探討電腦衛教影片介入大腸鏡檢查對鏡檢品質及瘜肉偵測率之研究-以南部某區域醫院為例

Research on the Effect of Computer Health Education Video’s Intervention into Colonoscopy Examination and Polyposis Detection Rate—Case Study of a Hospital of the South

陳宜宣(Yi-Shiuan Chen)

指導教授 ： 許弘毅

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士在職專班/碩士(2018年)

摘要

研究目的
大腸鏡檢查是篩檢大腸癌的首要利器，然而如何提高大腸鏡檢查前的腸道清潔品質是進行大腸鏡檢查的完成必要任務。本研究旨在探討醫院病患於接受大腸鏡檢查，因行動裝置平版電腦視頻衛教介入後所影響的認知程度差異、大腸鏡檢查知覺感受及照護滿意度及大腸鏡報告檢查品質相關之影響。
研究方法
本研究採前瞻性類實驗性研究設計(Quasi- experimental design)，資料蒐集地點為南部區域教學醫院，由醫護同仁討論並製作「平版電腦視覺衛教影片」作為介入性措施，收案對象為經本院門診預約進行大腸鏡檢查之病患，年滿20歲以上，意識清楚及無心理障礙及精神病患診斷，本研究以亂數表隨機單盲分派成兩組分別進行比較，收案時間為2017年7月1日至2017年12月31日止，總共發放問卷人數為280人，但排除大腸鏡報告及問卷填寫資料不完整個案後，實驗組106人、控制組133人。比較二種衛教方式對在臨床面大腸鏡報告之腸道清潔度、檢查時間、有無瘜肉、有無腺瘤型瘜肉，及病患面在檢查認知程度及大腸鏡檢查知覺感受及照護滿意度之影響，進而探討影響大腸鏡檢查品質相關因子。
研究結果
大腸鏡檢查在實驗組上衛教認知程度呈現顯著差異，表示有接受實驗組認知程度較控制組為高(p=0.002)，但在人口學及臨床特性因子無顯著差異。
大腸鏡檢查知覺感受2組衛教認知程度無顯著差異，人口學及臨床特性因子具有顯著差異，女性知覺感受疼痛度較男性高(p=0.009)、教育程度高中程度相較初中以下程度較不痛(p=0.007)、檢查前飲食方式以食用代餐者較自行準備為痛(p=0.014)、全部檢查時間越長者疼痛度越為明顯(p<0.001)。
大腸鏡檢查滿意度實驗組衛教認知程度越高不滿意程度越高(p=0.003)，可能原因為病患的教育程度較高或是要求標準越高，但在教育程度並無顯著差異，在臨床特性因子具有顯著差異，過去曾經接受腹部手術則感受滿意(p=0.013)，知覺感受疼痛度越痛者滿意度將會越低(p=0.045)。
腸道清潔度對實驗組病患腸道清潔度較佳OR=0.55, 95%CI=0.30-0.98, p=0.044，性別男性的清潔度較女性佳OR=0.49, 95%CI=0.27-0.88, p=0.017，
年齡56歲~64歲的清潔度比75歲以上者較佳OR=0.28, 95%CI=0.08-0.98, p=0.046。
從盲腸到退出到肛門口時間，年齡小於<=55歲及56歲~64歲與75歲以上者相比越年輕者檢查時間越短(p=0.011, p=0.014)，及在第三次以上檢查者與初次檢查者檢查時間較短(p=0.011)，2位經台灣消化系醫學會認證之消化系內科專科醫師檢查時間具有顯著差異(p<0.001)。
全部檢查時間，男性檢查時間越短(p=0.007)，年齡小於<=55歲及56歲~64歲與75歲較年輕者檢查時間越短(p=0.004, p=0.005)，高中程度檢查者與初中以下程度檢查者時間為長(p=0.024)，2位執行檢查經消化系內科專科醫師檢查時間也有顯著差異(p=0.032)。
腺瘤型瘜肉偵測率，性別男性較女性發現腺瘤較多OR=1.94, 95%CI=1.05-3.58, p=0.033，年齡<=55歲較>75歲者發現腺瘤較少OR=0.27, 95%CI=0.08-0.91, p=0.034、檢查前飲食使用代餐者較發現腺瘤較少OR=0.52, 95%CI=0.27-0.98, p=0.045，檢查醫師呈現顯著差異OR=2.31, 95%CI= 1.25-4.28, p=0.008。
討論
以行動裝置平版電腦來進行介入大腸鏡檢查病患的衛教方式，瞭解與原有衛教方式照護品質的差異，做為醫療院所教育病患的參考模式，讓醫護人員除了照顧病患，能提供病患更好的知識及衛教方法，同時讓病患更能對自身的健康問題更加關心，進而提升對醫療院所產生更高的滿意度與信任度。建議未來研究可朝向多家全國不同層級與屬性的醫院研究樣本作為來源，可收集病患多年追蹤大腸鏡檢查作為統計趨勢分析。

關鍵字

大腸鏡檢查 ； 視頻衛教影片 ； 疼痛度 ； 照護滿意度 ； 檢查品質 ； 腸道清潔度 ； 腺瘤偵測率

並列摘要

Objective
Colonoscopy is the primary tool for screening colorectal cancer. However, how to improve the bowel preparation quality before colonoscopy is a necessary task for the completion of colonoscopy. This research aims to explore the effect of differences in awareness, colonoscopy perception on painfulness, patient satisfaction and colonoscopy report inspection quality on the patients receiving colonoscopy after the intervention of health education video played by mobile tablet.

Methods
The prospective Quasi-experimental design was applied in this study, with the data collected from the teaching hospital in southern part of Taiwan. The medical care colleagues in Endoscopy Center and Management Office were engaging in discussing and producing “Tablet Visual Health Education Video” as an interventional measure. The objects of the case were patients over 20 years of age, making outpatient appointment for colonoscopy, who were clear without previous diagnosis of mental disorder/mental illness. The study divided the patients into two groups in a random and double-blind manner for comparison with random number table. The investigation was conducted from July 1, 2017 to December 31, 2017 with 280 persons receiving and filling in the questionnaires in total. However, after removing colonoscopy reports and incomplete questionnaire data, the actual questionnaires collected were 239, with 106 from the case group and 133 from the control group. The study also compared the effects of these two health education on bowel preparation, inspection time, whether there is polyps, whether there is adenomatous polyposis in the clinical aspect as well as the effect on examination cognition, colonoscopy perception on painfulness and patient satisfaction. Moreover, the research also discussed relevant factors influencing colonoscopy quality through referring to the basic personal information of patients.

Results
The colonoscopy of the case group showed a significant difference in terms of health education cognition, indicating that the cognition of case case group was higher than that of control group (p=0.002), however, there were no significant differences in demographic and clinical characteristics.
There was no significant difference among two groups in respect of colonoscopy perception on painfulness (p=0.415), but there was a significant difference in terms of demographic and clinical characteristics. Female’s perception of pain was higher than that of male (p=0.009), while patients with senior high school education background felt less painful than those with middle school education background (p=0.007). Those patients having meal replacement before examination felt more painful than those having foods self-prepared (p=0.014). The longer the total examination time was, the more painful patients would feel (p<0.001).
The higher the cognition on health education of the case group, the higher the dissatisfaction with the colonoscopy (p=0.003), possibly because the patients were with higher education, therefore requiring higher standards. However, patients who had no significant differences in education but with significant differences in clinical characteristics factors, who are undergoing abdominal surgery felt satisfied (p0.013). The more painful the patients perceived, the less they felt satisfied (p=0.045).
As for bowel preparation, the patients in case group had a better bowel preparation with OR=0.55, 95%CI=0.30-0.98, p=0.044. In terms of gender, male patients had a better bowel preparation with OR=0.49, 95%CI=0.27-0.88, p=0.017. Patients aged from 56 to 64 had a better bowel preparation than those aged over 75 with OR=0.28, 95%CI=0.08-0.98, p=0.046.
As for withdrawal time, patients aged <=55, between 56 and 64 and over 75 was different. The younger they were, the shorter the time was (p=0.011. p=0.014). In terms of the duration spent on examinations, patients that went through examinations for a third time spent a shorter amount of time than that of the first-timers (p=0.011). The time taken by 2 physicians in Gastroenterology Department certified by The Gastroenterological Society of Taiwan showed significant differences (p<0.001).
With respect to total examination time, male patients took less time (p=0.007). Among patients <=55, between 56 and 64 as well as over 75, the younger the patients were, the less time the examination took (p=0.004, p=0.005). Patients with senior high school and middle school education background spent less time in examination (p=0.024) and there were significant differences between 2 physicians in Gastroenterology Department in terms of examination time.
In terms of adenomatous polyposis, the adenoma found in males was more than that found in females with OR=1.94, 95%CI=1.05-3.58, p=0.033. Less adenoma was found in patients aged <=55 than that was found in patients over 75 with OR=0.27, 95%CI=0.08-0.91, p=0.034. Less adenoma was found in patients having meal replacement before examination with OR=0.52, 95%CI=0.27-0.98, p=0.045, and significant differences were found if examined by different physicians with OR=2.31, 95%CI= 1.25-4.28, p=0.008.

Conclusion and Suggestions
The educational mode with mobile tablet intervened into colonoscopy was applied to understand the differences of this mode with the original health education mode as well as to serve as the reference for medical institutes to educate patients. By this, the medical staffs can not only take care of patients but also provide patients with better knowledge and health education methods. In the meantime, patients can be more concern about their health issues, which further improve their satisfaction with and trust in the medical institutes. It is recommended that the future researches should utilize medical research samples from hospitals all over the country at different levels and attributes as a source to collect follow-up of colonoscopy patients for years to analyze statistical trends.

並列關鍵字

Colonoscopy ； health education video ； painfulness ； patient satisfaction ； quality of colonoscopy ； bowel preparation ； adenoma detection rate

參考文獻

英文文獻

1.World Health Organization(2015). World Cancer Report 2014.

2.Abuksis, G., Mor, M., Segal, N., Shemesh, I., Morad, I., Plaut, S., . . . Niv, Y. (2001). A patient education program is cost-effective for preventing failure of endoscopic procedures in a gastroenterology department. The American journal of gastroenterology, 96(6), 1786.

3.Achrol, R. S., & Kotler, P. (1999). Marketing in the network economy. The Journal of Marketing, 146-163.

4.Ankem, K. (2006). Factors influencing information needs among cancer patients: A meta-analysis. Library & information science research, 28(1), 7-23.