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  • 學位論文

初確診癌症病人之健康識能對醫療決策的影響

A Preliminary Study of Health literacy and medical decision-making among newly diagnosed cancer patients

指導教授 : 蔡麗雅
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摘要


研究背景:不同的治療決策情境有不同的價值考量與期望因子,初次罹患癌症的病人在決定癌症治療,需要面臨多方的決策。健康識能是決定個人獲得、理解及使用訊息,以促進維持健康的能力」,會影響其醫療決策,進一步影響健康結果。 研究目的:本研究探討初確診罹患癌症病人的健康識能、醫療決策的狀況以及健康識能與醫療決策間的相關性。 研究設計:本研究為橫斷式調查,立意取樣。 研究方法:於108年2月19日到109年3月30日,以中部某醫學中心綜合內科病房初確診癌症病人為收案對象,受試者基本資料、以「中文健康識能評估量表簡式量表」、「共同醫療決策量表」問卷收集資料,總計納入100人,將資料進行編碼,再以SPSS 20.0版套裝軟體進行分析。以百分比、平均值、標準差及獨立樣本T檢定進行敘述性分析,以單因子變異數分析、皮爾森積差相關分析及線性迴歸分析進行推論性分析。 研究結果:本研究受試者對象平均年齡為60±13.1歲,男性佔59%、女性佔41%、已婚佔85%、教育程度國中以下佔49%,國中以上佔51%,有宗教信仰佔75%,醫療決策為自己為佔48%、配偶或子女佔52%。在健康識能平均分數為9.8±1.46分,健康識能良好佔93%。在醫療決策量表平均分數分為3.84±0.69分,在3個構面中,「風險資訊溝通」分數最高,其次為「控制權偏好」,最低為「病患自主性」,顯示初確診罹癌病人傾向能在醫師的告知疾病治療方法的風險與醫師進行意見交流,但參與決策討論過程,病人易受外界干擾。將「人口學資料」與「共同醫療決策量表」進行獨立樣本T檢定、單因子變異數分析、皮爾森積差相關分析發現年齡(p=0.03)、教育程度(p=0.02)有顯著差異。以「健康識能量表」與「共同醫療決策量表」進行線性迴歸分析發現兩者有顯著相關(r=0.24,p=0.02)。另外,本研究透過統計差異檢定與相關檢定,找出與醫療決策之相關變項,再以線性迴歸模式進行分析,計算所有變項的迴歸係數,結果顯示年齡為醫療決策的預測因子,年齡45-59歲的β係數為-0.35(p < 0.04),年齡60-89歲的β係數為-0.38(p<0.03),表示年齡45-59歲比18-44歲者少0.35分,年齡60-89歲比18-44歲者少0.38分,整體解釋變量為10.6%。 結論:本研究中初確診罹患癌症病人教育程度為國中以上健康識能分數相對較高,健康識能分數較高對於共同醫療決策選擇較為適當。在初確診癌症病人中年齡小於60歲,當面臨醫療決策會立即決定及治療方向。因此,未來在臨床照護,應確實評估病人的健康識能、健康資訊、個人偏好及價值觀,病人面臨癌症相關檢查及治療時,可依據病人年齡、教育程度來提升健康識能的能力,如:依個別化提供或設計與疾病相關的教育課程及衛教單張,並在與其說明病情應以一般人可聽懂的語言,讓病人可理解其病情,進而增強病人參與醫療決策的能力,以增強初確診癌症病人參與醫療決策。本研究受試者大於60歲以上高於51%,其屬於相對保守及傳統,皆以家屬意見來當為自己的醫療決策,因此,建議在說明病情及討論病情應以家庭為中心概念,如:召開家庭會議共同討論病情及其治療方向,當然,討論過程仍需了解病人其意願,過程中營造病人可自由表達的對話環境,及提醒家屬適時尊重病人的價值觀。

並列摘要


Background: Medical decision-making is influenced by the consideration of values and expectations. Health literacy, the capacity of an individual to get access to, understand and use information to promote and maintain good health, affects the medical decision-making and health outcomes. Objective: The specific aim of this study is to investigate patient health literacy and medical decision-making as well as the correlation in between. Research design: This is a cross-sectional study with purposive sampling. Methods: Newly diagnosed cancer patients in the general medicine ward in a medical center in central Taiwan from February 19, 2019 to March 30, 2020 were recruited in this study. Data were collected as basic information, “Short form Mandarin health literacy scale”, and “Shared decision-making scale” from 100 patients. After coding, data was analyzed with SPSS 20.0. Descriptive statistics were carried out as percent, mean, standard deviation, and independent T-test; and inferential statistics was performed by one-way ANOVA, Pearson correlation, and linear regression analysis Results: The average age of the subjects in this study is 60±13.1 years old, 59% males and 41% females, 85% are married, education level of 49% are below and 51% are above junior high school, 75% are religious, 48% made medical decision for themselves, and 52% for their spouse or children. The average health literacy score was 9.8±1.46, and 93% were with good literacy. The average score in the medical decision is 3.84±0.69, with the highest score in the “risk communication facet”, followed by “preference for control” and “patient autonomy”. Data indicated that newly diagnosed cancer patients were able to communicate the treatment options to their physicians after they are informed about the treatments and risks. However, they are susceptible to external interference in the decision-making process. Independent t-test, one-way ANOVA, and Pearson correlation analysis of “demographic data” and “shared decision-making” indicated significant difference in age (p=0.03) and education level (p=0.02). Linear regression analysis revealed significant correlation between “health literacy” and “shared decision-making” (r=0.24, p=0.02). In addition, difference tests were carried out to find out the variables related to medical decision-making, and linear regression was applied to calculate the regression coefficient of each variables. Our data revealed age as predictor of medical decision-making. Age 45-59 and age 60-89 has a β coefficient of -0.35 (p <0.04) and -0.38 (p <0.03), respectively, indicating that age of 45-59 is 0.35 points less than that of age 38-44, and age 60-89 is 0.38 points less than age 18-44, and the overall explanatory power is 10.6%. Conclusion: In this study, we unraveled higher heath literacy in newly diagnosed cancer patients with education level above junior high school, and more appropriate shared decision-making was found in patients with higher literacy. When facing medical decisions, immediate determination of treatment direction was found in patients younger than 60. Therefore, patient health literacy, health information, personal preference and value should be evaluated in future clinical practice. When facing cancer-related examinations and treatments, health literacy can be improved according to the age and education level of the patients, for example, customized disease-centered health education, to overcome limited health literacy and to empower patients to engage in their medical decision-making by using plain language for explanation and communication. The fact that more than 51% participants in this study are above 60 years old indicated they are relatively conservative and traditional and rely on the opinions of family members for their medical decision-making, therefore, family-centered decision making is recommended, e.g., a family meeting for the explanation and discussion of disease conditions. However, the patient’s preference should be addressed during the discussion via creating a friendly environment for the patient to fully express his/her thoughts, as well as reminding the family members to respect the patient’s value in a timely manner.

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