某市立醫院之癌症醫療照護能力及民眾對安寧照護之認知

Cancer Care Capability of Taipei City Hospital

林哲斌(Che-Pin Lin) ； 吳振龍(Chen-Long Wu) ； 王威堯(Wei-Yao Wang) ； 朱素娟(Chung-Su Chu) ； 楊皓婷(Hao-Ting Yang) ； 王翠英(Tsui-Ying Wang)

《北市醫學雜誌》 2卷5期 (2005/05) Pp. 445-453

https://doi.org/10.6200/TCMJ.2005.2.5.05

摘要

目的：本研究計劃之目的在於探討罹患癌症之民眾經區域醫院級之市立醫院診斷後，留院治療之意願和對於安寧療護之了解及需求，以及市立醫院對於癌症醫療照護提供能力之分析。方法：1.探討市醫癌症患者之就醫型態與留院治療意願：我們從市立仁愛醫院之病理科之資料庫尋找2003年全年經病理證實為惡性腫瘤者，共652例，並一一檢視病患是否留在仁愛醫院繼續做後續之主要癌症治療。2.市立醫院對於癌症治療與現行之治療指引之比較，我們採專家會議模式並比對現行之治療指引與目前之治療模式之差異。3.對來院民眾及病患進行問卷調查，了解民眾對安寧療護之認知。結果：1.全年652位癌症病患中有486位(74.6%)繼續於本院接受治療。單科癌症別，以乳癌患者留院比例最高達94%；頭頸部癌患者最低，佔30%。2.市立醫院對於癌症治療之模式與治療指引相比，多能符合，但有些單科癌症因該科之發展沿革，無法做到全面性之醫療，仍有努力空間。3.問卷調查結果80.6%之民眾聽過安寧療護，不過了解其內容者較少僅佔65.57%。而78.3%受訪者同意在癌症末期轉往安寧病房，但也有九成以上的受訪者希望由原來之主治醫師或熟悉之醫療團隊照顧。結論：癌症之防治包括前段之預防篩檢，中段之積極治療及後段之安寧緩和療護。以往市立醫院對公共衛生相關之預防篩檢不遺餘力，今後配合聯合醫院之成立應該加強中、後段之醫療。以符合國民健康局對於癌症中心之嚴格要求。

關鍵字

治療指引 ； 治療模式 ； 安寧療護

並列摘要

Background and Purpose: Taipei Municipal Hospitals played roles in public health and did great jobs in cancer prevention and cancer screening in the past. However, as community hospitals, the Municipal Hospitals have their limitations in providing medical cancer care, either during cancer treatment or during palliative care. To evaluate the viability of providing cancer care in a Municipal Hospital and the general understanding of palliative medicine by Taipei citizens. Methods: (1) We searched the pathology database, finding 652 patients who were diagnosed with malignancies in 2003, and noted how many patients had stayed in Municipal Hospitals for their cancer treatment. (2) We compared the therapeutic pattern of our hospital with on-line cancer treatment guidelines (NOON guidelines and NHRI cancer guidelines) to see if there were any violations. (3) 200 questionnaires were issued to ask the patients, or their families or friends, for their understanding of hospice care or palliative medicine. Results: (1) 486 of 652 patients (74.5%) stayed in Municipal Hospitals for their cancer treatment. Patients suffering from breast cancer had the highest rate, 94%; those with head and neck cancer had the lowest rate, 30%. (2) Our hospital's therapeutic pattern is compatible with on-line guidelines; there is little violation. The main problem for Municipal Hospitals is a shortage of manpower, according to resident doctors. (3) The questionnaire revealed most people had heard of palliative medicine (80.6%) but only 65.6% understood the meaning of it. 78.3% were willing to be admitted to a hospice when the disease progressed to the terminal stage but more than 90% wished to be continuously cared for by a familiar medical team. Conclusion: The Municipal Hospitals are going to merge into a united Taipei City Hospital. To provide a better service for cancer patients, we should improve our cancer treatment and palliative therapy.

並列關鍵字

therapeutic guidelines ； therapeutic pattern ； palliative medicine