影響癌症篩檢意願之關鍵因素
–以臺北市立A醫院為例

癌症為我國死因率第一名自1982年起迄今，我國政府為照顧國人健康，降低癌症治療財政負擔，推動免費癌症篩檢服務多年，雖成效有漸入佳境之趨勢，但仍有許多民眾未能積極參與篩檢作業。我國2018年衛福部提供之癌症篩檢率其中乳癌39.9%、大腸癌40.8%，可見仍有進步空間。過往文獻資料針對癌症篩檢意願的研究，主要是使用「健康信念模式」或「計畫行為理論」等研究架構，其針對不同類別的癌症、不同地區的受訪者探討其影響因素，透過這些文獻資料，可以得知主要有以下九個準則對癌症篩檢有影響性，分別為：個人因子、生活習慣、專人諮詢、宣傳知識、門診提示、方便性、獎勵制度、抹片檢查由女醫師執行及法規強制等9項。考量政府機關及醫院的預算與人力資源有限，如要提升癌症篩檢意願，勢必要在此9項準則間做出取捨。本研究先以德爾菲法邀請A醫院實際從事癌症篩檢業務人員組成專家團隊，評估完9項準則後(修正其中生活習慣準則，新增乙項抹片車設備新舊程度)，再針對北部區域之民眾採問卷調查之方式，並使用決策實驗室分析法、網絡程序分析法及重要度/績效分析等方法評估其結果。研究顯示，針對男性而言「專人諮詢」與「宣傳知識」為相互影響的準則、「宣傳知識」單向影響「獎勵制度」、「專人諮詢」單向影響「便利性」、「個人因子」及「法規強制」及除了「獎勵制度外」的其他非關鍵準則；針對女性而言「專人諮詢」與「法規強制」為是相互影響的準則、「專人諮詢」單向影響「便利性」、「個人因子」及「宣傳知識」及其他非關鍵準則。本研究結果顯示「個人因子」、「法規強制」及「宣傳知識」為極需改善的關鍵準則，而不論男性或女性受訪者「專人諮詢」皆為最具影響力之關鍵準則，故提高「專人諮詢」此項準則的作業質量，對於提升癌症篩檢意願有正向的幫助。

關鍵字

癌症篩檢；德爾菲法；決策實驗室分析法；網路程序分析法、重要度績效分析

並列摘要

Since 1982, Cancer has risen to the top of the cause of death in our country. The government has promoted the free cancer screening policy for many years in order to take care of the health of national and reduce the financial burden of national for treating cancer. Even though the implementation results are getting better nowadays, there are still many people who are not actively involved in the screening. According to the percentage of people participating in cancer screening provided by the Ministry of Health Welfare serving our country in 2018 as follows: 39.9% of Breast cancer, 40.8% of Colorectal cancer, screening participation rate shows that there is still room for improvement. The research literature comparing the willingness to screen for cancer screening mainly uses the research framework of “Health Belief Model (HBM)” or “Theory of Planned Behavior (TPB)”, which explores the influencing factors for different types of cancer and respondents from different regions. Through these documents, it can be known that the following nine factors have an impact on cancer screening: individual factors, living habits, specialist consultation, information and guidance on cancer, outpatient reminder, convenience, reward system, privacy and mandatory regulations. Considering the limited budget and labor cost of government agencies and medical institutions if we want to increase the participation rate of cancer screening among nationals, it is necessary to start from these nine factors. By invited A hospital to engage in a professional team composed of cancer screening business personnel to help evaluate the 9 variables (corrected). Among them, the factor of" living habits" has been removed and "equipment technology" was added. Questionnaires were conducted for nationals in northern Taiwan, and the results of the survey were evaluated using Decision making trial and evaluation laboratory (DEMATEL), Analytic Network Process (ANP) and Importance & Performance Analysis (IPA). The survey shows that for men, "specialist consultation" and" information and guidance on cancer" are mutually influential factors." information and guidance on cancer " affects the "reward system" in one direction. "Specialist consultation" affects "convenience"," individual factors ", "mandatory regulations" and other non-critical factors except the "reward system". For women, "specialist consultation" and "mandatory regulations" are mutually influential factors. "Specialist consultation" affects "convenience", "individual factors", "information and guidance on cancer" and other non-critical factors. The results of this statistic show that "individual factors", "mandatory regulations" and" information and guidance on cancer" are urgently needed to be improved as soon as possible by the Government and medical institutions. The questionnaires also show that both men and women agree that "specialist consultation" is a key factor affecting their screening intention. Therefore, improving the quality of the "specialist consultation" for cancer screening has a significant positive effect on improving the willingness to screen cancer.