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博碩士論文 etd-0416117-183714 詳細資訊
Title page for etd-0416117-183714
論文名稱
Title
影響癌症患者使用安寧療護之相關因素
What Factors may Influence the Use of Palliative Care for Cancer?
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
61
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2017-05-10
繳交日期
Date of Submission
2017-05-16
關鍵字
Keywords
相關因素、癌症、安寧療護、住院安寧療護
Related Factors, Cancer, Hospice, Palliative care
統計
Statistics
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The thesis/dissertation has been browsed 5689 times, has been downloaded 27 times.
中文摘要
背景與目的:惡性腫瘤(癌症)已連續34年高居我國十大死因之首,其死亡率受高齡化影響,長期呈現上升趨勢。癌末患者在臨終前除了面臨嚴重的身體疼痛與混亂、身體機能衰退、呼吸困難等問題外,還須承受密集的無效醫療所帶來的痛苦與高額的醫療費用。許多國內外研究皆指出安寧療護不只能降低醫療成本支出,更能提升病患臨終前生活品質,故藉由探討影響癌症患者使用安寧的相關因素,可得知哪些特性將會影響是否使用安寧療護。

方法:本研究以臺灣地區人民為例,採用次級資料進行分析,研究期間為2010年至2013年。研究對象為持有重大傷病卡之癌症患者。統計方法包含描述性統計、卡方檢定、邏輯斯迴歸分析。

結果: 研究結果顯示,性別、年齡、投保金額、投保分局別、共病症指數(CCI)、職業別、醫師年齡、醫師年資、專科醫師科別、醫院權屬別、醫院投保分局別、醫院等級皆與病患是否使用安寧療護呈顯著相關。研究結果可供醫療人員於病患就醫時,針對較不偏好使用安寧療護之族群加強衛教宣導;並可供政府衛生單位作為制定相關法令之參考依據,以提升國人於安寧療護之利用。
Abstract
Background:Malignancy (cancer) has been the leading cause of death in Taiwan over the past 34 years. At the end of life, cancer patients not only bear severe pain, but also suffer from intensive ineffective medical care and high cost of medical expenses. Researches have pointed out that hospice & palliative care could reduce medical expenses and improve the quality of end-of-life. Thus the present research investigates the use of palliative care in cancer patients in Taiwan.

Objective:The goal of this study is to identify the related factors that influence palliative care use in cancer patients certified as catastrophically ill.

Methods:This study use secondary data collected from Taiwan National Health Insurance database. The study period is from 2010 through to 2013. Methods used for analysis include descriptive statistics, chi-square test and logistic regression analysis.

Results:The results shows that gender, age, insured amounts, patient residential area, Charlson comorbidity index (CCI), occupation, physician age, physician years of practice, specialist department, hospital ownership, hospital locality and hospital type are all significantly correlated with palliative care utilization. Recommendations for strategies that promote palliative care are provided in this study. These results may be useful for hospital management and government for developing palliative care policy.
目次 Table of Contents
摘要 .
Abstract .
目錄 i
表目錄 ii
圖目錄 iii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究重要性 3
第三節 研究目的 3
第二章 文獻探討 4
第一節 台灣安寧療護的演變 4
第二節 影響使用安寧療護之相關因素 7
第三章 研究設計與方法 10
第一節 研究架構 10
第二節 研究對象與資料來源 11
第三節 操作型定義 11
第四節 統計方法 13
第四章 研究結果 14
第一節 描述性分析 14
第二節 卡方之獨立性檢定 23
第三節 邏輯斯迴歸分析(Logistic Regression) 28
第五章 討論 34
第一節 安寧療護患者-人口學特性 34
第二節 安寧療護患者-醫師特性 37
第三節 安寧療護患者-醫院特性 39
第六章 結論與建議 41
第一節 研究結論 41
第二節 研究貢獻 42
第三節 研究限制 42
第四節 研究建議 43
英文參考文獻 44
中文參考文獻 50
附錄一 53
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