臺灣博碩士論文加值系統

背景與目的 癌症於近二十幾年來一直成為臺灣十大死因之榜首，傳統中醫於臺灣已經行之有年再加上國際間對CAM的重視，本土癌症患者的中醫就醫經驗一直是缺乏的，本研究目的在於以深度訪談的質性研究方法，來描繪臺灣癌症患者的中醫就醫行為，期望本研究之結果，能找出癌症患者的中醫就醫歷程，並就動機、決策、身體、心理、社會、靈性等方面的內容做深度的論述。

研究方法 本研究採用滾雪球抽樣，共選取10位臺北市立聯合醫院中醫與仁愛院區的癌症患者，進行半結構式大綱的深度訪談質性研究，透過與受訪者自然互動，將訪談結果全程錄音並以逐字稿呈現，再經由編輯及浸淫結晶的內容分析，來描繪出癌症患者的中醫就醫經驗。

結果 在癌症患者的中醫就醫行的議題上共呈現出五個層面：癌症的衝擊、癌症造成的不確定感、癌症患者的中醫就醫動機與固有觀念、影響癌症患者中醫就診決定的因素以及中醫就診經驗的轉變。癌症的衝擊包括得知診斷後的身心衝擊、治療不良反應的衝擊、家庭衝擊和工作上的衝擊；不確定感則從社會家庭人際關係、診斷與預後、治療療效、中醫西醫醫病關係、致病原因和醫療資訊取得上充分表現出來；中醫就醫動機歸納成調整體質、中西醫輔助、降低副作用、改善後遺症、提升免疫系統、治療癌症等六個面向；中醫固有觀念則有中醫調理體質、溫和適合長期服用、作用緩慢、冷熱和中醫有人味等五個特質；影響癌症患者中醫就診決定因素包括社會人際、醫療療效、資訊的取得、經濟考量、地理環境、後遺症六面項；關於中醫就診經驗的轉變是呈現出前後之間的改變的原因。

結論 癌症患者的中醫就醫行為實在是豐富的反映出了從衝擊、不確定感，到動機、固有觀念，進而決定是否中醫就醫與轉變的一連串過程。

Objective As the high incident rate of cancer and prevalence of traditional Chinese medicine (TCM) utilization in Taiwan, this study aimed to develop a conceptual framework of the TCM seeking behavior of Taiwanese adolescents with cancer.

Methods Ten adolescents (four males and six females) with cancer at all stages of the illness were interviewed by snowball sampling. Data were collected through in-depth interview by semi-structure guideline and observations, medical chart reviews, and researcher’s reflexive journals. As the data were received and transcribed, editing and immersion/ crystallization were used to represent constructs of the adolescents with cancer.

Results These multifaceted, naturalistic contextures were elicited by TCM out-patient department visiting in clinical status. Five distinct subcategories of the TCM seeking behavior reported by interviewees were emerged. The cancer impact included the mind-body impact after diagnosis, the adverse effect impact of treatment, family impact and work impact; the cancer uncertainty were fully showed out by the social-family-interpersonal relationship, the diagnosis and prognosis, the remedy self-efficacy, the patient– physician relationship between Chinese and western medicine, etiology and the gain of medical information; the TCM seeking motivation were extracted by constitution modulation, complementary of Chinese-Western medicine, side effect reduction, sequela improvement, immune system enhancement, and cancer treatment; the Chinese medicine inherent concepts merged by the TCM recuperate the constitution, temperately taking for long term, slow efficacy for a long time, cold -warm and TCM humanity; the TCM decision-making factors influenced by social relationship, medical effect, information obtains, economical consideration, geographical environment, and sequela; the experience transformation to utilize TCM were also presented.

Conclusions The Chinese medicine behavior seeking in cancer patients are demonstrated vividly by a succession of process of impact, uncertainty, motivation, the inherent concept, decision making of traditional Chinese medicine and transformation on physical and psychological, cognitive, social and future orientation aspects.

口試委員會審定書………………………………i
誌謝………………………………………………ii
中文摘要…………………………………………iii
Abstract…………………………………………iv
目 錄 …………………………………………v
圖表目錄…………………………………………viii
第一章 緒論……………………………………1
第一節 研究背景 ………………………………1
第二節 研究目的 ………………………………4
第二章 文獻探討………………………………5
第一節 癌症患者使用CAM的盛行率 …………5
第二節 癌症病患的相關議題之研究 …………6
第三節 癌症患者CAM的就醫動機與行為 ……8
第三章 研究方法 ……………………………10
第一節 研究對象 ……………………………10
第二節 研究資料收集 ………………………10
第三節 資料整理與分析 ……………………11
第四節 嚴謹度、可信賴度控制 ……………11
第五節 研究倫理 ……………………………12
第四章 研究結果 …………………………13
第一節 受訪樣本來源與描述…………………13
一、受訪者基本資料 …………………………13
二、受訪者取樣來源描述 ……………………13
第二節 癌症的衝擊……………………………17
一、得知診斷後的身心衝擊 …………………17
二、治療不良反應的衝擊…………………… 20
三、家庭的衝擊……………………………… 24
四、工作上的衝擊…………………………… 25
第三節 癌症造成的不確定感 ……………… 26
一、社會家庭人際關係的不確定感 ………… 26
二、診斷與預後的不確感…………………… 28
三、治療療效上的不確定感………………… 30
四、中西醫醫病關係上的不確定感………… 33
五、致病因上的不確定感…………………… 35
六、醫療資訊取得的不確定性……………… 37
第四節 癌症患者的中醫就醫動機與固有觀念38
中醫就醫動機………………………………… 39
一、調整體質………………………………… 39
二、中西醫輔助……………………………… 42
三、降低副作用……………………………… 45
四、改善後遺症……………………………… 47
五、提昇免疫系統…………………………… 50
六、治療癌症………………………………… 51
對中醫的固有觀念…………………………… 53
一、中醫調理體質…………………………… 53
二、溫和、長期服用………………………… 55
三、作用緩慢………………………………… 56
四、冷熱……………………………………… 56
五、中醫的人味……………………………… 57
第五節 影響癌症患者中醫就診決定的因素 58
一、社會人際方面 ………………………… 58
二、醫療療效 ……………………………… 61
三、資訊的取得……………………………… 63
四、經濟考量………………………………… 67
五、地理環境………………………………… 68
六、癌症的嚴重程度………………………… 69
七、後遺症…………………………………… 70
第六節 中醫就醫經驗的轉變 ……………… 72
一、使用中醫前對中醫的信念……………… 72
二、開始使用中醫的轉變…………………… 73
第五章 討論 ..... ………………………… 75
第一節 癌症的衝擊 ………………… 75
第二節 癌症造成的不確定感 ……… 75
第三節 癌症患者的中醫就醫動機與固有觀念76
第四節 影響癌症患者中醫就診決定因素……77
第五節 中醫就醫經驗的轉變…………………78
第六章 結論與建議 ………………………………79
研究優點與限制………………………………… 79
附錄一 研究受試者同意書………………………80
參考文獻…………………………………………108

圖表目錄
圖1 受訪者取樣關聯圖 16
圖2 中醫就診決定分析 78

表1-1 受訪者基本資 15
表2-1 癌症患者使用CAM的盛行率 83
表2-2 系統性文獻回顧:國際間癌症患者使用CAM的盛行 84
表2-3 國內癌症相關議題的質性研 96

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