台灣放射腫瘤專科醫師對其醫院之乳癌診療品質滿意度研究

近年來，由於飲食習慣西化和生活作息都市化的結果，乳癌的發生有日漸增加的趨勢。在台灣，每年有超過六千個新生病例。自 1995年起乳癌已躍升為台灣女性好發癌症第一位，面對可能罹患乳癌的陰影，往往成為婦女揮之不去的夢魘。我國國民健康局於民國92年開始蒐集六大癌症之診療明細於「癌症診療資料庫( TCDB )」，並於93至95年委由台大公衛學院的研究團隊(95年成立健保研究中心)發展完成六大癌症(子宮頸癌、乳癌、大腸直腸癌、口腔癌、肺癌、肝癌) 之核心測量指標，目的讓各癌症照護機構藉此工具達到內部品質改善及外部監測。是以本研究企思由醫療同儕的互相評認，來了解全台各醫院治療乳癌的現況，相對應於國健局乳癌核心指標的符合狀況如何。以國健局癌症評鑑中所使用之乳癌核心指標項目，將十二項核心指標轉化成滿意度問卷。對全國179位，於2009年有在臨床進行放射治療業務的放射腫瘤專科醫師，進行對其所處醫療院所之乳癌診治滿意度調查。滿意度分數總分為六十分，九十八位回答的醫師中平均分數為 50.41分，中位數為50.00分，眾數為54分，最低分數為36分，最高分數為59分。如果以乳癌核心指標問題滿意程度，來檢視醫療院所的乳癌診治品質。台灣正在臨床執業的放射腫瘤專科醫師，對其所屬醫療院所乳癌診治的醫療品質有達到滿意以上的程度。乳癌核心指標問題滿意度‘低於滿意’的程度，且達到統計學上顯著意義者，只有一項為: ‘對本院第一期和第二期乳癌患者執行乳房保留手術比率之滿意度’。顯示在臨床從事乳癌治療工作的放射腫瘤科的醫師經驗裡，台灣醫界對以‘保留性手術加上術後放射線治療’取代 ‘改良式根除手術’的共識仍有不足。複迴歸分析可以得知，其中以‘科內治療總病人數分組’此因子對乳癌核心指標滿意度總分數的解釋能力為最明顯。回答問卷醫師所屬之放射腫瘤科，科內治療總病人數越多的，其乳癌核心指標滿意度總分數越高。由專業的醫師評估台灣的乳癌治療環境。值得乳癌病人安心的是，在台灣的醫療環境中乳癌診治的品質，不會隨著醫療院所的層級、或是區域有所差別；亦不會隨著醫師的個人特質有所影響。在台灣的乳癌患者可以享有均等而有品質的診、治環境。

關鍵字

乳癌、乳癌核心指標、醫療品質、放射腫瘤科醫師

並列摘要

In recent years, the incidence rate of breast cancer increased gradually because of westernized eating habit and urban lifestyle. In Taiwan, there are more than 6,000 new breast cancer patients every year. Since 1995, breast cancer had become the most frequent cancer of female patients. In 2003, Department of Health in Taiwan Bureau of Health Promotion began to collect the details about the diagnosis and treatment of the six kinds of cancer in Taiwan Cancer Database( TCDB). From 2004 to 2006, the team from Public Health college of National Taiwan University was designated to develop the Core Measure Items for the six kinds of cancer (cervical cancer, breast cancer, rectal cancer, oral cancer, lung cancer and liver cancer). With these core measure items, every cancer- -caring center could improve not only the internal quality of the insti- -tution but also achieve external monitoring. This study aims on understanding current status of breast cancer treat- -ment in Taiwan’s hospital by mutual evaluation from medical colleagues and compare it with the core measure items from Bureau of Heath Pro- -motion. Twelve breast cancer core measure (BCCM) items are converted to the degrees of satisfaction questionnaire. One hundred and seventy- -nine radiation oncologists take this questionnaire to evaluate the satis- -faction of diagnosis and treatment quality in breast cancer for their respective organization in 2009. The full score of satisfaction degree is 60 point. In 98 responders, the average score is 50.41 point, the median score is 50.00 point, the modal score is 54 point, the lowest score is 36 point, and the highest score is 59 point. From this satisfaction questionnaire, active radiation oncologists in Taiwan are satisfied with their institution’s quality in breast cancer diagnosis and treatment. In these core item questionnaire, the only “less-than-satisfied” and statistically significant item was: “ The satisfaction degree about the per- -centage of the stage I and II breast cancer patient receiving breast con- -servative surgery”. It reveals that radiation oncologists who are treating breast cancer patients in Taiwan believe the consensus of “replacing modified radical mastectomy with breast conservative surgery and postoperative radiotherapy” is still not achieved. According to the multiple regression analyses, the item of “total patient numbers in the radiotherapy department” has the strongest relationship with the score of satisfaction degree. The higher the total patient numbers in the responder’s department,, the higher the score of satisfaction degree are. According to this study, the quality of breast cancer diagnosis and treatment in Taiwan is not changed with the level or localization of the hospital. It is also not affected by the individual characteristic of the physician. We believe all breast cancer patients in Taiwan could have the same level and great quality of diagnosis and treatment in breast cancer.

並列關鍵字

breast cancer, breast cancer core measure (BCCM) items, medical quality, the specialist of radiation oncology

參考文獻

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台灣放射腫瘤專科醫師對其醫院之乳癌診療品質滿意度研究

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