大腸直腸癌病人就醫經驗與復發擔憂之相關性探討

Abstract

背景與目的：大腸直腸癌為國人癌症發生率中最高的，為了提升癌症照護與醫療品質，以癌症病人為中心的照護被提倡可以提供高品質的癌症醫療照護，同時，以癌症病人為中心的照護也被台灣癌症診療品質認證作為衡量癌症照護品質的項目，近年來，以病人報告為結果的測量方式(PROMs)逐漸被發展，病人主觀感受的醫療品質可以做為醫療照護服務接受者對於所接受到醫療品質優劣的評價，其中，以癌症病人就醫經驗調查最受到推崇，由於癌症病人的經驗評價可以避免過去在調查病人滿意度時，會受到病人喜好和期望的影響，可以較準確判斷癌症照護品質的優劣。復發擔憂是癌症存活者表示在其癌症治療結束後最大的未被滿足需求及困擾，因為復發擔憂會造成癌症病人生活品質的下降及過度使用醫療資源，變向增加全民健保的財務負擔及排擠其他醫療服務需求者的權益，若能了解癌症病人就醫的經驗對於其後續復發擔憂的影響，可以作為政府機關及醫療服務提供者做為癌症照護品質提升的發展策略參考，因此本研究欲探討癌症病人就醫經驗與其害怕復發之現況及其相關性。 研究方法：本研究為橫斷性研究，收案對象為接受過癌症相關治療的大腸直腸癌存活者，有效樣本為124份，收案期間為2015年3月10號至6月30號，問卷採用癌症病人就醫經驗問卷(CPES)及復發擔憂短版問卷(FoP-Q-SF)作為調查工具，在就醫經驗的部分將癌症病人在醫療過程中實際感受到的經驗轉換成構面的百分比來計算，在復發擔憂的部分採用Likert五點尺度的方式作為程度高低的分數加總，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、皮爾森績差相關及複迴歸方法做資料分析。 研究結果：在病人特質與疾病特性的部分，大腸直腸癌病人的癌症是否復發、工作狀態、長期性症狀數目、共病症數目、癌症治療後的反應與其復發擔憂之間存在統計上的顯著關係。在大腸直腸癌病人就醫經驗的構面當中，控制其他變項後，病人在就醫過程中接受到以病人為中心的照護經驗、醫病間的溝通經驗、癌症資訊的提供及社會支持、病人參與治療決策與照護計畫與其復發擔憂存在統計上的顯著相關。經由逐步回歸(Stpewise)分析後的結果發現，在醫病間的溝通經驗與病人參與治療決策與照護計畫達統計上的顯著意義。 結論：在大腸直腸癌病人的就醫經驗中，以病人為中心的照護正向經驗、醫病間溝通的正向經驗、癌症資訊的提供及社會支持的正向經驗及病人參與治療決策與照護計畫的正向經驗與其復發擔憂的程度呈現負向的相關。在進一步的分析後，醫病間溝通的經驗及病人參與治療決策與照護計畫的經驗是最重要的兩個變項，建議在大腸直腸癌病人的癌症治療過程中，可以重視醫療人員與病人間的溝通狀況及是否需要溝通的橋梁，並在情況允許下，讓病人可以參與自己的治療決策和尊重病人的喜好，以減緩癌症病人對於自身癌症復發或病程進展的擔憂。

Background: In Taiwan, the annual incidence of newly-diagnosed colorectal cancer is in first place. In order to improve the quality of cancer care, cancer patient-centered care has been advocated to provide a high-quality cancer care, also became an evaluation included in Taiwan cancer care quality accreditation. In recent years, patient-reported outcome measures (PROMs) has been developed, patient subjective perception the quality of cancer care can be used as recipients for the receive medical care quality evaluation of the merits. However, the cancer patient experience survey is the most popular method, because it can avoid the previous cancer patient satisfaction survey would influenced by patient favor and expectation. Fear of recurrence is among the most commonly reported problems and one of the most prevalent areas of umet needs for cancer survivors, it will cause cancer patients to decrease quality of life and overuse medical resources, changing to increase the financial burden on national health insurance and other marginalized health care needs of those rights. This study attempt to explore the relationship among patient reported experience and fear of recurrence in patients with colorectal cancer. Method: This is a cross-sectional study. The patients were recruited at 12 hospitals in Taiwan and 2 non-governmental organizations. All samples came from convenient sampling. There were 124 valid samples with collection period from March 10th to June 30th, year 2015. The questionnaire use Cancer Patient Experience Survey (CPES) and Fear of Progression Questionnaire - Short Form (FoP-Q-SF) as an investigative tool. In CPES, the cancer patient during a medical procedure practical experience, is converted into a percentage calculated under dimensions. In FoP, using the sum of Likert five-point scale as the scores of high and low degree. The data is analyzed by methods of descriptive analysis, independent-samples T test, one-way ANOVA, Pearson correlation underperformance and multiple linear regression. Results: In the part of the patient characteristics and disease characteristics, there is a statistically significant relationship between cancer recure, working conditions, the number of long-term symptoms, the number of comorbidities, the reaction of cancer after treatment with their fear of recurrence. In the part of medical treatment experience, controlling for other variables, the patient receives a patient-centered care experience in the process, communication experience with healthcare givers, hospital providing social support and cancer information, patient involvement in treatment-related decision-making and care planning are significant. Results via stepwise regression analysis found that communication experience with healthcare givers and involvement in treatment-related decision-making and care planning are significant. Conclusion: The colorectal cancer patients’ medical treatment experience during treatment, and there is a correlation between fears of recurrence. The positive treatment experience in patients with their fear of recurrence of exhibits negative correlation. After further analysis, communication experience with healthcare givers and involvement in treatment-related decision-making and care planning are the two most important dimensions. It is recommended during cancer treatment of colorectal cancer patients, we can pay attention to the patient-physician communication and physicians share the decision-making and care planning so that the patient can participate in their own treatment decisions and respect the patient's preferences, in order to decrease the cancer patients for cancer recurrence or progression of their own concerns.