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研究生:陳韵宜
研究生(外文):Yun-Yi Chen
論文名稱:癌症兒童生命末期照護型態相關因素之探討
論文名稱(外文):Exploring the Utilization Patterns Near the End of Life for Children with Cancer
指導教授:鍾國彪鍾國彪引用關係唐秀治唐秀治引用關係
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:醫療機構管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2006
畢業學年度:94
語文別:中文
論文頁數:88
中文關鍵詞:癌症兒童生命末期照護積極度安寧緩和醫療
外文關鍵詞:CancerChildrenEnd of LifeAggressiveness of CareHospices
相關次數:
  • 被引用被引用:3
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  • 收藏至我的研究室書目清單書目收藏:5
目的:
本研究欲瞭解台灣癌症兒童生命末期之照護型態,與照護積極性之程度。並以人口學特質、疾病特質與就醫場所特質等因素,探究其對生命末期照護及積極性程度之影響。
方法:
本研究係橫斷式之次級資料分析,使用國家衛生研究院1999年至2002年全民健康保險資料庫結合全國死亡檔,針對2000年至2002年間死亡之0-18歲癌症病童進行分析,研究對象共691位。
結果:
2000—2002年間,癌症兒童生命末期使用安寧緩和醫療之總比例為4.8%。安寧緩和醫療整合性照護試辦計畫於2000年7月實施後,隔年安寧緩和醫療使用比例自2.5%提昇為6.9%。主診斷為白血病、居住地點隸屬縣轄市,或就醫地點為中區分局者,使用安寧緩和醫療之比例較低。
無論是否使用安寧緩和醫療,3成以上癌症兒童於生命末期時仍使用住院或加護病房等高度醫療資源。年齡較小之病童,或就醫場所隸屬北區分局、中區分局、南區分局者,照護積極度較高。
結論:
台灣地區癌症兒童於生命末期時,(1)多半仍持續積極性照護;(2)使用居家安寧緩和醫療之比例低,且整體安寧緩和醫療使用情況呈現城鄉差距與地域差別;(3)推行「安寧療護整合性照護納入全民健康保險給付試辦計畫」有助於提昇安寧緩和醫療之使用。
Purpose:
To explore the medical utilization patterns and aggressiveness of care for cancer children at the end of life, and its relationship to factors of demographics, disease and characteristics of medical institution.
Method:
The study was based on claim data from the Bureau of National Health Insurance (BNHI) from 1999 to 2002. There were 691 patients aged 18 and younger with a diagnosis of cancer between 2000 and 2002.
Result:
During the study period, average utilization rate of hospice services was 4.8 percent. After implementing the demonstration project by BNHI for comprehending the integrated care of hospices, study sample who received hospice care increased from 2.5 percent in year 2000 to 6.9 percent in year 2001. Patients with diagnosis of leukemia, living in county, or seeking medical services in areas covered by Central Branch of BNHI were related to fewer utilization rate of hospices.
No matter using hospices or not, more than 30 percent children with cancer experienced admission to acute-care hospitals, intensive care unit, or had emergency department visit in the last month of life. Children who were younger or seeking medical services in areas covered by Northern Branch, Central Branch or Southern Branch, would have risk to experience higher aggressiveness of care compared with Eastern Branch of BNHI.
Conclusion:
In Taiwan, some children with cancer still received aggressive interventions at the end of life. The rate of receiving hospice homecare was low and the whole hospice services had disproportional distribution across the areas and the degree of urbanization. The demonstration project from BNHI for comprehending the integrated care of hospice services enhanced the use of hospice.
第一章 緒論
第一節 研究背景………………………………………………………1
第二節 研究目的………………………………………………………4
第二章 文獻探討
第一節 兒童癌症之流行病學…………………………………………5
第二節 兒童生命末期之照護…………………………………………7
第三節 癌症生命末期照護之衡量………………………………….10
第四節 相關實證研究……………………………………………….12
第五節 安寧緩和醫療整合性照護給付試辦計畫………………….24
第六節 綜合評論…………………………………………………….25
第三章 研究方法
第一節 研究架構與研究設計……………………………………….26
第二節 研究假說…………………………………………………….28
第三節 變項操作型定義…………………………………………….29
第四節 研究對象與研究材料……………………………………….36
第五節 資料分析方法……………………………………………….37
第四章 研究結果
第一節 描述性分析………………………………………………….39
第二節 雙變項分析………………………………………………….48
第三節 迴歸分析…………………………………………………….57
第五章 討論
第一節 重要研究結果之討論……………………………………….66
第二節 研究限制…………………………………………………….71
第六章 結論與建議
第一節 結論………………………………………………………….72
第二節 建議………………………………………………………….74
參考文獻……………………………………………………………………….76

圖表目錄
表2-1 台灣地區1979-2000年全癌症年齡別之粗發生率……………6
圖2-1 癌症病童生命末期照護品質之理論模式…………………….9
表2-2 生命末期住院情況之相關實證研究…………………………16
表2-3 生命末期加護病房與急診使用之相關實證研究……………17
表2-4 死亡地點之相關實證研究……………………………………18
表2-5 生命末期安寧緩和醫療使用之相關實證研究………………19
表2-6 生命末期照護之相關實證研究總覽…………………………20
圖3-1 研究架構……………………………………………………..27
表3-1 研究變項之操作型定義………………………………………33
表3-2 虛擬變項表……………………………………………………35
表3-3 本研究資料來源及使用之欄位………………………………36
表4-1 人口學特質之描述性統計資料分析…………………………42
表4-2 疾病特質之描述性統計資料分析…………………………..44
表4-3 就醫場所特質之描述性統計資料分析………………………43
表4-4 安寧緩和醫療使用情況之描述性統計資料分析……………44
表4-5 積極度指標之描述性統計資料分析…………………………45
表4-6 生命末期照護之相關描述性統計資料分析…………………46
表4-7 安寧緩和醫療使用時機之描述性統計資料分析……………47
表4-8 人口學特質對是否使用安寧緩和醫療之雙變項分析………50
表4-9 疾病特質對是否使用安寧緩和醫療之雙變項分析…………51
表4-10 就醫場所特質對是否使用安寧緩和醫療之雙變項分析……52
表4-11 人口學特質對照謢積極度之雙變項分析……………………53
表4-12 疾病特質對照謢積極度之雙變項分析………………………54
表4-13 就醫場所特質對照謢積極度之雙變項分析…………………55
表4-14 是否使用安寧緩和醫療對照護積極度之雙變項分析………56
表4-15 是否使用安寧緩和醫療對照護使用之雙變項分析…………56
表4-16 人口學特質、疾病特質與就醫場所特質對使用安寧緩和醫療之羅吉斯迴歸分析表……………………………………60
表4-17人口學特質、疾病特質與就醫場所特質對照謢積極度之次序羅吉斯迴歸分析表(模式一)…………………………62
表4-18人口學特質、疾病特質與就醫場所特質對照謢積極度之次序羅吉斯迴歸分析表(模式二)…………………………64

附錄一 癌症病童生命末期更換就醫場所之情況…………………84
附錄二 台灣安寧緩和醫療資源分佈情況…………………………86
附錄三 本研究歸類為宗教背景之就醫場所………………………88
中文文獻
中央健康保險局支付標準,摘自http://www.nhi.gov.tw/20download/index_ down load.htm
中央健康保險局特約醫療院所名冊,摘自http://www.nhi.gov.tw/20download /index_download.htm
中央健康保險局提供住院安寧緩和醫療之醫事服務機構名單,摘自http://www.nhi.gov. tw/ 20download/index_download.htm
中央健康保險局安寧療護整合性照護納入全民健康保險給付試辦計畫,摘自www.nhi.gov.tw/webdata/AttachFiles/Attach_3060_2_安寧緩和醫療計畫書修訂版.pdf
中華民國兒童癌症學會兒童癌症的特性,摘自http://ccf.wingnet.com.tw/p4-2.htm
行政院衛生署九十四年台灣十大死因年齡結構別死亡概況,衛生統計資訊網,摘自http://www.doh.gov.tw/statistic/data/死因摘要/94年/94.htm
台灣癌症登記年報年齡別長期趨勢,摘自http://crs.cph.ntu.edu.tw/crs_c/annual.htm
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賴安琪,勞保體系癌症末期住院病患之醫療費用結構研究。未發表的碩士論文。台北:國立陽明大學,1994。
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