癌症患者的中醫就醫行為

Traditional Chinese Medicine Seeking Behavior in Cancer Patients

林恭儀(Justin, Kung-Yi Lin)

指導教授 ： 季瑋珠

國立臺灣大學/公共衛生學院/預防醫學研究所/碩士(2008年)

https://doi.org/10.6342/NTU.2008.02393

摘要

背景與目的 癌症於近二十幾年來一直成為臺灣十大死因之榜首，傳統中醫於臺灣已經行之有年再加上國際間對CAM的重視，本土癌症患者的中醫就醫經驗一直是缺乏的，本研究目的在於以深度訪談的質性研究方法，來描繪臺灣癌症患者的中醫就醫行為，期望本研究之結果，能找出癌症患者的中醫就醫歷程，並就動機、決策、身體、心理、社會、靈性等方面的內容做深度的論述。

研究方法 本研究採用滾雪球抽樣，共選取10位臺北市立聯合醫院中醫與仁愛院區的癌症患者，進行半結構式大綱的深度訪談質性研究，透過與受訪者自然互動，將訪談結果全程錄音並以逐字稿呈現，再經由編輯及浸淫結晶的內容分析，來描繪出癌症患者的中醫就醫經驗。

結果 在癌症患者的中醫就醫行的議題上共呈現出五個層面：癌症的衝擊、癌症造成的不確定感、癌症患者的中醫就醫動機與固有觀念、影響癌症患者中醫就診決定的因素以及中醫就診經驗的轉變。癌症的衝擊包括得知診斷後的身心衝擊、治療不良反應的衝擊、家庭衝擊和工作上的衝擊；不確定感則從社會家庭人際關係、診斷與預後、治療療效、中醫西醫醫病關係、致病原因和醫療資訊取得上充分表現出來；中醫就醫動機歸納成調整體質、中西醫輔助、降低副作用、改善後遺症、提升免疫系統、治療癌症等六個面向；中醫固有觀念則有中醫調理體質、溫和適合長期服用、作用緩慢、冷熱和中醫有人味等五個特質；影響癌症患者中醫就診決定因素包括社會人際、醫療療效、資訊的取得、經濟考量、地理環境、後遺症六面項；關於中醫就診經驗的轉變是呈現出前後之間的改變的原因。

結論 癌症患者的中醫就醫行為實在是豐富的反映出了從衝擊、不確定感，到動機、固有觀念，進而決定是否中醫就醫與轉變的一連串過程。

關鍵字

中醫 ； 癌症 ； 質性研究 ； 就醫行為

並列摘要

Objective As the high incident rate of cancer and prevalence of traditional Chinese medicine (TCM) utilization in Taiwan, this study aimed to develop a conceptual framework of the TCM seeking behavior of Taiwanese adolescents with cancer.

Methods Ten adolescents (four males and six females) with cancer at all stages of the illness were interviewed by snowball sampling. Data were collected through in-depth interview by semi-structure guideline and observations, medical chart reviews, and researcher’s reflexive journals. As the data were received and transcribed, editing and immersion/ crystallization were used to represent constructs of the adolescents with cancer.

Results These multifaceted, naturalistic contextures were elicited by TCM out-patient department visiting in clinical status. Five distinct subcategories of the TCM seeking behavior reported by interviewees were emerged. The cancer impact included the mind-body impact after diagnosis, the adverse effect impact of treatment, family impact and work impact; the cancer uncertainty were fully showed out by the social-family-interpersonal relationship, the diagnosis and prognosis, the remedy self-efficacy, the patient– physician relationship between Chinese and western medicine, etiology and the gain of medical information; the TCM seeking motivation were extracted by constitution modulation, complementary of Chinese-Western medicine, side effect reduction, sequela improvement, immune system enhancement, and cancer treatment; the Chinese medicine inherent concepts merged by the TCM recuperate the constitution, temperately taking for long term, slow efficacy for a long time, cold -warm and TCM humanity; the TCM decision-making factors influenced by social relationship, medical effect, information obtains, economical consideration, geographical environment, and sequela; the experience transformation to utilize TCM were also presented.

Conclusions The Chinese medicine behavior seeking in cancer patients are demonstrated vividly by a succession of process of impact, uncertainty, motivation, the inherent concept, decision making of traditional Chinese medicine and transformation on physical and psychological, cognitive, social and future orientation aspects.

並列關鍵字

traditional Chinese medicine ； cancer ； qualitative research ； medical seeking behavior

參考文獻

丁志音（2003）。誰使用了非西醫的補充與另類療法？社會人口特質的無區隔性與健康需求的作用。台灣衛誌，22(3)，155-166。

蔣欣欣＆盧孳豔，（1996），健康與疾病的文化觀及現象分析，護理雜誌，43，42-48。

賴文恩，季瑋珠，丁志音 (2005)。以微軟EXCEL套裝軟體處理質性研究田野資料。臺灣衛誌，19(5)，696-702。

簡靜慧(2007)。侷限性前列腺癌病患參與治療決策過程相關經驗探討。護理雜誌，54，1,35-42。

Chuang, C.H., & Lai, J.N., & Wang, J.D., & Chang, P.J., & Chen, P.C. (2005). Prevalence and Related Factors of Chinese Herbal Medicine Use in Pregnant Women of Taipei. Taiwan Journal of Public Health, 24(4), 335-347.