大腸直腸癌個案管理介入成效之研究

The Effeteness of Case Management Intervention for Patients with Colorectal Cancer

林詩涵(Shih-Han Lin)

指導教授 ： 丘周萍

義守大學/醫學院/醫務管理學系/碩士(2015年)

https://doi.org/10.6343/ISU.2015.00152

摘要

臺灣近年來老年人口增加，同時因為油脂的攝取量增加、食物中纖維的攝取量少、飲食習慣逐漸西化，不但心血管疾病增加，大腸直腸癌病例也有大幅攀升的趨勢。其所帶來的耗用資源成本也造成健康照顧體系重大的負擔，爲有效管控照顧與醫療品質，管理性健康照護的推動順勢所趨，其中個案管理遂成為目前有效的管理策略之一。 本研究在探討南部某區域教學醫院之有無接受個案管理的病患對大腸直腸癌之知識、自我照顧的差異及瞭解大腸直腸癌患者對個案管理功能認知及期望的差異。問卷發展首先參考文獻及臨床經驗自擬而成，敦請相關領域的學者及臨床專家共5位修正，問卷信度Cronbach’s alpha均高於0.7，收案期間為2014年10月31日至2015年02月28日之大腸直腸癌病患為研究對象，有效問卷為109份。研究方法：以立意取樣後進行隨機抽樣，分派為個案管理組與無個案管理組，個案管理組係由一位個案管理師執行管理照護計畫，無個案管理組則依病房常規照顧模式進行。兩組收案評估由個案管理師進行，病患在治療完成後，回診時由研究生進行收案。資料分析以描述性統計包括平均數、標準差、範圍、百分比；推論性統計採用無母數的統計分析:Mann-Whitney 檢定及Kruskal-Wallis檢定統計方法。結果顯示兩組大腸直腸癌知識在統計學上呈現顯著的差異(p<.05)，個案管理照護對於個案的大腸直腸癌知識比無個案管理組有顯著成效。病患希望個案管理師提供的服務方面，兩組分別為47.37%及50%的病患希望回門診時進行訪視、73.68%及76.92%的病患希望以衛教手冊得到相關癌症資訊、77.19%及73.08%的病患希望以打電話的方式來聯絡、衛教資訊以飲食衛教為主佔59.65%及71.15%、在服務團體的部分以89.47%及98.08%的病患希望以醫院的社工及營養師為主要諮詢的對象。結論:個案管理照護在病人住院期間的管理照護計畫提供個別性的衛教指導能提升個案的大腸直腸癌知識，且透過出院後的電話追蹤、提供諮詢服務可以讓大腸直腸癌知識。對疾病認識及了解日常生活照護原則以具有特殊狀況之處理能力，所以個案管理模式確實有助於提升癌症醫療品質。

關鍵字

大腸直腸癌 ； 知識需求 ； 自我照護需求 ； 個案管理

並列摘要

Recently, the aging population increase in Taiwan; their food consumptions become more westernized. Increasing of fat intake and decreasing fiber uptake make cardiovascular disease and colorectal cancer incident have the trend of growing up. The results increase the loading and abuse of the medical care resource. For better medical care resource control and quality improvement, the care managers play an important role for this control.
This study is to investigate the role of case manager for colorectal cancer patients’ care in one of the regional hospital in Southern Taiwan. The difference in the recognized of the function for with or without case manager by the patients is also studied. The questionnaires had been designed base on articles reviewed, clinical experience and five specialists’ consultation. The 109 colorectal cancer cases were collected within October 31, 2014 to February 28, 2015. The methodology was randomized the patients for questionnaires study with or without case manager care. The case manager group has a nurse imply the care plan for the cancer patients. The group without the case manager has followed the regular care in the patient’s ward. After the completion the treatment, the case manager collected all two groups’ information for analysis. The data analysis included average number, standard deviation, range and percentage. The statistic methods included Mann-Whitney and Kruskal-Wallis analysis. The results showed the significant difference in colorectal cancer recognition between two groups (p<.05), and the case manager group revealed better disease knowledge compared with the group without case manager. The patients expected case manager can provide interview during OPD visit (47.37% vs.50%). They also expected to get the cancer education information through case manager (73.68% vs.76.92%). Some expected the cases manager could call them by phone (77.19% vs.73.08%). The education information was focus on nutrition consultation (59.65% vs.71.15%). In group service, most of the patient needed social and dietitian service. (89.74% vs. 98.08%) In conclusion, the efficacy for the role of case manager, colorectal cancer patient will increase the know-how for the disease through individually education during admission; furthermore, patient will also increase their knowledge for the disease through telephone follow-up. It can be enhanced their self-care ability and face some special situations during daily life. The role model for case manager should increase the quality of cancer patient care.

並列關鍵字

colorectal cancer ； knowledge need ； self-care need ； case manager

參考文獻

Chen, Y.Y., Lee, K.D.(2014). Weight Loss and Cancer Risk Reduction. Journal of Health Commun,,3 ,3-10.

姚遠賢、謝東呈、蘇淑芬、王守玉(2011)。現今大腸癌之治療趨勢。弘光學報，65，72-92。

溫金成(2007)。從免疫學觀點看腸道與人體健康的關係。生命學報，2， 241-250.

趙昭欽(2010)。腸保健康~淺談大腸癌。秀傳季刊，25(2)，1-3。

梁金銅(2013)。預防勝於治療－談大腸直腸癌。聲洋防癌之聲，夏季號，11-15。