醫病關係對癌症病人服藥遵從性與症狀控制的影響

Cancer Patients Adherence and Symptom Management: The Influence of the Patient-Physician Relationship

適宜的癌症症狀處置對癌症病人的生活品質有著重要的影響，病人往往因對藥物的未能有效遵從使得症狀控制不佳、疾病復發、而產生其他的共病以及死亡。影響癌症病人對於藥物遵從行為的情境相當複雜，除了個人屬性因素、對疾病的認知與信念、對藥物的知識、個人自我效能、社會支持等因子外，醫病關係乃是其間醫療情境所屬的重要影響因子。醫病關係不僅是衡量醫病互動品質的終端指標，亦扮演著促進遵從行為的重要推手；在癌症症狀控制的研究結果顯示，提升良好的醫病關係將可有效地增進病人對藥物的遵從，對於疼痛控制、口服荷爾蒙療法的完整性、定期追蹤檢查等方面均有正向的影響。在癌症症狀處置的相關研究中，醫病關係尚屬新興的構念；然而，在探討促進病人遵從行為的因素時，不應忽視醫病關係對病人遵從行為的影響，才能更全面、完整地改善現存癌症病人藥物遵從性低的課題，並進而提升癌症症狀處置品質。

Appropriate of cancer symptoms positively influences quality of life. Inappropriate symptom management, disease recurrence, co-morbidity and death result from lack of medication adherence. Factors influencing adherence are multidimensional and include personal attributes, knowledge and beliefs regarding the disease and medication, self-efficacy and social support. The patient-physician relationship is a significant factor of influence in patient medication adherence and ultimate positive outcomes. If patients are satisfied with the relationship, they are highly likely to comply with health provider advice. Improving patient-physician relationships can effectively promote patient medication adherence. In cancer pain management and adjuvant hormone therapy for breast cancer, regular follow-up examinations have a positive impact. The physician-patient relationship with regard to cancer patient satisfaction is a relatively new topic of discussion, and many implications are scarcely understood. However, the physician-patient relationship should not be ignored as a factor in cancer symptoms management, especially with regard to promoting compliance behavior.