| Summary: | 碩士 === 長庚大學 === 醫務管理學系 === 101 === Background: Cancer is the leading cause of death in Taiwan and comprised 28.4% of mortality cases in 2012, include 16,395 of females.
Breast cancer is the first leading cause of female cancer and the fifth mortality rate from cancer among females. Treatment adherence may affect cure care outcomes and survival rate of cancer patients. Therefore, it is important to provide a more comprehensive understanding of factors associated with discontinuation and non-adherence to cancer treatment. This study takes breast cancer patient as example, to understand the relationship between cancer case manager and patient discontinuation. The understanding will help healthcare providers to improve the healthcare quality of care of breast cancer patients.
Materials and Methods: This study is a retrospective quasi-experimental study review analyzed data from a case management information system concerning breast cancer patients enrolled in case management information system of cancer patients from 2006 to 2010 in Chang Gung Memorial Hospital. According to the definition of discontinuation, 42 samples are select among 818 cancer patients who has case manager visit records as discontinual group, and the continual group are matching by the proportion of characteristics of age, cancer stage and distance to hospital of discontinual group also include 42 samples. In addition to descriptive statistics and chi-square test, we used content analysis to analyze factors associated with case manager and patient discontinuation of cancer therapy.
Results: The highest frequency of case manager appears in first week after patients were received. The average personal visit rate of discontinual group is 0.36 person-times, and continual group is 0.81 person-times. As the case manager role functions we make up in this study divided into 7 different roles, such as recorder, clinical expert, consultant, educator, coordinator, supporter and change agent. In the patient dimension, case manager play most role in recorder (49%) in discontinual group and clinical export (34%) in the continual group. In the time dimension, case manager play most role in clinical export (26%) during first month and most in recorder (39%) during chemotherapy. Whether in the first month or chemotherapy period, case manager spend most time in recorder (37%; 56%) in discontinual group and clinical export (32%; 37%) in continual group.
Discussion: The later or least case manager come to visit, educate and provide disease information to patient are significantly associated with discontinuation and non-adherence to breast cancer therapy in breast cancer patients. To arrange the over loading patient quantity we suggest case manager could investigate patient’s available visit time first then make a visit schedule plan. In this way case manager could not only save more time but also could provide patient what they need in the appropriate time, further more could improve the quality of breast cancer in the future.
|
|---|
