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論文名稱 Title |
建構乳癌全人健康照護的創新模式 To Build an Innovative Holistic Healthcare Model in Breast Cancer Patient |
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系所名稱 Department |
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畢業學年期 Year, semester |
語文別 Language |
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學位類別 Degree |
頁數 Number of pages |
200 |
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研究生 Author |
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指導教授 Advisor |
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召集委員 Convenor |
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口試委員 Advisory Committee |
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口試日期 Date of Exam |
2021-07-28 |
繳交日期 Date of Submission |
2021-09-20 |
關鍵字 Keywords |
乳腺癌、全人健康照護、整合醫療、多專科團隊、作業準則 breast cancer, holistic healthcare, integrated medicine, multidisciplinary team, protocol |
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統計 Statistics |
本論文已被瀏覽 305 次,被下載 73 次 The thesis/dissertation has been browsed 305 times, has been downloaded 73 times. |
中文摘要 |
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 |
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. |
目次 Table of Contents |
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 |
參考文獻 References |
1. Muhmmad, I. N., & Zawiyah M. Y. (2013). Integration of Business Intelligence and Enterprise Resource Planning within Organizations. Procedia Technology. 11, 658-665. https://doi.org/10.1016/j.protcy.2013.12.242 2. Farajollah, R., & Nahid, B. (2014). Key factors in the successful implementation of enterprise resource planning system. Management Science Letters. 4(4), 747-752. https://doi.org/10.5267/j.msl.2014.2.013 3. Wild, C.P., Weiderpass, E., & Stewart, B.W., editors. (2020). World Cancer Report: Cancer Research for Cancer Prevention. Lyon: International Agency for Research on Cancer. ISBN-13 (PDF) 978-92-832-0448-0 4. WHO report on cancer (2020). Setting priorities, investing wisely and providing care for all. Geneva: World Health Organization; License: CC BY-NC-SA 3.0 IGO. 5. Reuters. (2021). Breast cancer overtakes lung as most common cancer-WHO. https://news.yahoo.com/breast-cancer-overtakes-lung-most-111945174.html 6. TRT World (2021): World Cancer Day: Interview with Andre Ilbawi, World Health Organization Cancer Control. https://www.youtube.com/watch?v=r8hKKHY8E8k 7. UN News (2021). How COVID-19 has forced cancer patients and medics to juggle deadly trade-off. https://news.un.org/en/audio/2021/02/1084592 8. Benjamin, O. A., André, M. I., Elena, F., Weiderpass, E., Lisa, S., May, A., & Bente, M. (2021). The Global Breast Cancer Initiative: a strategic collaboration to strengthen health care for non-communicable diseases. Lancet Oncol. 22(5):578-581. https://doi.org/10.1016/S1470-2045(21)00071-1 9. Health Promotion Administration, Ministry of Health and Welfare, Taiwan: Cancer registry annual report 2018, Taiwan. file:///C:/Users/hongt/Downloads/107%E5%B9%B4%E5%A0%B1_20210322.pdf 10. Coleman, M. P., Forman, D., Bryant, H., Butler, J., Rachet, B., Maringe, C., Nur, U., Tracey, E., Coory, M., Hatcher, J., McGahan, C. E., Turner, D., Marrett, L., Gjerstorff, M. L., Johannesen, T. B., Adolfsson, J., Lambe, M., G Lawrence, Meechan, D.,…the ICBP Module 1 Working Group.(2011). Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet. 377(9760):127–38. https://doi.org/10.1016/S0140- 6736(10)62231-3 11. Suanna, S. B., Todd, A. P., Wendy, V., Amy, H., Caroline, S., Elizabeth, G., Eric T., Margaret, R., Heather, H., Shannon, N. W., Noël,S., Conor, L., Michael, P. K., & Stephanie F. W. (2018). Understanding the Role of Advanced Practice Providers in Oncology in the United States. JAAPA. 31(12):1-12. https://doi.org/10.1097/01.JAA.0000549592.10756.4a. 12. Bevan, G., & Janus, K. (2011). Why hasn't integrated health care developed widely in the United States and not at all in England? J Health Polit Policy Law. 36(1):141-64. https://doi.org/10.1215/03616878-1191135 13. Kosty, M.P., Hanley, A., Chollette, V., Bruinooge, S.S., & Taplin, S.H. (2016). National Cancer Institute-American Society of Clinical Oncology teams in cancer care project. J Oncol Pract. 12(11):955–958. https://doi.org/10.1200/JOP.2016.018127. 14. U.S. News. (2021) Best Hospitals for Cancer. https://health.usnews.com/best-hospitals/rankings/cancer 15. McMullen, L. (2013). Oncology Nurse Navigators and the Continuum of Cancer Care. Seminars in Oncology Nursing, 29(2): 105–117. https://doi.org/10.1016/j.soncn.2013.02.005. 16. Loiselle, C.G., Attieh, S., Cook, E., Tardif, L., Allard, M., Rousseau, C., Thomas, D., Saha-Chaudhuri, P., & Talbot, D. (2020). The nurse pivot-navigator associated with more positive cancer care experiences and higher patient satisfaction. Can Oncol Nurs J. 30(1):48-53. https://doi.org/10.5737/236880763014853 17. Schäfer, W., Kroneman, M., Boerma, W., van den Berg, M., Westert, G., Devillé, W., & van Ginneken, E. (2010). The Netherlands: Health system review. Health Syst Transit 12(1):1–229. 18. Health Consumer Powerhouse (2017): Dutch News.nl (January 31, 2017): NL has best healthcare system in Europe, Swedish consumer group says. https://www.dutchnews.nl/news/2017/01/nl-has-best-healthcare-system-in-europe-swedish-consumer-group-says/ 19. Helliwell, J. F., Layard, R., Sachs, J. D., & Neve, J. D. E. (Editors) World Happiness Report 2020. New York; 2020. https://happiness-report.s3.amazonaws.com/2020/WHR20.pdf 20. Said, A. M. N., Thushara, S., Kelly, H., Deborah, C., & Jean, H. (2017) Ranked Performance of Canada’s Health System on the International Stage: A Scoping Review. Healthc Policy. 13(1): 59–73. https://doi.org/doi: 10.12927/hcpol.2017.25191 21. World Health Organization. Life expectancy and healthy life expecancy - data by country. Glob Heal Obs. Published online 2020. https://www.who.int/data/gho 22. Internationalinsurance.com. Understanding the Japanese Healthcare System. https://www.internationalinsurance.com/health/systems/japan.php 23. Smith, P. C., & Witter, S. N. (2004). Risk pooling in health care financing: the implications for health system performing. Health, Nutrition and Population (HNP) discussion paper; World Bank, Washington, DC. https://openknowledge.worldbank.org/handle/10986/13651 License: CC BY 3.0 IGO 24. Wong, C. Y., & Lee, H. C. (2008). Healthcare in Singapore: challenges and management. JMAJ 51(5): 343–346. 25. Tan, K. B., & Lee, C. E. (2019). Integration of primary care with hospital services for sustainable universal health coverage in Singapore, Health Systems & Reform. 5(1); 18-23. https://doi.org/ 10.1080/23288604.2018.1543830 26. National University Health System NUHS. Enabling care in the community-our care collaborators. https://www.nuhs.edu.sg/Care-in-the-Community/Enabling-Community-Care/Pages/default.aspx 27. Choi, B. C., & Pak, A.W. (2007). Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy: 1. Definitions, objectives, and evidence of effectiveness. Clin Invest Med. 29:351-365. https://doi.org/10.25011/cim.v30i6.2950 28. Ingrid, M., Brian, J., Marijke, S., & Geralod, W. (2003). Development of integrated care in England and the Netherlands: managing across public-private boundaries. Health Policy. 65(3):227-41. https://doi.org/10.1016/S0168-8510(02)00215-4 29. Goodwin, N. (2016). Understanding and evaluating the implementation of integrated care: a ‘three pipe’ problem. Int J Integr Care. 16(4): 19. http://doi.org/10.5334/ijic.2609 30. Haire, K. D., Burton, C., Park, R., Reynolds, J., Stewart, D., & Purushotham, A. D. (2012). Integrated Cancer System: a perspective on developing an integrated system for cancer services in London. London J Prim Care (Abingdon). 5(1):29-34. https://doi.org/10.1080/17571472.2013.11493369 31. Matti, A., Alain, A., Riccardo, A. Ian, B., Pierre, B., Etienne, B., David, C., Paolo, C., Arturo, C., Leticia, D. M., Daniel, K., Denis, L., Per, J. N., Martine P., Philip, P., Katrine, R., Gunnar, S., Martin, S., Riccardo, S., …Peter N. (2017). Identifying critical steps towards improved access to innovation in cancer care: a European CanCer Organisation position paper. Eur J Cancer. 82:193-202. https://doi.org/10.1016/j.ejca.2017.04.014 32. Laura, B., Fatima, C., Marc, B., David, C., Luigi, C., Charlotte, E. C., Roberto, C. D. B., Maria D. T., Sema, E., Maria, F., Romain, G., Mathijs, G., Christiane, K., Lorenza, M., Peter, N., Simon, O., Jean, P., Antonio, P., Marco, R. D. T., … Philip, P. (2020). The Breast. 51: 65-84. https://doi.org/10.1016/j.ejca.2013.07.017 33. Schad F., Thronicke, A., Merkle, A., Steele, M.L., Kröz, M., Herbstreit, C., & Matthes, H. (2018).Implementation of an Integrative Oncological Concept in the Daily Care of a German Certified Breast Cancer Center. Complement Med Res 25:85-91. https://doi.org/10.1159/000478655 34. Muhammad, A., Mehwish. I., Muhammad, D., & Asmat, U. K. (2017). Awareness and current knowledge of breast cancer. Biol Res. 50:33. https://doi.org/10.1186/s40659-017-0140-9 35. Thomas, B., Luc, B., John, D., Marc, K., Fabian, K., Rainer, L., Jingfei, M., Lalith, K. S. S., Benjamin, T., & Osama, M. (2020). What scans we will read: imaging instrumentation trends in clinical oncology. Cancer Imaging. 20:38. https://doi.org/10.1186/s40644-020-00312-3 36. Leithner, D., Wengert, G.J., Helbich, T.H., Thakur, S., Ochoa-Albiztegui, R.E., Morris, E.A., & Pinker, K. (2018). Clinical Role of Breast MRI Now and oing Forward Review. Clin Radiol. 73(8): 700-714. https://doi.org/10.1016/j.crad.2017.10.021 37. Narayanan D., & Berg, W.A. (2018). Dedicated Breast Gamma Camera Imaging and Breast PET: current status and future directions. PET Clin. 13:363-381. https://doi.org/10.1016/j.cpet.2018.02.008 38. NCCN Guidelines Version 4.2021. (2021). NCCN Evidence BlockTM. https://www.nccn.org/professionals/physician_gls/pdf/breast_blocks.pdf 39. Savino, B., Patrick, M., Paola, C., Nicole, R., Sonia, R., Marco, M., Marcello, P., Alberto, C., Franco M., Donata, C., Franco, D., Tommaso, S., Virgilio, S., Andrea, D., & Umberto, V. (2005). Incidence and risk factors for non-alcoholic steatohepatitis: prospective study of 5408 women enrolled in Italian tamoxifen chemoprevention trial. BMJ 23; 330 (7497):932. https://doi.org/10.1136/bmj.38391.663287. 40. Clough, K.B., Gabriel J. Kaufman, G. J., Nos, C., Buccimazza, I., & Sarfati, I.M. (2010). Improving Breast Cancer Surgery: A Classification and Quadrant per Quadrant Atlas for Oncoplastic Surgery. Ann Surg Oncol 17:1375–1391. https://doi.org/10.1245/s10434-009-0792-y 41. Franceschini, G., Sanchez, A.M., Leone, A.D., Magno, S., Moschella, F., Accetta, C., & Masetti, R. (2015). New trends in breast cancer surgery: a therapeutic approach increasingly efficacy and respectful of the patient. G Chir. 36(4): 145-152. https://doi.org/10.11138/gchir/2015.36.4.145 42. Nathan, B., Mia, S., Margaret, A., Elise, H., & Malcolm, W. R. (2017) Axillary treatment for operable primary breast cancer. Cochrane Database Syst Re |
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