台灣地區執行預防保健之口腔黏膜篩檢者其態度與篩檢意向關係之探討

The relationship between attitude and intention toward oral cancer screening among physicians and dentists implementing oral mucosa inspection in Taiwan

陳鈺宜(Yu Yi Chen)

指導教授 ： 季瑋珠

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2012年)

https://doi.org/10.6342/NTU.2012.00074

摘要

摘 要
目標
惡性腫瘤自1982年起，即位居國人十大死因的第一位，於亞洲地區相對的發生率較低，但我國男性之口腔癌發生率卻是為居世界前幾位，值得衛生單位注意。國民健康局於2010年起，為維護國人健康，擴大推動口腔黏膜目視檢查，並透過各種健康傳播管道，呼籲民眾可前往健保特約醫事服務機構篩檢。因此對符合可提供口腔黏膜篩檢者，做初步的意向及態度探討，以瞭解篩檢者所遇到的瓶頸及困難。

方法
質化研究已廣泛被應用於社會及人文科學領域，基本上以分析歸納(analytical-induction)為主要推論模式，強調社會現象中「人」的主體性及情境和詮釋的重要性。然訪談法最能收集到更深入的資料，其目的在於使回答者有較大的自由答覆空間，可使受訪者在毫不受限制的情境下，充分與詳細訴說事件、經驗或表達意見。研究者採立意抽樣的方式，且根據最大變異之抽樣原則，讓類別之間無窮盡互斥，故選擇基層門診、區域醫院(地區醫院)及醫學中心等，各級院所之有意願及無意願執行口腔癌篩檢之醫師進行質性訪談(雙方各收10位醫師)，如此持續資料收集，直到資料飽和才結束訪談工作。

結果
本次研究訪談者共計21人，研究者運用深度訪談的內容分析，歸納呈現出實務面之概況，發現執行口腔黏膜篩檢醫師訓練，不論是牙醫師、耳鼻喉科醫師及接受過口腔黏膜訓練的醫師，其專業能力皆有待加強；亦因如此間接造成執行者因擔心產生醫療風險而不願執行口腔黏膜篩檢，造成醫療人力的缺口；除此之外亦發現於口腔黏膜篩檢政策面推動過程中，未與現行健保體制推行的轉診制度及醫療分級有所整合，導致醫療資源耗損及產生基層與教學醫學之既定任務之間相互矛盾情結。

結論
經研究者訪談不同層級及不同科別之醫生，對於政府大力推行「口腔黏膜篩檢」的精神表示認同及肯定，於實務面上亦發掘許多口腔癌病患，經由早期診斷、早期治療，是有助於提昇病患未來的生活品質。惟對於國家衛生策政單位，如何積極運用政策執行力強制介入；如何規劃現有的醫療資源並有效的做適當配置；如何使民眾需求及醫療利用率提高，這部分議題有較多期待，希望「口腔黏膜篩檢政策」推動能朝這個方向多加思考。除此之外，醫學教育亦應跟隨社會的健康問題有所修正。

關鍵字

口腔癌 ； 口腔黏膜篩檢 ； 轉診制度 ； 醫療分級制度 ； 醫學教育

並列摘要

Abstract
Objectives
Malignant tumor since 1982, first among the ten leading causes of death in Taiwan in the Asian region is relatively low incidence of male oral cancer rate is worth the attention of the health units for the world several. National Health Council in 2010 to safeguard the health of citizens, and expand to promote the visual inspection of the oral mucosa, and through a variety of health communication pipeline, called on the people to the NHI contracted medical care institutions screening. That meet the oral mucosa screening, the initial intention and attitude of, to understand the screening bottlenecks and difficulties encountered.

Method
Qualitative research has been widely used in the field of Social Sciences and Humanities, basically analyzed and summarized (analytical-induction) as the main inference model, emphasizing the importance of subjectivity and context of the "people" in the social phenomena and interpretation of Then interview to collect more in-depth information, with the aim I have a greater free reply space, allows respondents cents unrestricted context, full and detailed telling of events, experience or express their views . Researchers used purposive sampling method, based on the principle of maximum variation sampling, endless mutually exclusive between the categories, so choose primary care, regional hospitals (district hospitals) and the Medical Center institutions at all levels of willingness and willingness to perform oral cancer screening, physicians conducted qualitative interviews (each party received 10 physicians), so that continuous data collection until data saturation before the end of the interview.

Results
A total of 21 study interviewers, researchers use depth interviews, content analysis, summarized presents an overview of the practical perspective, found that the implementation of the oral mucosa screening physician training, both dentists, otolaryngologists, and received oral mucosa training physicians, their professional capacity are to be strengthened; was also so indirectly caused by the performer rather than to produce medical risk because of worry about the implementation of the oral mucosa screening, resulting in the gap of medical manpower; addition is also found in the oral mucosa screening policy side promote the process, the referral system is not implemented with the current health care system and medical grade integration of medical resources depletion and production of complex contradictions between the grassroots and teaching medicine given task.

Conclusions
The researcher interviews at different levels and different divisions of the doctors, the spirit of recognition and affirmation of the Government in carrying out the oral mucosa screening of Practice on the surface to explore the many oral cancer patients through early diagnosis, early treatment is help to improve the patient's future quality of life. Political unit for the national health policy, but how active use of the compulsory intervention of the policy implementation force; how to plan for the existing health care resources and make the appropriate configuration; how to make the public's needs and health care utilization, more looking forward to this part of the issue, I hope oral mucosal screening policies to promote more thinking in this direction. In addition, medical education should follow the community's health problems may be revised.

並列關鍵字

oral cancer ； oral mucosal screening ； referral system ； the medical classification system for medical education

參考文獻

4. 韓良俊。向檳榔及菸害宣戰的牙科硬漢。醫療品質雜誌；2011；11；94-99。

6. 羅英毓;王森德;李芸霏;蘇千田。口腔癌危險因子與癌前病變。家庭醫學與基層醫療:2010；8:310-317。

7. 陳啟明。癌症篩檢、診斷及治療迷思。北市醫師公會會刊；2009：6：5-7。

12. 滕宣德。口腔癌之篩檢、診斷與治療-台灣的現況。臺北市醫師公會會刊:2011；3：32-37。

14. 陳秋琴。屏南原住民社區之飲食習慣與口腔癌前病變相關性之探討。高雄:高雄醫學大學口腔衛生學系碩士在職專班碩士論文；2010；122p。