臺灣博碩士論文加值系統

早期偵測及早期治療能降低癌症的死亡率。臨床上及文獻上都有發現肝癌肝危險群患者定期監測者，發現的肝癌較小且預後較佳。早期偵測亦有賴於個體即時且遵從監測的求醫行為。國內仍缺乏有關肝癌患者求醫歷程的研究資料。本研究的目的在於探討肝腫瘤病患自發現肝癌高危險因子之延遲就醫行為及相關因素。本研究採回溯性相關性研究設計，以連續性取樣於宜蘭縣內某地區教學醫院招募166位具肝癌高危險因子且經臨床診斷為肝癌或是肝癌前病變、18歲、以國語或台語溝通、無精神疾病者參與。研究工具以經先趨研究檢測之調查表訪談樣本之危險因子發現、監測與肝癌診斷治療的求醫經歷；並由病歷收集相關疾病資料。本研究的樣本平均年齡為62.5歲(SD=12.24 )，平均接受過6.6年的正式教育，多數為男性、已婚、診斷為肝癌、肝臟剩餘功能為Child A(77.1%)、肝腫瘤BCLC分期為A期、接受根除性治療(62.7%)。
研究結果發現44%於發現肝癌高危險因子14天內就醫。在癌前監測階段中(高危險群監測期)，平均約30.2個月才就醫追蹤監測一次，但50%在間隔最多5.7個月時就醫追蹤一次。一旦診斷為肝腫瘤之後，最常於5天後接受治療，50%至少在7天內開始治療。影響就醫的因素經Logistic regression發現，在發現高危險因子或症狀發現的就醫上，年齡減少(OR=1.03)、家人支持(OR=1.31)、無共病(OR=2.97 )、自覺無不適(OR=6.62)為延遲14天才就醫之危險因子。 在發現後至肝腫瘤診斷中間的追蹤監測就醫方面，年齡減少(OR=1.03 )、不知後果(OR=13.16)、診所就醫(OR=4.37 )為延遲12個月才就醫追蹤之危險因子。在診斷為肝腫瘤後的治療就醫行為上，年齡減少(OR=1.03)、家人支持(OR=1.31)、無共病(OR=2.97 )、自覺無不適(OR=6.62)為延遲14天才就醫之危險因子，年齡(OR=1.03)、就醫公里數(OR= 1.06)、無共病(OR=1.56 )、自覺疾病嚴重度(OR=1.18)為延遲30天才就醫治療之危險因子。本研究的發現將協助醫護團隊更進一步了解影響肝腫瘤高危險族群之就醫行為及就醫延遲的危險因子，以助日後發展照護措施，以利公共政策之制定。

Early detection and treatment can reduce cancer mortality. Previous studies reported that regular surveillance of high risk patients for hepatocellular carcinoma (HCC) can significantly reduce tumor size as HCC diagnosed. HCC is one of common cancer in Taiwan. There is lack of research data about the delay for medical seeking behaviors as the people diagnosed as high risk for HCC. Thus, a retrospective study was designed to understanding the medical seeking behaviors and the risk factors of delayness since the HCC risks was diagnosed in a sample of patient with hepatic tumors. A total of 166 consecutitive subjects were recruited in a hospital in Yilan city of northern Taiwan. The including criteria inlcuded diagnosis of HCC or pre-cancer lesion with history of risk factors for HCC, older than 18, capability to communicate in Mandarine or Taiwanese, and without psychiatric disease. A questionnaire to retrieve the help-seeking behaviors and the trajectory after the HCC risk factors were found was developed and tested via a pilot testing for feasibility. Disease and treatment information was gathered from medical charts. The sample had a mean age of 62.5 and a mean formal education-year of 6.6. A majority was male, married, diagnosed with HCC, Child A (77.1%), BCLC stage of A and was receiving and had received curative treatment. The findings revealed that 44% delayed till 14 days for medical visits after HCC risk factors was found. During the surveillance period and before the hepatic tumor was diagnosed, there was an average of 30.2 months per follow-up; 50% had less than 5.7 months between to follow-ups. After the tumor found, 50% received the first treatment 7 days after. After the analysis of logistic regression, age decrease(OR=1.03)、family support(OR=1.31)、no commobility (OR=2.97 )、no discomfort (OR=6.62) were the significant risk factors for 14-or -more-day delays as the HCC risk factors were found. During the surveillance period, age decrease(OR=1.03 )、not knowing the consequence(OR=13.16)、receiving care at local clinics (OR=4.37 ) were the significant risk factors for 12-or-more-month per follow-up. After the tumor diagnosed, age decrease (OR=1.03 )、milages for medical visits(OR=1.06)、no commobility(OR=1.56 )、 perceived severity (OR=1.18) were the significant risk factors for 30-or-more-day delays before receiving treatment for　hepatic tumors.
These findings increase the understandings of the medical help seeking behaviors of the persons with HCC risks and the influencinf factors of the delayness. In the hope of promoting the surveillance regularly and reach finding and treatment in early days

目 次
中文摘要 ……………………………………………………
i
英文摘要 ……………………………………………………
iii
目次 …………………………………………………………
iv
表次 …… …………………………………………………
vii
圖次 ………………………………………………………………
viii
第一章 緒論--研究背景和動機
1
第一節 肝癌早期偵測
1
第二節 尌醫與延遲
3
第三節 小結
5
第四節 研究目的
6
第二章 文獻探討
7
第一節 尌醫行為與理論
7
第二節 尌醫行為相關理論
13
第三節 國人尌醫行為與醫療利用
15
第四節 肝癌
20
第五節 癌症病人的尌醫與資源利用
28
第六節 小結
31
第七節 研究問題
33
第八節 研究理論架構
34
第九節 名詞界定
36
第三章 研究方法
39
第一節 研究設計
39
第二節 樣本與取樣
39
第三節 研究工具
41
第四節 資料收集與過程
44
第五節 資料整理及分析
45
vi
第四章 研究結果
48
第一節 樣本特質
48
第二節 各期尌醫特質
55
第三節 尌醫延遲
64
第四節 尌醫延遲相關之分佈
67
第五節 尌醫延遲與癌症分期
90
第五章 討論
94
第一節 人口學特質與尌醫歷程特質
94
第二節 尌醫延遲
97
第三節 尌醫延遲相關之分佈
100
第四節 尌醫延遲與肝癌診斷期別之關係
107
第六章 結論與建議
109
第一節 結論
109
第二節 研究建議
110
第三節 研究限制
112
參考文獻
113
中文部分
113
外文部分
116
附錄
123
附錄一 研究問題之測量方式問卷之變項屬性及操作型定義一覽表
122
附錄二 受詴者同意書
130
附錄三 肝腫瘤病患尌醫行為之調查問卷
132
附錄四 IRB審查通過通知書
144
附錄五 IRB修改審查通過通知書
145

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