病患參與治療決策之探討--以乳癌婦女為例

Abstract

研究目的： 了解國內乳癌病患參與治療決策的偏好程度，及病患的實際參與情況，並更進一步探討影響乳癌病患參與治療決策之相關因素。 研究方法： 採用橫斷性調查研究法，以立意取樣的方式選取國內之乳癌病友團體，並以女性乳癌病友為分析單位，以結構式問卷為研究工具。資料收集期間自民國96年5月20日至6月20日，共發出800份問卷。 研究結果與建議： 共回收346份有效問卷(43.25%)。在參與治療決策的偏好中，偏好合作角色者最多，有156位(45.88%)；其次為被動角色，有123位(36.18%)；最少的是主動角色，有61位(17.94%)。在偏好合作角色者中，有118位(76.62%)希望能由自己、家人與醫師共同決定；29位(18.83%)希望是自己與醫師共同決定；7位(4.55%)希望是自己與家人決定。在偏好被動角色者中，希望由家人與醫師來幫忙決定治療方式的人最多，有68位(55.28%)；其次是由醫師決定，有53位(43.09%)；有2位(1.63%)則希望由家人幫忙決定。在實際參與的情況中，79.52%的受訪者表示，醫師有與她們討論各種適合的治療方式。整體而言，有241位(73.03%)受訪者認為自己有選擇治療方式的機會。在實際參與治療決策的程度方面，大部分病患的參與程度皆與自己所希望的相近，所佔的比例在40~60%之間。影響因素方面，在同時考慮疾病相關資訊及人口學特質的情況下，參與治療決策偏好的影響因素包括：教育程度及家族史兩項。實際參與治療決策的影響因素則包括：進行治療醫院之評鑑等級、病理期別、第一次治療至今期間、教育程度、居住狀況及職業。對於後續研究的努力方向，建議：1.同時將病患及醫療服務提供者納入考量2.以病患整體的治療過程為分析單位3.以不同疾病的病患為研究對象，以獲得關於病患參與治療決策偏好及實際情況更全面、完整的了解。

Purposes: The purposes of this study were to find out Taiwan women’s preferred and perceived participation in breast cancer treatment decision making, and explore their relatred factors. Methods: This is a cross- sectional study. Convenient sampling was applied to select breast cancer support groups in Taiwan. Data were collected from May 20th 2007 to June 20th 2007. A total of 800 questionnaires were distributed. Results and Recommendations: 346 (43.25%) patients were replied : 61(17.94%) preferred active role; 156 (45.88%) preferred collaborative role and 123 (36.18%) preferred passive role. Among those who preferred collaborative role, 76.62% want to make treatment decision with their doctors and families; 18.83% want to make decision with their doctors and only 4.55% want to make treatment decision with their families without doctors. Among those who preferred passive role: more than a half (55.28%) want to delegate the right to their doctors and families and only 1.63% delegate it to their families without doctors. Overall, 79.52% cancer survivors have discussed with their doctors about treatment options, 40 to 60% of women participated as much as they desired. Family history of breast cancer and educational level were factors that related to patients’ preference. Hospital accredited status, cancer staging, duration since first treatment, educational level, living condition and occupation were factors related to actual participation. Recommendations to further research: 1.considering both clinicians’ and patients’ view ; 2.taking patients’ whole course of treatment as unit of analysis; 3.focusing on different cancer, in order to obtain more comprehensive understanding about patient involvement in treatment decision making.