醫院提升婦女癌症篩檢率與陽性追蹤率之現況及關鍵成功因素探討

Abstract

背景（Background）:乳癌與子宮頸癌長期位居臺灣婦女癌症負擔的重要來源。儘管政府推動多項篩檢與追蹤政策，不同縣市及醫療院所在篩檢涵蓋率、陽性追蹤率與五年相對存活率方面仍存在明顯差異。另外，既有文獻多著重於障礙因素的探討，對於「成功經驗」與「組織層級的執行歷程」之研究相對不足，亦缺乏能連結政策、資源分布與院所實務運作的多層次整合視角。 目的（Objective）:本研究旨在整合量化趨勢與質性訪談資料，描繪臺灣乳癌與子宮頸癌防治表現的地區差異，並辨識高績效院所在篩檢與陽性追蹤過程中的關鍵成功因素，以提供可供政策與組織採行的可操作策略。 方法（Methods）:本研究分成兩部分進行，量化部分使用 99–112 年全國縣市層級之乳癌及子宮頸癌篩檢率、陽性追蹤率與五年相對存活率資料，進行時間趨勢與地區差異分析。質性部分採立意抽樣，邀請篩檢與追蹤績效優異之醫療院所進行半結構式訪談，質性資料以主題分析法進行編碼，後以社會生態模式（SEM）分析障礙因素，並結合 CFIR 架構歸納跨院所可複製的關鍵成功因素，再透過聚類分析進行雙重驗證。 結果（Results）:趨勢分析顯示乳癌與子宮頸癌之篩檢率與陽性追蹤率整體呈逐年改善，但縣市間差異持續存在，包括篩檢單位密度、確診可近性與巡迴服務覆蓋率均呈現不均。質性分析發現多層次障礙，包括健康識能不足、恐懼與疼痛預期、交通與時間限制、院內人力與流程負荷、設備空間與資訊系統不足、申報規定或誘因設計限制等。而根據院所在克服障礙過程中逐步制度化的經驗中，歸納出高績效院所普遍展現三項關鍵成功因素：（1）資訊支援與永續人力；（2）流程優化與資源彈性；（3）健康識能與心理支持策略。 結論（Conclusion）:本研究提供連結政策推動、資源配置與組織執行歷程的整合性分析視角，補足過往研究多聚焦於障礙的不足，並透過高績效院所提出具可複製性的關鍵成功因素。研究結果有助於強化癌症防治政策的設計，亦為醫療院所提供可行的策略，以促進婦癌篩檢與陽性追蹤服務的品質及效率。

Background: Breast and cervical cancers remain major contributors to the cancer burden among women in Taiwan. Despite the implementation of multiple national screening and follow-up programs, substantial variations persist across counties and healthcare institutions in screening coverage, positive follow-up rates, and five-year relative survival. Existing literature has largely emphasized barriers to screening and follow-up, with relatively limited attention to “successful practices” and the organizational processes that enable high performance. Furthermore, there is a lack of multi-level integrative analyses that link policy design, resource distribution, and institutional operations. Objective: This study aims to integrate quantitative trends with qualitative interview data to map regional disparities in breast and cervical cancer prevention outcomes in Taiwan, and to identify key success factors adopted by high-performing institutions during screening and follow-up processes. The findings aim to inform actionable strategies for both policy development and organizational implementation. Methods: This study consisted of two components. The quantitative analysis examined county-level breast and cervical cancer screening rates, positive follow-up rates, and five-year relative survival from 2010 to 2023 (Years 99–112), assessing temporal trends and regional differences. The qualitative component adopted purposive sampling to recruit healthcare institutions with outstanding screening and follow-up performance for semi-structured interviews. Data were coded using thematic analysis. Barriers were analyzed using the Social Ecological Model (SEM), and cross-institutional key success factors were synthesized using the Consolidated Framework for Implementation Research (CFIR), with cluster analysis applied for triangulation. Results: Trend analyses revealed overall improvements in breast and cervical cancer screening and positive follow-up rates, yet persistent regional disparities remained. Counties varied notably in screening unit density, access to diagnostic services, and mobile screening coverage. Qualitative findings identified multi-level barriers, including low health literacy, fear and anticipated pain, transportation and time constraints, workforce and workflow burdens within hospitals, limited space or equipment, inadequate information systems, and regulatory or incentive-related constraints. From the institutionalized practices used to overcome these challenges, three cross-cutting key success factors emerged among high-performing institutions: (1) robust information support and sustainable workforce capacity; (2) streamlined workflows and flexible resource allocation; and (3) health-literacy–oriented and psychologically supportive patient engagement strategies. Conclusion: This study provides an integrated perspective linking policy implementation, resource distribution, and organizational processes, addressing gaps in prior research that focused predominantly on barriers. By highlighting replicable key success factors from high-performing institutions, the findings offer evidence-informed guidance for enhancing cancer prevention policies and supporting healthcare organizations in optimizing workflows, strengthening team coordination, and improving patient-centered support. These insights can contribute to improving the quality and efficiency of women’s cancer screening and positive follow-up services in Taiwan.