- 學位論文
探討不同醫師職別於口腔癌篩檢的態度與行為之差異
Understanding the Attitude and Practices of Oral Cancer Screening among Doctor Specialists
摘要
台灣自2004年開始推動口腔癌篩檢，然而至今口腔癌的死亡率依然沒有明顯的下降趨勢，顯示篩檢成效尚未達理想。因此本研究對符合口腔黏膜篩檢資格的醫師進行調查，探討不同職別的醫師對口腔癌篩檢態度及行為現況及其相關影響因素。資料擷取於衛生福利部第三期癌症研究計畫，以橫斷式研究設計，採立意取樣方式來寄發問卷，共有高雄市390名牙科醫師(21.67%)、121名耳鼻喉科醫師(39.93%)，及2015-2017年國民健康署委託高雄市政府衛生局訓練認可之105名其他科醫師(58.01%)回覆問卷，問卷內容包括醫師職別、口腔癌篩檢態度及行為。本研究以二元邏輯斯迴歸(binary logistic regression)來分析影響口腔黏膜篩檢行為的相關因素。結果發現耳鼻喉科醫師對口腔癌篩檢行為執行度最高(61.98%-80.99%)，但是各職別篩檢醫師對口腔黏膜的觸診與詢問菸酒檳榔習慣及轉介戒除服務都執行度偏低。醫師例行性執行口腔癌篩檢的態度得分愈高，愈會願意執行篩檢；其中以「對自己工作的影響」的影響最大 (OR=1.30-2.87)。而耳鼻喉科醫師於「對自己工作的影響」的態度得分顯著高於牙科與其他科別醫師(P<0.001)，例行性篩檢率是牙科醫師的1.30-5.97倍。綜合研究成果，如果篩檢醫師於對自己「對自己工作的影響」的態度愈正向愈有自信，口腔癌篩檢業務的執行力就可能更強，且有參與培訓課程的醫師在「對自己工作的影響」的態度得分上有顯著高於沒有參加者(P=0.012)。因此本研究建議篩檢醫師可以持續參加口篩訓練，溫故知新，以確保篩檢效率與效益。
並列摘要
The Taiwan Oral Cancer Screening (TOCS) program has been implemented since 2004, but the mortality rate of oral cancer is still rising, that means the screening progem may not be very effective. Therefore, TOCS doctors are selected as the research object, the differences on practices and attitude among the different categories, and the relationship between attitude and practices of TOCS doctors are investigated and discussed. The cross-sectional were obtained by a questionnaire from a Ministry of health and Welfare Phase Ⅲ cancer research project. Questionnaires were responded by 390 dentists (21.67%), 121 otolaryngologists (39.93%), and 105 other doctors certified by Health Promotion Administration (HPA) in Kaohsiung (58.01%). The questionnaire design consisted of medical category, oral cancer screening attitudes and practices. Finally, binary logistic regression method was used to analyze the related factors affecting oral cancer screening practices. The results showed that otolaryngologists have the highest percentage to practice oral cancer screening (61.98%-80.99%), but doctors is perform lessim palpation of the oral mucosa, ask and transfer ramcl patient's oral cancer risk behaviors in goeial. The better TOCS doctors' attitudes are, the more enthusiastic TOCS doctors' practices will be. The “Having professional knowledge and skills for mucosa screening” has the highest influence (OR=1.30-2.87), that means TOCS doctors have more confidence in the screening business itself to practices. The otolaryngologists got the highest grades than the dentists and HPA certified doctors in “Having professional knowledge and skills for mucosa screening” of attitudes (P<0.001), and the odds ratio of “always practice” is 1.30-5.97 than dentists. The main research achievement is TOCS doctors will be enthusiastic in oral cancer screening when they having professional knowledge. Therefore, continued educated on oral cancer screening may improve effectiveness in oral cancer screening for the TOCS doctors.
參考文獻
延伸閱讀
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