個案管理師運用PRECEDE-PROCEED 談癌症病人拒絕治療因素評估

Evaluation of Factors Influencing Patient Refusal of Cancer Treatment by Case Managers Using the PRECEDE-PROCEED Model

目的：探討國內癌症病人拒絕治療之相關影響因素。方法：運用PRECEDE-PROCEED模式，參照其前傾、增強、使能因素，分析可能影響癌症病人拒絕治療之相關因素。結果：本文利用PRECEDE-PROCEED模式的前傾、增強及使能因素應照在臨床個案管理上，分析癌症病人拒絕治療的因素，並藉由個案管理師角色介入，評估拒絕治療的可能因素，給予更多協助關懷及衛教疾病治療知識、合併症的處理方式以及適時轉介社會資源，在對治療期間有疑問時，也提供電話諮詢，減少患者不確定感，並做好病人與團隊間的溝通聯繫。結論：癌症病人藉由個案管理師角色能有連續性關懷，對癌症病人來說能夠增加對治療的信心、減少對癌症治療錯誤的觀念，提升癌症照護完整性。期本文能在臨床人員在照護實務上，增加面臨病人拒絕治療時之因應能力。

Purposes: Investigation of factors related to refusal to receive treatment amongst Chinese cancer patients. Methods: With reference of the predisposing, reinforcing, and enabling factors, the PRECEDEPROCEED model was adopted to analyze factors that affect refusal of treatment be cancer patients. Results: In this study, predisposing, reinforcing, and enabling factors of the PRECEDEPROCEED model were applied to clinical case management to analyze factors related to refusal to receive treatment by cancer patients. Through case manager intervention, the possible refusal factors were assessed. The results enable the provision of more assistance and care, disease and treatment knowledge, methods to manage complications, and timely distribution of social resources. When patients had questions during the treatment period, telephone consultation was provided to reduce feelings of uncertainty and to maintain good communication between the treatment team and the patients. Conclusions: Cancer patients can receive continuous care through the actions of case managers. Such continuous care increased the confidence of cancer patients in treatment, reduced incorrect concepts of cancer treatment, and enhanced the integrity of cancer care. It is expected that this study can help practicing clinical staff better respond to cancer patients who are unwilling to receive treatment.