以醫療人員觀點探討癌症存活者照護現況：乳癌為例

背景：癌症位居臺灣十大死因之首，自民國71年起已30餘年；臺灣癌症防治法自2003年起實施，推動辦理癌症防治宣導、癌症篩檢服務、癌症診療品質提升、安寧緩和醫療與癌症病友服務等，期望降低癌症發生率和死亡率、並提升照護品質；然而，目前國內針對康復後的癌症病人卻沒有相應的照護計畫、政策措施或資源分配來滿足這些癌症存活者的需求；而對於癌症存活者身體、心靈及社會心理等照護需求相關的探討也相當有限。目的：乳癌為台灣女性癌症發生率第1位之癌症，若能早期發現、早期治療，不僅可做乳房保留手術，5年存活率更可達90％以上。乳癌存活者增加對於後續追蹤照護、身體副作用、社會心理、照護品質的需求也隨著提升。故本研究以醫療人員觀點探討國內目前乳癌存活者照護現況並提出建議，期待有助於未來照護計畫的擬定及推行。方法：本研究採用質性研究方法，針對乳癌照護團隊之醫療人員進行半結構式訪談研究。共計訪談乳癌照護團隊成員，包含主治醫師、護理師、個案管理師及社工師共27人。後續運用質性分析軟體輔助處理訪談資料整理及歸納。結果：乳癌存活者在照護上可能面臨的問題可歸納出「生理」、「心理與情緒」、「社會與家庭」、「醫療照顧追蹤」四個面向；而醫療端提供照護服務上面臨照護追蹤、人力資源與制度上的問題，受訪者也針對乳癌存活者的照護追蹤現況分別就「醫療端」與「乳癌存活者端」提供改善建議。未來癌症存活者照護計畫的執行，醫療人員多數認同照護計畫能帶來正向幫助，仍需考量到實際臨床工作負荷、資源與經費來源、照護施行模式等問題，以克服執行層面的困難。結論：隨著乳癌存活者人數的增加，可預期存活期愈來愈長，在治療後日常生活、副作用處理、生理及心理影響等問題，更應關注他們對於照護追蹤的需求。未來應導入更全面及個人化的照護服務，推動相關照護計畫的進行與政策措施，以改善存活者心理健康、照護滿意度、生活品質，並建構高品質的存活者照護模式。

關鍵字

乳癌；乳癌存活者照護；癌症存活者；癌症存活者照護計畫；質性研究

並列摘要

Background: Cancer is the first leading cause of death in Taiwan for over 30 years. Enforced in 2003, Cancer Control Act is aimed at promoting cancer prevention measures to reduce the cancer incidence rate and mortality rate, further improving care quality. However, so far, no corresponding resources in Taiwan can meet the needs of cancer survivors after recovery while there is also limited research on the care needs of their physical, mental, and psychological aspects, etc. Objective: Among females, breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death in Taiwan. When found and treated early, the average five-year survival rate can reach over 90% for breast cancer. Besides, for breast cancer survivors, the needs for follow-up care, long-term and late side effects, psychological and quality of care are also increasing. The purpose of this research is to investigate the current situation and issue of breast cancer survivorship care from healthcare providers' viewpoints in Taiwan. Hope to shape the future of cancer survivorship care, and improve the provision of care for cancer survivors. Methods: Qualitative method was adopted for this study. A total of 27 participants in multi-disciplinary breast cancer care teams were enrolled in this study, including oncologists, surgeons, nurses, oncology nurse case managers, and social worker. The data was collected through in-depth semi-structured interviews which were direct by the semi-structured interview guide. The qualitative data analysis software Nvivo was applied to manage and categorize the interview data. Results: The potential problems of cancer survivor care could occur in physical, psychological, psychological/emotional, social/family, and follow-up medical care. As healthcare providers are faced with medical practice, workforce management, and healthcare system issues, the respondents also made some suggestions to improve the current survivorship care for “healthcare providers” and “breast cancer survivors.” Most healthcare providers agree that the implementation of cancer survivorship care plan would be beneficial to survivors. While there are difficulties such as clinical workload, resources, budget, and how the survivorship care will be implemented should not be ignored as well. Conclusion: With the increasing number of breast cancer survivors and expected survival time, their follow up care needs ensue and their daily life, side effects, physical or psychological problems are the current focus of cancer care. Policy-making and related care plan implementation and innovation are needed to improve survivors' mental health, satisfaction with health care, and quality of life. Accordingly, more comprehensive and personalized care services should be established for high-quality cancer survivorship care.

並列關鍵字

Breast Cancer ； Breast Cancer Survivorship Care ； Cancer Survivorship ； Survivorship Care Plan ； Qualitative Research

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