摘要
在Choosing Wisely American Association of Blood Banks中提及關於輸血的低價值照護是不必要的，然而輸血做為醫療程序中最常見的治療手段，在臨床上由於能有效改善病人缺血的狀況，因此許多輸血行為是不可避免的，輸血行為有時可能引起身體的不良反應，即輸血反應，因此，許多醫師在進行輸血前可能會考慮同時開立抗組織胺藥物，以減少輸血反應的發生，然而，根據過去的醫學資料和文獻，顯示在輸血前給予病人退燒藥或抗過敏藥物並無法顯著減少發熱性非溶血性輸血反應或過敏反應的發生，過度的低效益醫療行為不只會增加醫療成本也會降低醫療品質，因此欲透過這項研究以質性訪談結合「計畫行為理論」為理論建構加入五大人格特質之問卷探討醫師主要開立輸血前用藥的因素及面臨之障礙。
本研究以全台醫療機構之執業醫師為研究對象，採用google表單線上問卷施測，共回收283份問卷且訪談三位南部公立醫學中心的醫師，本研究以SPSS 20版本與STATA 14.0版本之統計軟體進行資料處理與分析，其分析包含描述性統計、獨立樣本 T 檢定、單因子變異數分析、皮爾森相關分析與迴歸分析進行資料處理，所得結果如下(1) 知覺行為控制顯著正相關醫師開立輸血前預防用藥的行為意圖、主觀規範顯著負相關醫師執行輸血前預防用藥的行為意圖；(2) 醫師開立輸血前預防用藥頻率醫囑之高低程度在態度、主觀規範、行為意圖具有顯著差異；(3)五大人格特質可以做為預測醫師開立輸血前預防用藥的態度、主觀規範、知覺行為控制、行為意圖因素；(4)經由訪談得知醫師在開立醫囑時主要會參考病人過敏史作為依據，而護理師的請求、前輩的教學及自身經驗會是影響決策的因素，在減少開立的過程中遇到的障礙是承擔來自護理師的壓力、過去的經驗、預防心理，在臨床環境中，雖然相信實證醫學的存在，但仍會以自身經驗為主要考量因素。

Abstract
It is unnecessary to mention low-value care about blood transfusion in Choosing Wisely American Association of Blood Banks. However, blood transfusion, as the most common treatment in medical procedures, is clinically effective in improving the ischemic condition of patients, so many Blood transfusion is inevitable, and blood transfusion may sometimes cause adverse reactions in the body, that is, transfusion reactions. Therefore, many physicians may consider prescribing antihistamine drugs at the same time before a blood transfusion to reduce the occurrence of blood transfusion reactions. However, According to past medical data and literature, it is shown that giving antipyretics or antiallergic drugs to patients before blood transfusion does not significantly reduce the occurrence of febrile non-hemolytic transfusion reactions or allergic reactions. Excessive low-efficiency medical behaviors will not only increase medical costs but also reduce quality of care. Therefore, through this study, qualitative interviews combined with "Theory of Planned Behavior" are used as the theoretical construction and added five personality traits questionnaires to explore the factors and obstacles that doctors mainly prescribe pre-transfusion medication.
In this study, practicing physicians in medical institutions across Taiwan were used as the research object. The google form online questionnaire was used to conduct the survey. A total of 283 questionnaires were collected and three physicians from southern public medical centers were interviewed. This study used SPSS version 20 and STATA version 14.0 for data processing and analysis, the analysis includes descriptive statistics, independent sample T test, single factor analysis of variance, Pearson correlation analysis and regression analysis for data processing, the major results are as follows (1) Perceived behavior control significantly positively correlated with physician prescribed premedication behavioral intentions and subjective norms of pre-blood transfusion prophylaxis were significantly negatively correlated with the behavioral intentions of physicians to execute pre-blood transfusion prophylaxis; (2) The frequency of pre-blood transfusion prophylaxis orders by physicians had significant differences in attitude, subjective norms, and behavioral intentions (3) The five major personality traits can be used to predict the attitude, subjective norms, perceived behavioral control, and behavioral intentions of doctors prescribing pre-transfusion prophylaxis; (4) According to interviews, doctors mainly refer to patients' allergies when prescribing medical orders. history as the basis, and the request of nurses, the teaching of predecessors and their own experience will affect the decision-making factors. The obstacles encountered in the process of reducing prescriptions are the pressure from nurses, past experience, and preventive psychology. In the clinical environment, although physicians believe in the existence of evidence-based medicine, they still take their own experience as the main consideration

論文審定書 i
摘要 ii
Abstract iii
第一章 續論 1
第一節 研究背景與動機 1
第二節 研究問題及研究目的 3
第二章 文獻探討 5
第一節 輸血反應 5
第二節 輸血前術前用藥 7
第三節 輸血前預防用藥國內外使用情形 10
第四節 計畫行為理論 11
第五節 五大人格特質 12
第六節 五大人格特質對行為之影響 13
第七節 文獻探討小結 14
第三章 研究方法 16
第一節 研究架構 16
第二節 研究假設 17
第三節 研究流程 18
第四節 研究對象與施測過程 19
第五節 研究變項的操作型定義與衡量 21
第六節 資料處理與統計分析工具 27
第七節 專家效度與問卷前測結果分析 29
第八節 正式問卷信效度分析 30
第四章 資料分析 40
第一節 問卷回收情況 40
第二節 T檢定與單因子變異數分析 - 47 -
第三節 輸血前預防用藥之態度、主觀規範、知覺行為控制、行為意圖之相關性 - 53 -
第四節 計畫行為理論五大人格特質與人口學特性之迴歸分析 - 55 -
第五節 質性研究結果分析 - 63 -
第五章 討論及建議 - 73 -
第一節 討論 - 73 -
第二節 研究限制 - 79 -
第三節 研究貢獻 - 80 -
第四節 建議 - 81 -
參考文獻 - 83 -
附錄一:問卷 - 91 -
附錄二:人體研究計畫同意函 - 95 -

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