病患選擇施做達文西機械手臂手術相關因素之探討-以科技接受模式觀點

Factors Associated with Patients Select da Vinci System for Surgery–Technology Acceptance Model Perspective

楊衣宸(Yi-Chen Yang)

指導教授 ： 高浩雲

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士班/碩士(2018年)

摘要

研究目的
醫療科技的進步，造就了微創手術的興起，目前更是以達文西機械手臂手術為趨勢，相較以往，諸多與達文西機械手臂手術的相關研究，都傾向於探討術後成效、生活品質，或者比較其他手術的優劣，較少去探討病患為何會願意使用達文西機械手臂手術。本研究主要探討病患使用達文西機械手臂手術的行為意願，以科技接受模式（TAM）為主要架構，並加入信任構面深入探討。

研究方法
本研究為回溯性研究，採用結構式問卷進行調查，以台灣南部醫學中心已使用達文西機器手臂術之單一病症病患為研究樣本，排除個案條件為非單一病症之患者。使用SPSS 22.0與Smart PLS2.0軟體進行統計分析，以描述性統計分析各項背景基本資料；以偏最小平方法（Partial Least Squares,PLS）進行研究模型之契合度分析，並驗證各個假設是否成立。由於本研究樣本數不多，因此使用PLS進行分析，可不受樣本數的限制與變項分配型態影響，具有良好預測與解釋能力。

研究結果
本研究共計收案136位，平均年齡標準差為67.40±11.043；男性114位(83.8%)、女性22位(16.2%)；教育程度以國中程度居多；職業為工商服務業比例較高；月收入多數以3至6萬為主。
研究驗證：信任分別會正向影響知覺有用性(β=0.550，T=4.527，即P<0.001)與知覺易用性(β=0.300，T=4.579，即P<0.001)；知覺易用性會正向影響知覺有用性(β=0.188，T=2.242，即P<0.05)；知覺有用性會正向影響使用態度(β=0.589，T=4.835，即P<0.001)；使用態度會正向影響使用意願(β=0.446，T=2.416，即P<0.05)；知覺易用性與使用態度未達統計上顯著差異；知覺有用性與使用意願未達統計上顯著差異。

結論與建議
在研究結果中，我們發現，病患多處於中高年齡層，且病患本身若覺得達文西機械手臂手術對他的病症幫助極大，其選擇意向的強度就會很高，相形之下，容易取得或已清楚知道達文西機械手臂手術的相關訊息，其並不會直接影響選擇意向。
從年齡的層面上也能推斷，多數採用達文西機器手臂手術是基於安全與風險考量，再者是達文西機器手臂手術對於患者本身的助益，但此手術也是眾多微創手術中需自費較高金額的手術，因此對於某些族群是為一種限制，建議政府能開放健保給付項目，讓更多有需要的患者能予以使用。

關鍵字

科技接受模式 ； 達文西機械手臂手術 ； 信任

並列摘要

Purposes
The emergent of medical science and technology has risen the minimally invasive surgery. Da Vinci Surgery is the trend at present. Compared with the past surgical methods, many studies related to Da Vinci Surgery tend to explore postoperative outcomes and quality of life or compare the advantages and disadvantages than the other surgery. The fewer studies to understand the patients' willings who use Da Vinci Surgery. This study mainly explores the patients' willingness to use Da Vinci Surgery, adopts the Technology Acceptance Model (TAM) as the theoretical foundation, and appended the trust concept to discuss.

Methods
This study was a retrospective study, which used a structured questionnaire to survey. The sample included the patients with single-disease who had used Da Vinci Surgery in a Medical Center of Southern Taiwan but excluded the patients with multiple disorder. This study conducted SPSS 22.0 and Smart PLS 2.0 software for statistical analysis, which included descriptive statistical analysis and applied Partial Least Squares (PLS) analysis for small sample size to test the fit of the research model and to test the established hypotheses.

Results
A total of 136 cases were collected in this study, The results have shown the average age is 67.40±11.043 that include 114 males (83.8%) and 22 females (16.2%). The educational level was mostly at the middle school level. Moreover, occupation was higher in the business service. Most of the income is mainly from 30,000 to 60,000.
Study Validation was tested. Trust positively affects Perceived Usefulness (β=0.550，T=4.527，P<0.001) and Perceived Ease of Use (β=0.300，T=4.579，P<0.001). Perceived Ease of Use positively affects Perceived Usefulness (β=0.188，T=2.242，P<0.05).Perceived Usefulness positively affects Attitude Toward Using(β=0.589，T=4.835，P<0.001). Attitude Toward Using positively affects Behavioral Intention (β=0.446，T=2.416，P<0.05). The relationship between perceived Ease of Use and Attitude toward Using was insignificant. Additionally, the relationship between Perceived Usefulness and Behavioral Intention was insignificant.

Discussions
In the research results, we found that patients are mostly in the middle and high age groups, and if the patient himself feels that Da Vinci Surgery is extremely helpful to his illness, the intensity of his choice of intention will be high. In comparison, the information related to Da Vinci Surgery has been clearly known, it does not directly affect the selection intention. According to age, most of the choices of Da Vinci Surgery is based on safety and risk considerations, and that Da Vinci Surgery is beneficial to the patient himself, but this surgery is also more costly in many minimally invasive surgeries. We recommended that the government can consider reimbursing this procedure (e.g. Da Vinci Surgery) the health insurance programs for more patients' needs.

並列關鍵字

Technology Acceptance Model ； Da Vinci Surgical System ； Trust

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