探討醫師使用乳癌核心測量指標之影響因素 -以計畫行為理論為例

Abstract

過去有許多國內外文獻討論照護指標的使用，對於病患的照護過程以及照護結果的影響，並且討論指標是否被使用的原因，然而，以醫師本身的態度及行為作為主要探討對象的研究，仍不多見。因此，本研究嘗試使用計畫行為理論作為醫師行為之研究架構，討論醫師之態度、主觀規範以及知覺行為控制如何影響醫師之行為意向及運用現況，作為未來推行醫護人員應用照護指標之參考。 本研究使用結構式問卷，以橫斷式問卷調查，從國內參與癌症登記與通過癌症品質認證的醫院中立意取樣了與乳癌照護相關的醫師做為研究對象，人數以願意回覆之醫生為主，無設定上限及下限人數，從2010年六月至十月底，共回收187份醫師問卷(回收率33.7%)做為資料分析來源，研究使用結構方程模式作為分析方法來討論影響醫師參考及應用台灣乳癌核心測量指標之影響因素。 在研究結果方面，分析發現，大部分計畫行為理論的構面之間皆有顯著相關，並且醫師的背景特質也對於其使用指標的行為有顯著的影響，而透過結構方程模式的分析結果可以得知，想要使醫師產生使用乳癌核心測量指標之行為，必須先使其產生行為意向，而行為意向又受態度、主觀規範以及知覺行為控制所影響，尤以態度影響較為明顯。 根據研究結果，如何讓醫師願意使用已建立之醫療指引，政府或主管機關應該要建立一個完全支持的環境，不管在人、事、物方面，整體改變醫師對臨床指引之態度、主觀規範及所感受到之知覺行為控制，才能夠有效的透過其行為意向，進而影響醫師行為，達到進而提升癌症照護品質之目的。

Many references are discussing both the influence of application of clinical indicators on the process and outcome of patient care, and whether physicians’ choice on the application of those indicators. However, only few studies discussed the physicians’ attitude and behavior. This study attempts to apply Theory of Planned Behavior for understanding the relationship among the physicians’ attitude, subjective norm, perceived control, the physicians’ intention and behavior to use the breast cancer core measure set in Taiwan. We expected this study can provide an effective model for medical professionals an evidence to put the theory and principles into practice. The study proceeds cross-sectional survey by using structured questionnaire. This study purposeful sampled the physicians in breast cancer who work in the hospital that passed the cancer quality certification as the study object. It is voluntary base with no limit of cancer care physician numbers in each hospital. The completed response questionnaires were included for analysis in the study with the collection period from June to October, 2011. There are 187 physicians involved into the research with response rate of 33.7 percent. Structural equation model was applied to elaborate the factors of influencing physician’s intention and behavior in applying core measure indicators of breast cancer. The result shows that almost every dimensions of the theory have significant relationship between each other. In addition, the characteristics of physicians also affect their behavior. Through the structural equation model, if we want to make physicians imply the core measure set we must make them have intention to do it. Physician’s intention was affected by attitude, subjective norms, and perceived control, where attitude was the most influential factor. As the result, government could establish a totally supportive environment in hospital from whatever resources to facilitate the medical professionals to use the already built clinical guidelines and change their attitude, subjective norms, and perceived control. In other words, only through improving the awareness of the attitude during physicians’ school time, or refer users’ opinion to modify the guidelines properly, we can effectively change the physician’s behavior to serve the purpose in improving cancer care quality.