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題名 | 個案管理過程藉由PRECEDE模式評估癌症病人中斷治療影響因素=Understanding Discontinued Treatment through the PRECEDE Model |
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作者姓名(中文) | 周淑嵐; 林玉芬; 林梅香; 姜亭妤; 王靜婷; 王昭慧; | 書刊名 | 腫瘤護理雜誌 |
卷期 | 19:1 2019.06[民108.06] |
頁次 | 頁49-63 |
分類號 | 419.77 |
關鍵詞 | 個案管理; 中斷治療; PRECEDE模式; Case management; Discontinued treatment; PRECEDE model; |
語文 | 中文(Chinese) |
中文摘要 | 前言:癌症為十大死因之首,早期診斷且接受完整的治療可提升治癒率。中斷治療的結果會影響治療的預後,造成疾病復發和轉移機率增加,且耗費社會醫療成本。故了解無法完成治療的原因供參,以提昇照護醫療品質。目的:在個案管理過程中運用PRECEDE模式探討癌症病人中斷治療的原因。方法:採用回溯性次級資料分析研究設計,分析2010至2012年間,某醫學中心「癌症中心個案管理資訊系統」的十大癌症當年度新診斷病人資料,運用邏輯式迴歸分析進行多變項分析。結果:14974位癌症個案資料中,中斷治療有812人(5%),歸納中斷治療有四大因素:一、社會人口學變項及臨床指標:年齡(41-50歲)、喪偶、美國東岸癌症臨床研究合作組織(Eastern Cooperative Oncology Group Performance Status),簡稱ECOG體能評估分數、病情變化、最初診斷期別;二、(前傾因素)對治療的知識、態度及信心不足:害怕治療副作用(p < 0.001);三、(增強因素)缺乏支持系統;缺乏家庭支持系統(p < 0.001)及醫病關係(p < 0.001);四、(使能因素)資源可近性及可用性:經濟差(p < 0.001)及交通不便(p < 0.001)。結論/實務應用:個案管理過程中,提供治療的資訊及照護注意事項、良好醫病關係、社工及連接社區資源、建立醫院間個管師的聯繫管道作後續治療追蹤,依各癌別特性規劃主動電訪時間,讓病人能立即得到關心及正確資訊,並協助解決或改善無法完成治療的原因,幫助病人重返醫院完成治療。 |
英文摘要 | Introduction: Cancer is the leading cause of death in Taiwan. Early diagnosis and treatment adherence may improve treatment outcome. The consequences of discontinued treatment include poor prognosis resulting in increased risk of recurrence and metastasis, as well as additional healthcare costs to society. Therefore, it is important to better understand the factors associated with discontinued treatment. The finding will provide insights to the clinical care to improve the healthcare quality for cancer patients. Purpose: The PRECEDE model was used as a framework to explore the factors that caused cancer patients to discontinue treatment during the case management. Methods: This is a retrospective literature review analyzing data from a cancer case management information system from 2010 to 2012. Multiple logistical regression models were used to analyze factors associated with interruption of treatment. Results: A total of 14,974 cancer patients met the inclusion criteria for analyses. Among them, 812 patients (5.4%) discontinued treatment. The study shows four major factors such as (1). the social demographic variables and clinical indicators - age (41-50), widowed, ECOG, changes in medical condition and clinical stage; (2). the predisposing factors (awareness of the disorder, attitude towards treatment, level of understanding of the disease prognosis, and confidence in treatment) - concerns about adverse effects (p < 0.001); (3). the reinforcing factors (patients' social support system) - poor family support system (p < 0.001) and the physician-patient relationship (p < 0.001); and (4). enabling factors (Resource accessibility and availability) - financial limitations (p < 0.001), transportation difficulty (p < 0.001). Conclusions / Implications for Practice: this study hopes to provide knowledge on disease and treatment, on methods to manage complications, good patient-physician relationship, timely referrals to social workers and connection to community resources. We also hope to share the experiences on how to establish inter-hospital and case manager communication mechanisms to enhance the follow-ups on patient treatments to determine the characteristics of each cancer and control the timing of telephone consultation which will enable the patient to receive care and correct information, and to help resolve or improve the inability to complete the treatment and assist the patient to return to hospital to complete treatment. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。