摘　要
企業經營是一項競賽，成功絕對不是偶然的，必需完全掌握成功的要訣，才能在競爭中制勝。在各項大型成功企業的研究已發現，不同單位團隊共同合作常是成功關鍵。醫療機構的健康照護雖屬個別領域高度專業化，但為求醫療品質及病人安全，實應學習成功企業跨團隊整合模式來進行多元面向合作。譬如乳腺癌是婦女最好發之癌症，患者個人的身心狀況皆不同，甚且治療方式又日新月異，已非個別醫師能夠全盤兼顧。
本研究提出乳腺癌全人整合醫療概念框架，以病人為中心，圍繞各專業醫療及行政團隊，環環相扣提供病患照護；執行治療方案強調依據全面共識作業準則、提高作業透明度和導入更好的激勵措施；層面介入涵蓋全方位的身體、心理和社會面向，治療目標是以醫療品質和病人安全做為基石達成的健康和幸福。

本研究內容包括8項子題，這是團隊成員由5項醫療主題(影像檢查、外科手術、賀爾蒙藥物、心理需求和社會群體流行病學趨勢分析)裡找出需要檢討改善的作業並進行探討，我們研究的結果值得用來修正原來作業準則，亦可提供其他醫療機構參酌應用。

總結：我們提出不斷創新全人健康照護的多元整合模式，的確是提供乳腺癌患者健康照護得到最佳醫療品質及維護病人安全的不二法門。

Abstract

Enterprice management is a competition, and success is definitely not accidental. It is necessary to fully grasp the key to success in order to prevail in the competition. Studies in various large-scale successful enterprices have found that teamwork from different units is often the key to success. Although the healthcare of medical institutions is highly specialized in individual fields, in order to achieve medical quality and patient safety, it is necessary to learn the cross-team integration model of successful companies to carry out diversified cooperation.

Breast cancer is the most common cancer among women. The patient's personal physical and mental conditions are different, and the treatment methods are changing over time. It is no longer possible for individual doctors to take care of them. Even though the healthcare field of medical institutions is highly professional in an individual field; however, to ensure the safety of patients with better medical quality, it is necessary to learn the successful business model of integration teamwork and multi-faceted cooperation.

This study proposes a conceptual framework for breast cancer holistic integrated medical care, which is patient-centered and is provided with care by various professional medical and administrative core teams. The implementation plan emphasizes the basis of comprehensive consensus protocols, increased performance transparency and better alignment of incentives. The level of intervention covers the physical, mental, spiritual and social aspects. To achieve the goal of health and happiness based on medical quality and patient safety.

The study content includes 8 sub-topics, which are discussed by team members through 5 medical themes (imaging examination, surgery, hormone medication, psychological needs, and social group trend analysis) that need improvement. The research conclusions will be included in the revision of the team consensus protocols. Other medical institutions can also be provided for consideration.

In conclusion, we propose to continuously innovate the whole-person health care model, which is indeed the only way to provide the best quality of breast cancer medical care and maintain patient safety.

論文審定書………………………………….…..………........….i
誌謝………..……………………………………...….….....…....ii
中文摘要………………………………………......................…iii
英文摘要…………………..………….……..............................iv
第一章 緒論……………….....…………..……………....……....1
第二章 文獻探討…………...………..……………………..…....4
第一節 整合照護的必要性…………....…….…………...…......4
第二節 身體照護面……………..…….….....……….…........…10
第三節 心理支持照護..…….……………….............................16
第四節 社會群體面..…..……………….……..…..............…...18
第三章 方法和結果…………..…………………………......….19
第一節 身體照護面.…..…..…..…..…………….…..…....…….21
研究1：先進影像儀器檢查擴大利用……………..................21
子題1：FDG-PET/CT診斷極早期乳腺癌..…………..........…..21
子題2：使用FDG-PET/CT追蹤治療後乳腺癌…..……...........31
研究2：精進外科手術…………..…………………….....…....40
子題3：皮膚保留乳房全切除術合併使用橫向腹直肌肌皮瓣及時重建的安全性評估.……….…................................……..40
研究3：探討荷爾蒙藥物治療的潛在風險…….......…….….49
子題4：確立荷爾蒙藥物(Tmoxifen)併發脂肪肝的關聯.….49
子題5：脂肪肝患者如何面對Tamoxifen藥物治療……......58
第二節 心理照護 面研究……………………………....…..…67
研究4：病患形象改變的心理衝擊……………….….………67
子題6：病患伴侶同理心感知和抑鬱症狀之關係……..…..67
第三節 國家層級醫療照護資料分析研究…………….…….78
研究5：台灣乳腺癌流行病趨勢和結果的研究……….......78
子題7：全國乳腺癌發病率和手術結果的預測因素……...78
子題8：全國醫療機構與醫師手術量與成本的關聯性…...87
第四章 討論………………………………………………..…..95
第五章: 應用(Implication)…………..………………………..100
第六章: 研究侷限性與未來研究建議……………………….103
參考文獻…………………….……………...……………...…..105
附錄……………….…………………………………......……..144
附圖(Figure)…………………………………………………....144
附表(Table)………….…………………………………........…161

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