 10.7257/1053-816X.2016.36.3.141.