探討積極衛教與雙次糞便採集對於大腸癌篩檢陽性個案追蹤完成率之影響-以南部某區域醫院為例

The Effects of the Comprehensive Instructions for Stool Collection and the Two-Sample Stool Tests on the Adherence Rate of Patients with Positive Stool Test. -Case Study of a Hospital of the South

張鈺翎(Yu-Ling Chang)

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(2019年)

摘要

研究目的
本研究目的探討積極衛教與雙次糞便採集對於大腸癌篩檢陽性個案追蹤完成率之影響-以南區某區域醫院為例，國民健康署政策針對50-74歲提供每兩年免費執行免疫法糞便潛血檢查(iFOBT)，符合大腸癌篩檢資格之民眾，可藉由各醫療院所領取採便管，經由專業人員衛教後帶回採集糞便，再繳回檢驗糞便潛血為陰、陽性與否；若為陽性個案將由專業人員進行電訪衛教，追蹤至醫療院所進一步接受大腸鏡檢查。研究目的從民眾來院執行篩檢，探討隨機發放一支或兩支採便管，並隨機進行一般衛教或積極衛教後，是否會影響大腸癌篩檢陽性檢出率與陽性個案追蹤完成率，即為本研究之目的。
研究方法
本研究之方法採準實驗設計（Quasi-experimental design，或稱類實驗）收集南部某區域醫院之收案為期一年三個月來院民眾，採隨機發放採便管數量不同，探討一支採便管為實驗組與兩支採便管為對照組，探討陰、陽性與各個基本人口學變項之影響性，排除未繳回採便管與拒絕回訪醫院檢查陽性個案數量，是否會影響大腸癌篩檢陽性檢出率與陽性個案追蹤完成率，藉以SPSS 21版套裝軟體進行資料分析，針對資料性質採取描述及推論性之統計分析方式分述。
研究結果
本研究由統計分析發現以母群體(N=7006人)檢視採便管支數與人口學變項之統計結果為年齡、教育程度、家族史、衛教程度及檢驗結果，以及，再檢視檢驗結果與人口學變項之統計得性別、教育程度、家族史、採便管支數皆達統計意義(P<0.05)。另以陽性個案數(N=440)分析採便管支數不同與有、無確診，進行統計後得衛教方法、年齡具統計意義(P<0.05)。
綜上所述，將有意義之變項納入迴歸模式調整及探討發現，篩檢為陽性結果者以男性勝算比是女性的1.5-1.6倍、教育程度低之勝算比1.4倍高於教育程度高者、雙次糞便採集之勝算比是單次的1.4倍；就追蹤陽性個案的勝算比而言，以女性高於男性為1.5-1.7倍、年齡為60-70歲高過其他年齡的2.5倍、教育程度高相較於教育程度低者之1.5-1.7倍。
研究結論與建議
經研究結果發現以男性、教育程度低，雙次採便者會有較高的陽性率，且影響陽性篩檢追蹤則以女性、年齡為60-70歲、教育程度高者影響較高。由此可知，藉由大規模篩檢可望降低大腸癌死亡率，成功且有效率推動癌症篩檢防治是重要的方向，免疫法對於大癌病兆的偵測度而言優於化學法，透過雙次採檢可因採檢次數而提升陽性檢出機率，同時基層醫療院所配合轉介陽性個案尤為重要。
當民眾對篩檢為陽性個案之後續確診認知不足則無法積極確診，是以，提倡防治教育可使民眾瞭解篩檢行為，可早日發現是否為癌症高危險群，若篩檢為陽性則安排後續診斷檢查，給予正確診斷及必要追蹤與治療，可避免醫療資源浪費進而促進民眾健康，讓預防知識深植民眾心中，使其提升陽性個案追蹤以達治療成效。

關鍵字

大腸癌篩檢 ； 免疫法糞便潛血檢查 ； 陽性個案追蹤 ； 雙次糞便採集 ； 衛教

並列摘要

Objective
The purpose of this study was to investigate the impact of active education and double stool collection on the completion rate of colorectal cancer screening positive cases - a regional hospital in Southern District, for example, the National Health Agency policy provides free immunization every two years for 50-74 years old. The method of fecal occult blood test (IFOBT), which meets the qualifications for screening for colorectal cancer, can be collected by the medical institutions, collected by the professional health education, and then returned to collect feces, and then returned to test fecal occult blood as yin, positive Whether or not; if it is a positive case, a professional visit will be conducted by a professional, and it will be traced to a medical institution for further gut microscopic examination. The purpose of the screening is to conduct a screening from the people to discuss the random distribution of one or two collecting tubes. After random general education or active education, whether it will affect the positive detection rate of colorectal cancer screening and the completion rate of positive case tracking is the purpose of this study.
Methods
The method of this study adopts Quasi-experimental design (or class experiment) to collect the hospitals in a certain regional hospital in the south for a period of one year and three months. The number of randomly collected pigs is different. The tube is the experimental group and the two collection tubes are used as the control group to investigate the influence of yin, positive and basic demographic variables. Exclude the number of positive cases that have not been returned to the hospital and refused to return to the hospital. Will it affect colorectal cancer? Screening positive detection rate and positive case tracking completion rate, using SPSS 21 version of the package software for data analysis, based on the nature of the data to describe and inferential statistical analysis.
Results
This study found that the statistical results of the number of fecal tube counts and demographic variables in the mother group (N=7006) were age, education level, family history, degree of education, and test results, and re-examination test. Results and demographic variables were statistically significant (P<0.05) in terms of gender, educational level, family history, and feces. In addition, the number of positive cases (N=440) was analyzed. The number of fecal tube counts was different and there was no diagnosis. The statistics and age were statistically significant (P<0.05).
In summary, the meaningful variables are included in the regression model adjustment and discussion. The positive results of screening are 1.5-1.6 times that of males, and the odds of lower education are 1.4 times higher than those with higher education. The odds ratio for double feces collection is 1.4 times that of a single time; the odds ratio for tracking positive cases is 1.5-1.7 times higher than that of men, and 60-70 years old is 2.5 times higher than other ages. The level of education is 1.5-1.7 times higher than that of those with low education.
Conclusion and Suggestions
According to the results of the study, it is found that males and low education have higher positive rates, and positive screening screening affects women with ages of 60-70 years and higher education. It can be seen that large-scale screening is expected to reduce the mortality of colorectal cancer. Successful and effective promotion of cancer screening is an important direction. Immunoassay is superior to chemical method in detecting the symptoms of large cancer. Through double-checking, the probability of positive detection can be increased due to the number of inspections, and it is especially important for primary hospitals to cooperate with referral positive cases.
When the public is not aware of the follow-up diagnosis of the positive screening case, it cannot be positively diagnosed. Therefore, advocating prevention and treatment education can make the public understand the screening behavior, and can find out early whether it is a high risk group of cancer. If the screening is positive, arrange for follow-up. Diagnostic examinations, giving correct diagnosis and necessary tracking and treatment can avoid waste of medical resources and promote public health, so that prevention knowledge can be deeply rooted in the minds of the people, so that positive cases can be tracked to achieve therapeutic results.

並列關鍵字

Colorectal cancer screening ； immunological fecal occult blood test ； positive case tracking ； double stool collection ； health education

參考文獻

英文文獻

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