探討「癌症醫療品質提升計畫」對醫療提供者與婦女的乳癌及子宮頸癌篩檢之相關影響：焦點訪談質性研究

Investigating the Associations between the Cancer Quality Improvement and Prevention Program and Breast Cancer and Cervical Cancer Screening from Healthcare providers’ and Women’ perspective：A Focus Group qualitative study

康雅婷(Ya-Ting Kang)

指導教授 ： 謝慧敏

高雄醫學大學/健康科學院/公共衛生學系公共衛生學碩士班/碩士(2017年)

摘要

背景：乳癌和子宮頸癌等婦女癌症可以透過定期篩檢降低發生率與死亡率。因此，為提高民眾癌症篩檢率，國民健康署在2010年開始實施擴大民眾癌症篩檢與實施「癌症醫療品質提升計畫」補助醫療提供者端提供的癌症篩檢服務，但相較歐美等國家，婦癌篩檢比率仍然有很大的落差。
　　目的：本研究利用質性訪談研究方法，深入瞭解探討醫療提供者與婦女對於國民健康署實施婦癌篩檢政策計畫的看法，以及影響癌症篩檢服務成效的缺口。
　　方法：本研究針對一家醫學中心及兩家區域醫院的醫療提供者(共16位)和到院民眾(共17位)進行八場質性焦點團體訪談。訪談資料整理逐字稿後，利用Atlas.ti 5.0 version 進行內容分析法和主題的歸納。
　　結果：本研究結果發現民眾是否進行癌症篩檢行為會受到民眾端的個人因素、醫療提供者端及政策端的因素所影響。本研究從受訪者提供的訪談資料中挖掘影響癌症篩檢推廣的整個過程之成效缺口，並且建立缺口模式架構，包括政府推廣癌篩缺口、政府經費補助醫院缺口、醫院內部員工獎勵缺口、醫院員工推廣癌篩障礙、總結影響癌篩成效的缺口等。
　　結論：本研究針對影響婦女接受婦癌篩檢的因素和癌篩服務缺口提出相關建議，希望提供政府與醫療提供者未來在癌症篩檢推廣策略擬定之參考。

關鍵字

乳癌篩檢 ； 子宮頸癌篩檢 ； 健康信念模式 ； 癌症篩檢策略 ； 癌症篩檢缺口

並列摘要

Background：Breast cancer and cervical cancer screening may reduce the cancer incidence and mortality. Compared to the European countries and the United States, Taiwan's breast cancer and cervical cancer screening rate is still relatively low. In order to improve the screening rate of cancer, the Health Promotion Administration, Ministry of Health and Welfare implemented the Cancer Quality Improvement and Prevention Program (CAQIP) in 2010 through both subsidizing hospitals to provide cancer screening services, and subsidizing more eligible people for cancer screening.
　　Object：This study conducted a qualitative research using focus group approach to investigate the associations between the CAQIP program and women cancer screening services from both Healthcare providers’ and women’ perspective. Additionally, this study also explore potential service quality gaps for cancer screening
　　Method：This study hosted eight focus group interview in a medical centers and two regional hospitals. Participants were included sixteen medical providers and seventeen women. Interview discussions were all recorded and organized into interview transcripts for further analysis. Atlas.ti 5.0 version was used to analyze and extract primary theme based on content analysis apporach.

Results：The study findings indicated that women health behavior on cancer screening may be influenced by personal demographic factors, medical providers factors and policy factors. In addition, this study found several potential cancer screening service quality gaps exist between medical providers and women, including gaps in governmental health promotion, gaps in subsiding hospitals from the CAQIP program, gaps in internal incentives for health professions, gaps in cancer screening promotions from medical providers, and overall gaps between medical providers and women.
　　Conclusion：The results provided important policy implications regarding the CAQIP program and found potential service gaps. This study conducted a cancer screening service gap model. This model may provide both policy makers and health providers a framework for modifying current cancer screening policy or strategies in the future.

並列關鍵字

breast cancer screening ； cervical cancer screening ； health belief model ； cancer screening strategy ； cancer screening service gaps

參考文獻

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