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  • 學位論文

醫師與病人對「以病人為中心照護」之信念、感受與執行相關研究—以乳癌為例

A study of physicians’ and patients’ beliefs, perceptions and practices of patient-centered care:An example of breast cancer.

指導教授 : 鍾國彪

摘要


背景與目的: 21世紀醫療照護體系六大目標其中之一即是提供以病人為中心的照護(IOM,2004)。雖然已出現不少相關研究,但綜觀國內外相關文章發現,很少以乳癌為研究主題,亦很少同時調查醫師與病人雙方對以病人為中心之信念、執行度與感受度為何。故本研究欲同時調查醫病之信念、感受度與執行度,盼能了解雙方之差異,並探討信念與感受之關係。 方法: 本研究引用英國Survey大學Ogden等學者發展的以病人為中心照護量表,來測量病人、醫師對此照護模式之信念、感受與執行度。獲得原作者的授權,中文化過程包括英翻中、中翻英的回譯,並邀請Professor Ogden作為回譯版本的品質標準,並依其給分予以修正,最後依前測結果修改完成定稿。本研究採用橫斷性研究,經徵詢院方同意與倫理委員會審查後,最後以大台北地區2家國立醫學中心、3家私立醫學中心與1家私立區域醫院為個案醫院,以其一般外科(乳房外科)、血液暨腫瘤內科與放射腫瘤科門診乳癌病人與相關照護醫護人員為研究對象。本研究採立意取樣,於2008/3/4至2008/4/22收案期間,共蒐集284位乳癌病人、28位相關照護醫師與33位跟診護理人員有效樣本。 研究結果: 本研究中以病人為中心量表共有34題具有高度內在一致性(信念部份Cronbach α係數為0.869,感受部分Cronbach α係數為0.907)。經相依樣本t檢定發現病人與醫師對於以病人為中心照護之各構面信念具有差異,其中在「病人參與」與「醫病關係情感內涵」兩構面醫師信念高於病人,而在「醫師感受性」與「資訊給予」兩構面則是病人信念高於醫師;此外,病人對以病人為中心照護之感受與醫師實際執行度亦具差異,其中於「醫師感受性」、「病人參與」與「資訊給予」三構面病人感受低於醫師執行度。經複迴歸分析,發現病人對以病人為中心照護之各構面信念與各構面感受有顯著相關;醫師對以病人為中心照護之各構面信念與各構面執行度亦有顯著相關。所有研究假說皆得到支持。 建議: 對於未來研究的建議包含:擴大醫院參與數與醫師參與數;後續類似配對研究可採用多層次分析方法;輔以質性研究以驗證量性結果;將以病人為中心照護與病人結果面做連結,探討此種照護模式所帶來的影響。

並列摘要


Background and aims: The Institute of Medicine (IOM) proposes patient-centered care as one of six aims for quality of care in the 21st century. After reviewing literatures, we found that limited studies focused on breast cancer and investigate physicians’ and patients’ beliefs, perceptions and practices simultaneously. This aims of this study are to examine and compare the beliefs and the congruence of perceptions and practices between breast cancer patients and their attending physicians by matched questionnaire. In addition, we would like to find out the relationship between their beliefs and perceptions. Method: This study adopted the patient-centered care questionnaire developed by Professor Ogden etc. in Survey University to measure breast cancer patients’ and physicians’ beliefs, perceptions and practices of patient-centered care. The study obtained the authorization directly from Professor Ogden. The modification procedures included dual translation between English version and Chinese mandarin, rated finally by Professor Ogden as gold standard, and modified to Chinese according to her rating. The final version was decided after pretest of the draft. This is a cross-sectional study. After looking for hospitals’ cooperation and approved by the Institutional Review Board procedure later on, six hospitals in Taipei Metropolitan Areas agreed to join this study that included two public medical centers, three private medical centers and one private regional hospital. The participants of this study include breast cancer patients, physicians and nurses in specialty of breast surgery, hematology and radiology oncology at outpatient department. All samples came from convenient samples. There were 284 patients, 28 physicians and 33 nurse valid samples with collection period from March 4th to April 22, year 2008. Result: There were 34 questions in the patient-centered care questionnaire with high internal consistency (the coefficient of Cronbach α in belief and perception section is 0.869 and 0.907, separately). From paired-t test, the results found that there are differences between patients’ and physicians’ beliefs toward patient-centered care. Physicians’ beliefs are higher in constructions of ”patient involvement” and “the affective content of the relationship”. However, patient’s beliefs are higher in the constructions of “doctor receptiveness” and “information giving”. Besides, there are differences between patients’ perceptions and physicians’ self-report of practices, which patients’ perceptions are lower in the constructions of “doctor receptiveness”, ”patient involvement” and “information giving”. From multiple regression analysis, patients’ beliefs toward patient-centered care had significant relationship with their perceptions; physicians’ beliefs toward patient-centered care had significant relationship with their practices. All hypotheses are supported from the survey data. Suggestion: Suggestions for study in the future include: first, increase the sample size of hospitals or physicians for better representative; second, apply multilevel analysis to elaborate the effect of patient and physician or organization as a whole; third, adopt qualitative approach to verify the findings from quantitative study;finally, link patient-centered care to patient outcome to explore its effects.

並列關鍵字

Patient-centered care breast cancer

參考文獻


郭文宏,張金堅(2006)乳癌。台灣醫學,10(4):475-481。
國家衛生研究院(2004)乳癌診斷與治療共識。
蘇正熙(2007)認識乳癌。聲洋防癌之聲秋季號:6-12。
張金堅(2006)揮別乳癌,永保美麗健康。聲洋防癌之聲夏季號:10-12。
謝渙發(2001)淺談乳癌。聲洋防癌之聲秋季號:2-5。

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