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1
題名:臺灣癌症中心病人面向的照護品質探討    
PATIENT-FOCUSED QUALITY OF CARE FOR CANCER CENTERS IN TAIWAN
著者:唐秀治(ST Tang) ;陳美伶(ML Chen) ;鍾國彪(KP Chung) ;賴美淑(MS Lai) ;鄭守夏(SH Cheng) ;邱秀渝(SYC Lee) ;邱昭華(CH Chiu) ;孔憲蘭(SL Koong) ;蕭淑純(SC Hsiao)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:病人面向的照護品質 ; 癌症照顧品質 ; 病人滿意度 ; 推薦醫院意願 ; Patient-perspective quality of care ; quality of cancer care ; patient satisfaction ; willingness to recommend
刊名:中華民國癌症醫學會雜誌
頁碼:7-21
語言:繁體中文
摘要: 中文摘要PDF ; 英文摘要PDF

世界各國於定義醫療照顧品質面向時,「以病人為中心」、「回應病人的需求」、「提供完整、連續、及適時的照顧」等漸成為重要指標,且實證證據顯示,對醫療照顧越滿意之病人,醫療處置遵從性越高,進而使醫療處置效益越佳,且對醫療照顧機構保持越高忠誠度,越有意願將照顧自己之醫療團隊介紹給有需要之病人。本研究藉由子宮頸癌、乳癌、肺癌、直腸結腸癌、肝癌及口腔癌病人主觀經驗,評值檢驗臺灣癌症中心專業人員於(1)告知癌症病人疾病相關訊息,協助病人做成最符合其利益之醫療決策的程度;(2)適當處理癌症疾病或治療所引發之副作用與影響,提昇癌症病人生活品質的程度;及(3)統整癌症病人治療經驗,使病人獲得具完整性、連續性、及適時性之癌症照顧程度;(4)並探討上述三項本研究所建立之「癌症病人面向」照顧品質指標,對癌病人整體評值其所接受到之照顧的滿意程度及願意將照顧自己之醫療團隊介紹給有需要的病人的影響。 本研究自九十四年四月二十日至九十五年七月三十一日,共電話訪談14家癌症中心,2,128位癌症病人(研究參與率為84.4%)。受訪病人高度肯定(>80%)在每一次與醫護人員的接觸中,均能感受到被尊重、自己或家人所提出的問題有被重視、醫護人員有足夠的時間照顧自己或回答自己所有的疑問,及有充分告知診斷訊息及疾病嚴重度,但對醫療專業人員曾與之討論疾病治療在情緒上,及對家人朋友關係上可能造成的影響;及當其經歷到此方面之困擾時,能獲得醫療人員足夠且適時的協助,感到最不滿意。但整體而言,仍對所接受到的醫療照顧感到很滿意(於1-4分量表中平均分教:3.47分),並且高度願意將他的醫療團隊介紹給其他需要的人(平均分數:3.41分)。 由多變項統計結果顯示,於控制了癌症病人之基本人口學及疾病屬性、病人對於參與醫療照顧決策之態度與經驗、診斷與醫院別、及病人之症狀困擾程度後,本研究所建立之三面向癌症病人照顧品質指標,「對所接受到的醫療照顧感到滿意程度」及「會將自己的醫療團隊介紹給其他需要的人程度」仍貢獻了最大程度之變異性解釋量(41.1%~41.4%),其中「被告知疾病訊息並於決定治療模式時被尊重程度」及「醫院能提供完整、連續、適時及適當對待病人之醫療照顧的程度」此二面向為最重要因素。由此研究結果,提供了各癌症中心未來可努力的方向。相對於病人之基本人口學及疾病屬性及診斷別等醫療專業人員無法操控之因素,滿足癌症病人被告知疾病訊息並於決定治療模式時被尊重的需求,並將癌症醫療照顧系統之運作,設計為可提供完整、連續、適時及適當對待病人之醫療照顧,將是提昇癌症病人滿意度及促使其願意推薦自己的醫療團隊給其他需要的人最具效益之方法。
Patient-centered care is widely endorsed as a central component of high-quality health care and gradually the patient's perspective has been incorporated into the assessment of effectiveness of cancer care. Empirical evidence showed that satisfaction with cancer care is associated with treatment compliance. Greater compliance, in turn, is associated with a better clinical outcome. In addition, there were strong relationships between patient satisfaction and loyalty to hospital and intention to recommend the Pospital. In order to improve the quality of cancer prevention, diagnosis and treatment, the Bureau of Health Promotion (BHP) launched and subsided 25 cancer centers since 2004 under the regulation of the Cancer Control Act. In order to evaluate the BHP's this new initiative and to keep in line with the worldwide trend of emphasis of patients' perspective in the assessment of quality of cancer care, this study was conducted to assess the subjective experiences of newly diagnosed breast, cervical, lung, colon-rectal, liver, and oral cancer patients as they interact with providers within the context of the health care system to evaluate how well the cancer centers in Taiwan function in the following dimensions: (1) information disclosure and respect for patients' preferences in treatment decision-making; (2) adequate management of side effects or impact induced by the disease or cancer treatments; (3) coordination of care, including timeliness, continuity, and comprehensiveness of care. We also analyzed how patients' experiences with care were related to their overall ratings of the quality of cancer care and their intention to recommend the health care team to other patients who may be in need of cancer care. From April 20, 2005 to July 31, 2006, a total of 2, 128 newly diagnosed cancer patients were telephone-interviewed from 14 cancer centers (response rate: 84.4%). Overall satisfaction was high (mean score=3.47, on a 1-4 Likert scale) and surveyed patients were highly willing to recommend their health care teams to other patients who may be in need of cancer care (M=3.41), but specific reporting questions revealed many areas for improvement such as concern and care of impact of the disease and treatments on their and their family members' psychological/social well-being and providing emotional support for themselves and their family members. Results from the hierarchical multiple regression analyses indicated that, after controlling for demographic and disease characteristics, attitudes towards and experiences in participation in treatment decision-making, diagnosis, hospital, and symptom distress, the three dimensions of quality of cancer care developed by the research team contributed substantially to the explanation of variance (41.1%~41.4%) of the extent of overall satisfaction to cancer care and willingness to recommend the health care team to other patients who may be in need of cancer care. Specifically, the cancer center's extent of (1) information disclosure and facilitation in decision-making in accord with patients' preferences and (2) coordination of care plays the most significant roles. This survey highlights existing good practice, points to areas where individual cancer centers and teams can make changes to improve patients' experience of cancer care, and to provide the Nation with a baseline against which to measure further progress.


    

本卷期目次
中華民國癌症醫學會雜誌
POLYMERASE CHAIN REACTION IN THE DIAGNOSIS OF GASTRIC MALT LYMPHOMA AS ATYPICAL LYMPHOCYTIC INFILTRATES: A CASE REPORT/ Huan-Chau LinJohnson LinKen-Hong LimRuey-Kuen HsiehMing-Jer HuangYi-Fang ChangMing-Chih ChangChia-Yuan LiuChin-Yuan Tzen
臺灣癌症中心病人面向的照護品質探討/ 唐秀治陳美伶鍾國彪賴美淑鄭守夏邱秀渝邱昭華孔憲蘭蕭淑純
 
   
 
   

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