探討大腸鏡檢查滿意度與追蹤意願之相關性

Abstract

背景：根據國民健康署統計，民國95年以來大腸癌，為所有癌症發生人數的第一名，每年發生人數約計14,000人，每年因大腸癌死亡人數超過5,000。早期發現大腸直腸癌前病變及去除癌前病變降低大腸癌發生率。早期發現大腸直腸癌，增加存活率及可下降大腸癌死亡率。糞便潛血檢查是篩檢大腸癌方法之一，糞便潛血檢查陽性個案需大腸鏡檢查確診。大腸鏡檢查是公認診斷大腸直腸癌最好的工具，在大腸鏡檢查的同時也可以進行治療。國內，大腸癌篩檢全國僅有約33%，大腸癌篩檢為陽性個案，接受後續確診率約60%，糞便潛血檢查陽性個案大腸鏡檢查確診率低仍有很大的努力空間。大腸直腸癌篩檢後，根據大腸直腸癌的篩檢與追蹤的指引，病人需進行後續大腸鏡追蹤檢查。但是在進行大腸鏡檢查時，患者往往會覺得，腹部脹，腹痛和不適，這也是一般民眾恐懼大腸鏡檢查的最大原因之一。提升糞便潛血檢查陽性個案接受後續確診率及根據大腸直腸癌指引後續大腸鏡追蹤檢查是提升大腸癌防治及治療成效的重要問題。 目的：研究目的是由顧客的觀點來評量，顧客對大腸鏡檢查之了解及實質需求，並從中探討為顧客創造更具價值的大腸鏡檢查服務需求。希望提供研究單位作為提升大腸鏡鏡檢服務品質之依據及進一步提升顧客對大腸鏡檢查篩檢意願及追蹤意願。 方法：自擬式結構性問卷作為滿意度調查之研究工具。問卷內容包含人口基本資料，就醫屬性，大腸鏡檢查前衛教及準備，檢查過程中流程及感受，大腸鏡檢查之整體滿意度，大腸鏡追蹤之意願。 個案的收集以新北市某地區教學醫院為收案場所，45至75歲之間病患，收案時間由107年5月至107年9月，採立意取樣進行滿意度調查。本次研究共發出300份問卷，回收300份問卷，剔除填答不完全的問卷後，共294 份有效問卷進行統計分析。 結果：研究結果顯示年齡、性別、教育程度、、就醫動機、過去檢查經驗、本次檢查醫療處置與大腸鏡檢查滿意度無相關。職業、居住地、本次檢查麻醉方式與大腸鏡檢查滿意度有部份相關。年齡、教育程度、職業、居住地與再次接受大腸鏡檢查意願無相關。男性再次接受大腸鏡檢查意願高於女性。大腸直腸癌增加性風險群、未曾接受過大腸鏡檢查者、再次接受大腸鏡檢查意願有相關。 結論：研究結果顯示男性、大腸直腸癌增加性風險群、未曾接受過大腸鏡檢查者與再次接受大腸鏡檢查意願有相關。87.4%的就醫民眾願意再次接受大腸鏡檢查。

Background: Cancer is the first leading cause of death in Taiwan, from 2007 to now colorectal cancer has taken the first place in incidence of cancer and more than 5000 people had die from colorectal cancer every year. Early colon cancer had no specific symptom, early detection and treatment of precancerous lesion of colon and rectum, reduced incidence of colorectal cancer incidence. Early detection and treatment of colorectal cancer will reduce colorectal cancer mortality and may improve survivor. In Taiwan colon cancer surveillance program by iFOBT (immunochemical Fecal Occult Blood Test) with colonoscopy examination for those iFOBT positive person fulfil for early detection and treatment of precancerous lesion of colon, rectum and colorectal cancer. But according to National Health Bureau statistic data only 33% of population age between 50 to 70 years in Taiwan received iFOBT surveillance and only 60% of positive iFOBT followed colonoscopy examination, relatively low follow up colonoscopy examination rate. Further need to enhancing colonoscopy follow up is needed. According to Guidelines for colonoscopy surveillance after screening and polypectomy, patient need follow up colonoscopy at different interval.Discomfort and pain during colonoscopy examination is factors to overcome to increase screening colonoscopy and follow up colonoscopy . Objective: .To search factors effecting patient satisfaction during colonoscopy and relationship between patient satisfaction and willingness to come back colonoscopy. To enhance colon cancer screening and follow up colonoscopy Method: We use self-structured questionnaire to measure factors effecting satisfaction for colonoscopy and willing to come back colonoscopy again. Patient satisfaction questionnaire for analysis included patient demographic, reason for colonoscopy, understanding of pre-colonoscopy preparation, satisfaction during colonoscopy,overall satisfaction and willing to come back again for colonoscopy. The study was conducted at New Taipei regional teaching hospital, patients age between 45 to 75 years old were included, 300 questionnaire were collected from patients who had colonoscopy during 2018 May to september and exclude uncompleted questionnaire. The 294 questionnaire were conducted statistical analysis. Result: This study found age, sex, education levels, aim of colonoscopy examination, past colonoscopy experience and therapeutic manipulation during colonoscopy had no correlation with colonoscopy satisfaction. The occupation, residents, method of colonoscopy (anesthesia or non- anesthesia) had partly related to colonoscopy satisfaction. The age, education level, occupations, and residents were not associated with willing to come back colonoscopy again. The Male sex, higher colon cancer risk population, past colonoscopic experience had associated with willing to repeat colonoscopy. Conclusion: Patient satisfaction is key factor of patient loyalty and willing to come back for colonoscopy. The Male sex, higher colon cancer risk population, past colonoscopic experience had associated with willing to come back again for colonoscopy. The 87.4% of patient in our study had willing to come back again for colonoscopy.