頭頸癌癌症存活者支持性照護需求與生活品質之間關係的探討

Abstract

背景:癌症自1982年起為十大死因之首，而隨著癌症存活者的人數不斷增加，癌症治療存在著治療後延遲效應(Late effects)，且長時間下來受限於人力和資源等因素影響，便逐漸被忽略，但其實仍存在著未被滿足的支持性照護需求，台灣是全世界口腔癌發生率最高的國家之一，頭頸癌位居台灣十大癌症第六，並且是台灣25歲至44歲男性死於癌症的主要原因。因此，本研究希望能利用服務品質模式的設計架構，探討擴大頭頸癌癌症存活者人口學變項、疾病變項與支持性照護需求和生活品質之間的關聯。 目的:(1)驗證頭頸癌癌症存活者病人心中期望的支持性照護需求與實際感受的支持性照護需求之間是否有差異並分析造成缺口的原因。(2)探討心中期望的支持性照護需求與實際感受的支持性照護需求之間的落差跟生活品質之間的關係。 方法:本研究為橫斷面研究，採自填式問卷調查，以某頭頸癌病友團體和台灣北部某公立醫學中心和雲林分院之腫瘤醫學部和耳鼻喉部為研究收案單位，研究對象為接受完治療的頭頸癌病患，研究期間為民國110年2月18日至民國110年5月12日期間，共發出241份問卷，回收234份問卷，而有效問卷共220份，研究工具包括:支持性照護需求(SCNS-ST9)、華盛頓生活品質(UW-QOL V4)和基本人口與臨床變項等。 結果:每個服務品質構面的差距分數為負值，Wilcoxon rank-sum test檢定分析結果發現期望與感知間存在顯著差異。透過IPA分析後會發現落在第一象限為健康系統與資訊需求；第二象限為心理需求；第三象限為生理日常需求；第四象限為病患照護與支持需求。感知的支持性照護需求(生理日常需求、健康系統與資訊需求和病患照護與支持需求和落差(感知-期望)支持性照護需求與生活品質呈現顯著正相關，而期望的支持性照護需求則與生活品質呈現顯著負相關。迴歸分析結果，感受的支持性照護需求構面與生活品質未達統計顯著，而落差的支持性照護需求構面中心理需求與生活品質呈現顯著正相關。放入期望、感受和落差的支持性照護需求可得，心中期望心理支持性照護需求和感受病患照護與支持需求對於生活品質來說是相當重要的。 結論:SERVQUAL可以以病人的觀點看支持性照護需求之間的落差，藉以弭平頭頸癌存活者期望的支持性照護與實際支持性照護間的差距，由於頭頸癌疾病特殊性，建議可以於癌症治療前安排心理師的輔助諮詢服務，以弭平病患對於治療照護效果認知上的落差，並更能實踐以病人為中心之癌症照護模式。

Background: Since 1982, cancer has been ranked top of death. The number of cancer survivors continues to increase due to the early detection and effective treatment of cancer. Cancer treatment has late effects after treatment, and it is gradually ignored due to human resources and other influences for a long time, but there is still an unmet need for supportive care. Head and neck cancer (HNC) has become a burden in Taiwan, especially with oral cancer becoming one of the highest incidences in the world. Therefore, this study attempts to use the design framework of the service quality model to explore the relationship between the need for supportive care, the patient characteristics and disease characteristics of head and neck cancer survivors, and the quality of life. Objective: The purpose of this study are (1) To verify whether there is a difference between the expected supportive care needs and the perceived supportive care needs in head and neck cancer survivors and analyze the reasons for the gap (2) To explore the relationship between the gap between the expected supportive care needs and perceived supportive care needs and the quality of life. Methods: This is a cross-sectional study and adopts a self-report questionnaire to collect data. Patients were eligible if they had a cancer diagnosis and had completed first-line cancer treatment. Also, this research was a result of cooperation with the Taiwan Head Neck Cancer Association and 2 hospitals in Taiwan. Data was gathered from February 18th, 2021 to May 12th, 2021, the 226 patients were enrolled and assessed by self-report questionnaires including the form basic demography and disease informative, the nine-item Supportive Care Needs Survey-Screening Tool (SCNS-ST9), and the Chinese version of the University of Washington Quality of Life Scale (UW-QOL V4). Result: The differences between perception and expectation in four dimensions of Supportive care needs were significant. Based on IPA analysis, it is found that the first quadrant is the health system and information needs; the second quadrant is the psychological needs; the third quadrant is the physiological daily needs; the fourth quadrant is the patient care and support needs. The results showed that the perceived supportive care needs and the unmet supportive care needs are significantly positively correlated with quality of life, while expected supportive care needs are significantly negatively correlated with quality of life. Multiple linear regression analysis results show that the perceived supportive care needs dimension and quality of life are not statistically significant, while the psychological needs in the unmet supportive care needs dimension are significantly positively correlated with the quality of life. Finally, using stepwise regression analysis, it is found that the expectation of psychological supportive care needs and health systems and information supportive care needs are very important for the quality of life. Conclusion: SERVQUAL can see the difference between supportive care from the patient's point of view. It is recommended to arrange a psychologist's counseling service before cancer treatment due to the specificity of head and neck cancer, to alleviate the gap in patients' perception of treatment and care effects, and to better practice the patient-centered cancer care model.