癌症早期與晚期病人對中醫藥使用意向與經驗之初探：以乳癌為例

Exploring the intention of utilization and experience toward traditional Chinese medicine among cancer patients in early and late stages：An example of breast cancer

陳凱威(Kai-Wei Chen)

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(2021年)

https://doi.org/10.6342/NTU202102037

摘要

背景與目的：癌症位居國人死因之首迄今已三十餘年，臺灣的癌症病人在診斷後除常規醫療之外，也經常併用中醫藥。而早期與晚期癌症病人的中醫藥使用意向與經驗之差異，可能影響照護需求及其臨床照護結果，卻未曾探討。本研究以乳癌為例，探討癌症早期和晚期病人在中醫藥的使用意向與經驗之差異，及其對中醫藥的照護需求影響因素，此外也探討中醫師對於此議題的觀點。
研究方法：採用質性研究設計，以半結構式訪談大綱進行訪談。透過方便取樣招募乳癌病人進行焦點團體訪談，另採立意取樣輔以滾雪球方式進行中醫師個人深度訪談收集資料。資料之分析使用內容分析法，透過NVivo 12輔助質性資料之分析，計算出特定編碼出現的頻率，並加以歸納呈現結果。
研究結果：乳癌病人焦點團體訪談進行5場，共有12位早期、7位晚期乳癌病人受訪者，中醫師個人深度訪談共有7位受訪者。早期與晚期之乳癌病人在癌症診斷後多會出現負面的心理衝擊，中醫藥使用之主要意向是受到副作用所困擾並希望調整體質，中醫藥之資訊來源是透過親友的推薦為主，在中醫藥使用的經驗中，面對西醫方面乳癌病人未必會向西醫告知中醫藥使用情形，而在中醫藥的照護之下，得到副作用改善、體能增強與心靈安定是主要的改變，對於現階段的中醫藥照護大致滿意，但仍對候診時間、用藥安全與便利性的改善有所期望；在早期乳癌病人則另有預防癌症復發或轉移的中醫藥使用意向，中醫藥使用的經驗中，會較正向與西醫討論中醫藥的使用，感受到較多中醫藥對腫瘤的控制與預防之效且提升生活品質等，並期待中醫藥能發展科學化與諮詢服務；而晚期病人之中醫藥使用意向以受副作用困擾之提及最為頻繁，中醫藥使用經驗中，中醫藥使用較不易被西醫接納，雖能感受中醫藥照護對副作用之改善，但未必能全然滿足照護需求，且對於癌症日間延長照護與健保涵蓋範圍有更多期望。影響早期與晚期乳癌病人促使、維持與阻礙其中醫藥照護需求之因素中，早期病人有更多面向的因素會影響中醫藥之使用。中醫師則認為乳癌病人在中醫藥的照護中，西醫治療的情形、病人的病情、就醫意向與目標等因素會受到期別的影響而有所不同，乳癌病人個別的體質、求醫心態與整體療效之於期別的影響則未有一致觀點，對於改進用藥的模式、中醫藥科學與實證化、健保與健康政策的發展是中醫師對癌症中醫藥照護的建議與期盼。
結論與建議：早期和晚期的乳癌病人在中醫藥使用意向與經驗，以及對中醫藥照護需求之影響因素不盡然相同，中醫師亦認為不同期別的癌症病人可能影響其中醫藥之照護。後續研究可以收集更多元的樣本來源，並更細部比較各期別之間的差異；建議健康政策制定者應建立完備的照護資源與方案，尤其強化早期病人對於腫瘤復發或轉移之中醫藥照護需求，以及更積極介入晚期病人對於西醫治療後的副作用症狀且以延長存活與提升生活品質為目標，並參考本研究結果與臨床實證做為依據，整合中西醫之癌症照護，給予早期或晚期之癌症病人適切的照護資源導引，以避免潛在風險而提升癌症之治療結果與照護品質。

關鍵字

癌症 ； 中醫藥 ； 期別 ； 使用意向與經驗 ； 乳癌

並列摘要

Introduction: Cancer is a leading cause of death in Taiwan for the last 30 years. After hearing their diagnosis, cancer patients oftentimes pursue conventional medicine and Traditional Chinese Medicine (TCM) at the same time, though research towards utilization of TCM among cancer patients in early and late stages has not been determined. This research aimed to explore the differences in the intention of utilization, experience, and the influencing factors of need towards TCM among breast cancer patients in early and late stages.
Method: A qualitative research study design was adopted. Focus group interviews were conducted with breast cancer patients via convenience sampling, whereas in-depth interviews were set with TCM physicians using purposive and snowball sampling. NVivo 12 software was used for content analysis to calculate the frequency of specific codes aimed to report the results.
Result: Among 5 focus group interviews, there were 12 and 7 early- and late-stage breast cancer patients, respectively. In-depth interviews were conducted with 7 TCM physicians. At all stages, most patients felt negative psychological responses after hearing their cancer diagnosis. Suffering from side effect symptoms and hoping to regulate the body constitution were the major intentions of the utilization of TCM. Improving the symptoms and the body constitution, as well as stabilizing the patients’ emotions, were the main benefits toward both stages of breast cancer patients. Early-stage breast cancer patients intended to use TCM to prevent recurrence or metastasis of the tumor. After utilizing TCM, early-stage breast cancer patients experienced controlling and inhibiting of their tumor when compared with late-stage patients. Late-stage breast cancer patients responded more frequently about suffering from side effect symptoms of their Western medicine treatment than early-stage patients, which was their main intention of TCM utilization. TCM utilization would improve their tumor’s side effects and symptoms; however, these symptoms might not be completely relieved. The majority of TCM physicians agreed that Western medicine, the conditions of the patients, the intention of seeking TCM, and the treatment plan would influence the utilization of TCM among different stages of breast cancer patients.
Conclusion: The intention of utilization, experience, and influencing factors of care of need toward TCM varied in early- and late-stage breast cancer patients. Health policymakers should take the results of this research and the evidence-based illustrations into consideration to develop plans about the resources of integrated medicine for various stages of cancer patients to improve the clinical outcomes and quality of care for cancer patients.

並列關鍵字

cancer ； traditional Chinese medicine ； stages ； intention of utilization and experience ； breast cancer

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