癌症診療品質認證對醫護人員可能影響之探討

Abstract

背景：癌症是全球第二大死亡原因，亦是我國十大死因之首；癌症不僅對個人及其家庭造成經濟負擔與身心靈壓力，亦對社會整體造成難以估計的生產力與經濟等損失。為提供國人高水準之癌症照護，行政院衛生署國民健康局自民國97年起，針對每年新診斷癌症個案病例數達五百例以上的醫院，施行癌症診療品質認證作業，希望藉此提升國內整體癌症照護的品質。 目的：探討醫院參與癌症診療品質認證的過程中，對癌症多專科團隊成員產生之影響，經由統整癌症多專科團隊的陳述與建議，以期給予相關單位在日後認證基準項目上的修訂與更新，能更符合實情、更貼近基層人員的意見與情況。 方法：本研究使用個人深度訪談進行資料的蒐集，以半結構式訪談大綱作為指引，受訪者為通過癌症診療品質認證醫院的癌症多專科照護團隊，根據其在團隊中的角色分為團隊負責人與團隊成員，至資料飽和後停止招募受訪者。使用N-Vivo質性分析軟體協助訪談資料的處理與分析。 結果：本研究共計21人參與研究，包含5位團隊負責人、16位團隊成員。研究結果發現，在參與過程中，團隊遇到的內部困難有「成員間溝通問題」與「人力吃緊」，外部困難有「要準備的東西很多」與「評審意見不統一」；而解決的方式，提及次數最多為「多次溝通磨合」與「制訂符合團隊內部的標準流程」。參與認證的正面影響，在團隊層面包含「促成團隊溝通」與「內部的自我審視」，醫院層面則有「提升癌症照護品質」與「癌症治療有依據可循」；在負面影響方面，包含「工作負荷變大」、「壓力很大」與「感到疲憊」。 結論：多數受訪者認為癌症診療品質認證的正面影響多於負面影響。癌症診療品質認證對醫院的癌症照護品質、癌症多專科團隊的整合與溝通、內部流程的改進、個人成長以及醫院知名度等方面皆有正向助益；然而，癌症診療品質認證產生的負面影響包含增加相關人員的工作負荷、感到壓力與倦怠、削減照護病人的時間等。

Background: Cancer is the second leading cause of death in the world. According to Ministry of Health and Welfare of Taiwan, cancer is the top cause of death in Taiwan. Cancer not only causes financial burden and body-mind-spirit pressure on individuals and their families, but also causes inestimable productivity and economic losses to the whole society. In order to provide high-quality cancer care in Taiwan, Ministry of Health and Welfare has implemented “Cancer Care Quality Accreditation Program” for hospitals that have more than 500 new diagnosed cases of cancer each year since 1998. Objective: Focus on hospitals that participate in Cancer Care Quality Accreditation Program, and explore potential impact of the program among members of cancer multidisciplinary team. Through the integration of the statements provided by the members, hoping that it will be able to help government to make updates of the certification rules in the future, and the rules will be close to the actual opinions and situation of the health care providers. Methods: A Qualitative research. Data was collected by personal in-depth interviews, guided by the semi-structured interview outline. All of the interviewees are member of cancer multidisciplinary team in hospital that passed Cancer Care Quality Accreditation. Use NVivo software to assist in data processing and analysis. Results: A total of 21 people participated in the study, including 5 team leaders and 16 team members. The results found that during the participation process, the internal difficulties encountered by the team included 'communication problems between members' and 'shortage of human resource', and external difficulties included 'too many things to be prepared' and 'inconsistent opinions of judge members'. The team's solutions of the difficulties are 'have more communication' and 'make the standard operation procedure of the team'. The positive impact of participation in accreditation includes 'promoting team communication' and 'internal self-examination' at the team level, and 'improving cancer care quality' and 'cancer treatment can based on the guideline' at the hospital level. And the negative impact includes 'increased workload', 'stressful' and 'exhausted'. Conclusion: Most of the interviewees believe that Cancer Care Quality Accreditation Program is of great help to the quality of cancer care in the hospital, and it can have positive effects, such as the integration and communication of the cancer multidisciplinary team, the improvement of internal procedure of the team, personal growth, and hospital reputation. However, the negative effects of Cancer Care Quality Accreditation Program include increasing the workload of health care providers, feeling burnout and stress, and reducing the time to care for patients.