心理社會因素與就診經驗對婦女乳癌定期篩檢之影響

Influences of Psychosocial Factors and Previous Care-seeking Experiences on Periodical Breast Cancer Screening among Women

林錦龍(Chin-Long Lin)

指導教授 ： 黃國哲

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2007年)

https://doi.org/10.6831/TMU.2007.00053

摘要

台灣婦女乳癌的發生率逐年上昇，近年已高居婦女十大癌症第二位，每年因乳癌而死亡的婦女也逐年增加，目前是婦女癌症死亡原因第四位，也是台灣所有癌症死亡原因的第四位。根據美國近年的經驗，由於推行乳癌定期篩檢的關係，零期與第一期乳癌佔了百分之六十，因此乳癌的死亡率正逐年下降。相較於美國而言，台灣女性乳癌在零期與第一期的比例僅佔百分之二十至二十五，第二期之後才發現的比例佔百分之八十，雖然行政院衛生署從民國九十二年起即大力宣傳乳癌定期篩檢的重要，但是真正有接受乳癌定期篩檢的婦女比例僅占百分之三十，因此，本研究的主要目的是從心理社會與就診經驗的角度探討影響婦女定期乳癌篩檢之因素。
本研究對象以台北市某醫學中心乳房外科、家庭醫學科及快速通關門診(子宮頸、乳癌篩檢)接受乳癌篩檢之25∼64歲婦女為主，以問卷施測為工具採便利抽樣方式實施。從民國九十六年一月至民國九十六年三月進行問卷收集，總共發出510份問卷，共回收有效問卷474份，有效問卷回收率為92.94%。回收之樣本經由因素分析、描述性統計、卡方檢定與羅吉斯迴歸來探討心理因素、社會因素及就診經驗對婦女接受定期乳癌篩檢之影響。
研究結果發現在人口統計變項方面年齡較大者、已婚者、生育過之女性、家庭主婦、教育程度較低者與家庭收入越高者，會接受定期乳癌篩檢的趨勢越明顯，在生育子女人數方面則與定期乳癌篩檢無顯著影響。另外在檢驗社會、心理及就診經驗等各個變項對定期乳癌篩選行為的預測效果方面，社會因素這個變項可以有效用來預測婦女的乳癌定期篩檢行為，然而，若從個別因素來分析，大眾媒體、醫療機構和親朋好友這三個因素皆未達顯著水準，表示這三個因素無法單獨有效預測乳癌定期篩檢行為。心理因素這個變項可以有效用來預測婦女的乳癌定期篩檢行為，若從個別因素來分析，罹病可能性、罹病嚴重性、知覺利益和知覺障礙四個因素只有知覺障礙達顯著水準，表示知覺障礙能單獨有效預測乳癌定期篩檢行為。就診經驗這個變項可以有效用來預測婦女的乳癌定期篩檢行為，若從個別因素來分析，儀器設備、醫療人員、檢查場所和檢查結果四個因素，其中儀器設備與醫療人員達顯著水準，顯示儀器設備和醫療人員能單獨有效預測乳癌定期篩檢行為。同時檢測社會、心理及就診經驗等變項所有因素對乳癌定期篩檢行為的預測效果，社會、心理及就診經驗這三個變項的所有因素可以有效用來預測婦女的乳癌定期篩檢行為。其中，知覺障礙、儀器設備和醫療人員皆達到顯著水準，表示相對於其他的因素，知覺障礙、儀器設備和醫療人員這三個因素，特別對乳癌定期篩選行為具有顯著的預測效果。
最後檢測社會、心理及就診經驗三個變項對乳癌定期篩檢行為的預測效果，以比較這三個變項的相對預測力，只有就診經驗達到顯著水準，顯示相較於社會因素及心理因素，就診經驗對婦女定期乳癌篩檢行為有較佳的預測力。

關鍵字

乳癌定期篩檢

並列摘要

Breast cancer rate in Taiwan has been escalating in recent years. Currently it is in second place of the top ten cancer chart in Taiwan. The death toll of women suffering from breast cancer is increasing and breast cancer is identified as the fourth deadliest cancer. According to statistics from America, 60% of women diagnosed of having breast cancer are in their zero or first stage. The fatality rates of detecting cancers at early phases are low, as compared to later discoveries. Thus the deaths of women diagnosed with such disease can be decreased significantly. On the other hand, only 20~25% of Taiwanese women identified as suffering from the illness are in their zero or first stage. Those acknowledged as in their second stages or above take up 80% of the population. Although both the American government and the Department of Health of Taiwan’s Executive Yuan have greatly promoted the importance of regular breast cancer screening to prevent breast cancer, it seems that the effects are only evident for the Americans. Of the total number of patients suffering from the illness in Taiwan, only 30% of them have habitual breast cancer screening. Thus, the current research attempts to identify the factors influencing Taiwanese women’s periodically breast cancer screening from psychosocial and previous care-seeking experience perspectively.
The present study utilizes a questionnaire method to test a conventional sample from one teaching hospital in Taipei City. Women ages between 25 to 64, who received breast cancer screening in either the outpatient department of general surgery , the family medicine unit, or the fast outpatient unit for pap smear and breast cancer screening were the targeted sample. Data was collected from January to March, 2007 and 474 in 510 queationaire were valid, it accounts for 92.94％. Factor analysis, descriptive statistics, chi-square test and logistic regression were performed on the data.
In demographic variables, it shows the older ages、the married、the women having children、the housewives、the higher educations and the higher family incomes will have more evidence to receive periodical breast cancer screening. In social factor variables, it can effectively predict the behavior of breast cancer screening alone, yet in analysis of the individual factors as mass media, the medical institutions, and family and friends, they can’t effectively predict the behavior of breast cancer screening alone. In psychological factor variable, it can effectively predict the behavior of breast cancer screening alone, yet in analysis of the individual factors as perceived susceptibility, perceived severity, perceived benefits and perceived barriers, only perceived barriers can effectively predict the behavior of breast cancer screening alone. In previous care-seeking experiences factor variable, it can effectively predict the behavior of breast cancer screening alone, yet in analysis of the individual factors as medical equipment, medical crew, medical place and examination data, only medical equipment and medical crew can predict the behavior of breast cancer screening. Combination of all the factors of the psychosocial and previous care-seeking experiences variables, they all can effectively predict the behavior of breast cancer screening. in them, perceived barriers、medical equipment and medical crew reach the significant level, it represents the three factors have more significant predict values in contrast to the other factors.
At last, we check the predict values of psychosocial and previous care-seeking experiences for breast cancer screening. Only previous care-seeking experiences reach the significant level, it represents the previous care-seeking experiences has more effective predict value in contrast to the other two variables.

並列關鍵字

Breast Cancer Screening

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