乳癌患者尋求西醫與非西醫治療之醫病關係初探

A Pilot Study of Doctor-Patient Relationship for Breast Cancer Women in Seeking Non-western Medicine

郭淑珍(Shu-Chen Kuo)；楊雪華(Hsieh-Hua Yang)

非西醫 ； 補充與另類療法 ； 乳癌 ； 質性研究 ； complementaryandalternativetherapies (CAM) ； breast cancer ； qualitative research

亞東學報

35期（2015 / 12 / 01）

239 - 249

繁體中文

台灣過去有關癌症病患使用非西醫的研究，主要為描述使用率或是使用那些樣式的療法，卻較少探索以及瞭解病患治療過程與醫師的互動關係；因此本研究透過深入訪談，訪問15 位乳癌病患使用非西醫療法歷程的醫病關係。研究初步發現15 位受訪者皆於確診初期以西醫療法為主，接受西醫療法後再輔以非西醫療法。罹癌病人求醫時與醫師建立的關係，形成強連結的可能性頗高，先與西醫建立強連結，接著尋求非西醫療法，如：補充與另類療法時，繼而與中醫師建立強連結，依據社會網絡關係理論，西醫與中醫之間也應形成關係。然而，由於中、西醫之間的鴻溝，該關係始終不存在。建議臨床癌症醫療團隊人員應以更開放的態度以及同理心，主動瞭解癌症病人對於非西醫療法使用的期待，主動與病患討論並提供相關知識，以增進更佳癌症照護品質。

In Taiwan, past researches about complementaryand alternativetherapies (CAM) users mainly focus on the rate or types. The interaction between doctor and patient had not yet explored. The purpose of this study is exploring the interaction between doctor and patient in medical encounter either for western medicine or using CAM. Fifteen breast cancer women were interviewed. After diagnosis, all of the respondents accepted western medicine in the beginning, then supplemented bynon-Western medicine. In the early stage, these cancer patients can establish strong relationship with physician. As they began to use CAM, they would establish strong link with Chinese doctor or healer. Based on the social network theory, there should be links between physician and Chinese doctor. However, due to the gap between western medicine and CAM, the links never existed. The reality is not helpful for cancer patient. It is suggested that the professionals should be more open-minded and empathetic for the benefit of patients. They would understand and accept patients’ seeking behavior, discuss with patients, and provide knowledge for better quality of care.

1. Beach, M. C.,Inui, T.(2006).Relationship-centered care. A constructive reframing.Journal of General Internal Medicine,21(Suppl. 1),S3-S8.
2. Boyer, C. A.,Lutfey, K. E.(2010).Examining critical health policy issues within and beyond the clinical encounter: patient-provider relationships and help-seeking behaviors.Journal of Health and Social Behavior,51,S80-S93.
3. Broom, A.(2009).Intuition, subjectivity, and Le Brioleur: cancer patients' accounts of negotiating a plurality of therapeutic option.Qualitative Health Research,19,1050-1059.
4. Charles, C.,Gafini, A.,Whelan, T.(1997).Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango).Social Science & Medicine,44(5),681-692.
5. Emanuel, E. J.,Emanuel, L. L.(1992).Four models of the physician-patient relationship.JAMA: The Journal of the American Medical Association,267(16),2221-2226.
6. Granovetter, M. S.(1973).The strength of weak ties.American Journal of Sociology,78(6),1360-1371.
7. Greenfield, G.,Pliskin, J. S.,Feder-Bubis, P.,Wientroub, S.,Davidovitch, N.(2012).Patient-physician relationships in second opinion encounters-The physicians' perspective.Social Science & Medicine,75,1202-1212.
8. Holmstrom, I.,Roing, M.(2010).The relation between patient-centeredness and patient empowerment: a discussion on concepts.Patient Education and Counseling,79(2),167-172.
9. Humpel, N.,Jones, S.C.(2006).Gaining insight into the what, why and where of complementary and alternative medicine use by cancer patients and survivors.European Journal of Cancer Care,15,362-368.
10. Juraskova, I.,Hegedus, L.,Butow, P.,Smith, A.,Schofield, P.(2010).Discussing complementary therapy use with early-stage breast cancer patients: exploring the communication gap.Integrative Cancer Therapies,9(2),168-176.
11. Mead, N.,Bower, P.(2000).Patient-centredness: a conceptual framework and review of the empirical literature.Social Science & Medicine,51(7),1087-1110.
12. Öhl'en, J.,Balneaves, L. G.,Bottorff, J. L.,Brazier, A. S.A.(2006).The influence of significant others in complementary and alternative medicine decisions by cancer patients.Social Science & Medicine,63,1625-1636.
13. Philip, J.,Gold, M.,Schwarz, M.,Komesaroff, P.(2010).Second medical opinions: the views of oncology patients and their physicians.Supportive Care in Cancer,18(9),1199-1205.
14. Roter, D.(2000).The enduring and revolving nature of the patient-physician relationship.Patient Education and Counseling,39(1),5-15.
15. Smithson, J.,Britten, N.,Paterson, C.,Lewith, G.,Evans, M.(2010).The experience of using complementary therapies after a diagnosis of cancer: a qualitative synthesis.Health,16,19-39.
16. Tasaki, K.,Maskarines, G.,Tatsumura, Y.,Kakai, H.(2002).Communication between physicians and cancer patients about complementary and alternative medicine: Exploring patients' perspectives.Psycho-Oncology,11,212-230.
17. Teutsch, C.(2003).Patient-doctor communication.The Medical Clinics of North America,87(5),1115-1145.
18. Thompson, J. J.,Kelly, K. L.,Ritenbaugh, C.,Hopkins, A.L.,Sims, C. M.,Coons, S. J.(2011).Developing a patient-centered outcome measure for complementary and alternative medicine therapies II: Refining content validity through cognitive interviews.BMC Complementary and Alternative Medicine,11,136.
19. Tovey, P.,Broom, A.(2007).Oncologists' and specialist cancer nurses' approaches to complementary and alternative medicine and their impact on patient action.Social Science & Medicine,64,2550-2564.
20. Wanchai, A.,Armer, J. M.,Stewart, B. R.(2010).Complementary and alternative medicine use among women with breast cancer: a systematic review.Clinical Journal of Oncology Nursing,14,E45-55.
21. 辛隆士、邱泰源、胡文郁、程劭儀、陳慶餘(1996)。癌末病人之另類治療行為。中華民國家庭醫學雜誌，6，127-136。
22. 張金堅、郭文宏、王明暘(2008)。台灣乳癌之流行病學。中華癌醫會誌，24，85-93。
23. 陳玉萍、曾振淦、曾雁明、洪志宏(2008)。放射腫瘤癌患接受西醫、中醫與另類療法的相關性調查分析。放射治療與腫瘤學，15，289-300。
24. 陳玉萍、曾雁明、曾振淦、林信吟、洪志宏(1999)。放射治療之癌患接受另類療法的調查。放射治療與腫瘤學，6(4)，295-300。