國家癌症防治五年計劃評估初探－從利害關係人角度探討

Abstract

背景與目的：為了全面有效防治癌症，在各國也積極發展癌症防治計畫，都希望能透過癌症防治計畫提升民眾防癌能力，降低癌症的發生率及死亡率。在台灣，推動國家癌症防治計畫整體評估計畫分別針對嚼檳榔介入措施、篩檢認知、篩檢成果，以及癌症病友與安寧共同照護服務等計畫進行整體性的成果評估。透過計畫評估，由利害關係人觀點所建構的政策問題，能提高政策之合理性及可行性，過去對於癌症防治計畫的評估也多來自於官方的自我評估，對於利害關係人如計畫的癌症防治相關人員、參與的病友團體或一般民眾對於此政策的看法、意見未在過去研究中加以說明，若能深入瞭解相關利害關係人對癌症防治計畫之認知、態度及行為，可以做為政府相關單位擬定相關發展策略之參考，所以本研究欲探討利害關係人之個人特質如何影響其對癌症防治計畫知識、態度及行為之現況及了解其相關性。 研究方法：本研究為橫斷性研究，問卷對象主要分為三類： (1)醫院之癌症防治中心主任及六癌多專科團隊負責人(2)病友(3)民眾，收案期間為2012年8月3日至2012年10月10日，測量量表為自擬式問卷，以李克式量表(Likert Scales)作為計算方式，李克式量表為評分加總式量表最常用的一種，屬同一構面項目用加總方式來計分，本研究將收集到的資料以描述性分析、獨立樣本T檢定、單因子變異數分析、皮爾森積差相關及複迴歸方法分析資料。 研究結果：不同利害關係人對於國家癌症防治計畫的認知、態度及行為差異，在病友方面，女性、年齡較大、教育程度較高者對於國家癌症防治計畫有較好的認知；已婚、年齡較大、教育程度較高、沒有工作者對於國家癌症防治計畫有較好的態度；已婚、年齡較大、教育程度較高、月收入較高、健康狀況較好者對於國家癌症防治計畫有較佳的行為表現。在民眾方面，女性、教育程度較高、居住地都市化程度高、健康狀況較好者對於國家癌症防治計畫有較好的認知；年齡較高、教育程度較高、居住地都市化程度較高、沒有工作、健康狀況較不好者對於國家癌症防治計畫有較好的態度；已婚、年齡較高、教育程度較高、居住都市化程度高、沒有工作、健康狀況較好者對於國家癌症防治計畫有較佳的行為表現。 結論：國家癌症防治計畫之認知與態度成正相關；國家癌症防治計畫之認知與行為表現成正相關；國家癌症防治計畫之態度與行為表現成正相關；國家癌症防治計畫之認知、態度與行為表現成正相關。在質性分析方面，專家認為癌症防治內容對於民眾教育宣導端投入不足，以致民眾認知不足，需加強中小學健康生活習慣觀念養成及癌症預防課材編製；人力配置不足，許多醫院癌症相關人力培訓成本主要由醫院自行吸收，整體而言，不論是癌症照護從業人員或是病友民眾，對於國家癌症防治計畫上之宣導與推動感到肯定與支持。

Background: To enhance the prevention of cancer effectively, many countries around the world are hoping that people can elevate their ability to keep away from cancer as well as decrease the incidence and mortality through cancer control program developed by government. In Taiwan,there are some procedures helping to promote the overall assessment of national cancer control programsuch asintervention of chewing betel nut, knowledge of screening, results of screening,results of the assessmentin the care services for cancer patients as well as palliativecare services,and so on.Therefore, to build a policy from the perspective of stakeholders can improve the rationality and feasibility of it. In the past, the evaluation of cancer prevention program mostly come from the official self-assessment. In short, some other people who really involved do not have opportunity to express their opinions about the policy. To sum up, it can be a useful agencies for government to develop related strategies if we can understand how relevant stakeholders think of the plan for cancer prevention from three perspectives-knowledge, attitude, and behavior. Method:This cross-sectional studysurveyed three categories: (1) Cancer Control Center director and six cancer multidisciplinary team leader in hospital (2) patients (3) people from August 3, 2012 to October 10, 2012, the measurement scale for the self-report questionnaire to Likert Scales as calculated, Likert Scales as the sum of scoreand the most commonly used, the author used descriptive statistics, independent sample T-test, one way ANOVA, Pearson correlation and multiple regression analysis to examine the collected data. Result:There aredifference resultsfor national cancer control program knowledge, attitude and behavior betweendifferent stakeholders.Females, older, high-educated patients have more national cancer control programs knowledge. Married, older,no jobs,high-educated patients have more positive national cancer control program attitude. Married, older,high-educated, more monthly income, better health status patientshave better national cancer control program behavior. Besides, females, degree of urbanization, better health status, high-educated people have more national cancer control programs knowledge. Older, degree of urbanization, no jobs, poor health status, high-educated people have more positive national cancer control program attitude.Married, older, degree of urbanization, no jobs, better health status, high-educated people have better national cancer control program behavior. Conclusion:There arepositive correlations between national cancer control program knowledge and attitude, national cancer control programknowledge and behavior, national cancer control program attitude and behavior,national cancer control program knowledge, attitude and behavior. In the qualitative analysis, experts believe that the promotion of educating people about the contents of cancer control is inadequatethat leads to the lack of cancer awareness among people.It is necessary to enhance the concept of living healthy and to bring the materials of the cancer prevention into classes in the primary and secondary education.Besides, staff shortage is a problem that many hospitals have to make the human training budgeted andthe cost is borne by themselves.Above all, the advocacy and promotion of the national cancer control program has been affirmed and supported by cancer care practitioners or patient or public.