屏東縣偏遠地區口腔癌篩檢陽性個案未轉介成功 之因素探討

Investigation for the of Reasons Unsuccessful Referral in Oral Cancer Screening in Remote Areas of Ping-Tung County

10.6832/KMU.2009.00064

蔡美珍

口腔黏膜疾病 ； 篩檢 ； 轉介 ； oral mucosal disease ； oral screening ； and referral

高雄醫學大學口腔衛生科學研究所碩士在職專班學位論文

2009年

碩士

楊奕馨

繁體中文

研究背景： 癌症篩檢是可以早期發現早期治療的重要方法，屏東縣過去每年至少有15,000個案參加口腔癌篩檢，陽性個案往往沒有全部轉介成功，延遲就醫治療易導致錯失治療良機。本研究期望能藉由了解口腔癌篩檢陽性個案未轉介成功的因素等結果，引申作推廣口腔癌篩檢陽性個案未能轉介成功之參考。 研究目的： 探討口腔癌篩檢陽性個案未成功轉介的因素與其影響因子。 研究方法： 本研究對象參加口腔黏膜篩檢2035名受檢民眾中，陽性個案計449名，其中未完成轉介的180名為對象。統計方法採用SAS、JMP套裝統計軟體進行資料分析。 研究結果： 180位未成功轉介的陽性個案當中有78位成功完成口腔外科醫師確診及問卷調查，其性別比例女性佔53.8%高於男性46.2%。人口特性資料年齡群45-64歲佔多數﹙46.2%﹚，種族以排灣族佔最多數﹙91.0%﹚，教育程度以國小佔最多數﹙60.3%﹚，職業以家管佔多數﹙46.2%﹚。 78位陽性個案接受問卷調查；發現多數皆有吸菸、喝酒、嚼食檳榔等習性，嚼食檳榔添加物以白灰最高﹙79.5%﹚。受訪者接受專科醫師確診後，口腔黏膜病變的診斷仍以白斑症佔最高。 受訪者家人對檢查結果的態度，「以家人清楚且支持儘速就醫」佔最高為67.9%。無法馬上到醫療院所做口腔查檢的原因，「以口腔黏膜症狀自己好了，也就放心了」佔多數為39.7%。若受訪者自行處理口腔病變時72.7%沒有注意到病變的顏色。在願意到醫療機構的檢查及治療的方式；是「以假日早上排定醫師到衛生局、所定點設立門診」意願最高為84.%。 研究結論： 本次研究整體探討口腔癌篩檢陽性個案未成功轉介的因素與其影響因子，在94年已被告知為口腔黏膜異常病變需到口腔外科進行確診，至96年還未完成轉介造成延遲就醫的情況。 未成功轉介之受訪者，其家人支持關心且鼓勵儘速就醫的比率很高，但不就診的原因則認為口腔黏膜症狀自己會好；或是工作太忙碌、排班不定不易請假就拖延了。民眾對於口腔病變沒有警覺性是口腔癌防制上需特別注意的問題。 關鍵字：口腔黏膜疾病、篩檢、轉介

Abstract Background： Cancer screening is an important early detection method for oral cancer prevention. There were at least 15,000 residents undertook oral cancer screening in Pingtung County, unfortunately not all of the positive cases received a specialty diagnosis, thus resulting in delayed treatment. We hope that by studying factors related to unsuccessful referrals may help to promote cancer screening and to reduce the unsuccessful referral rates. Aim of study: The purpose of this study was to investigate factors for unsuccessful referral cases. Material and Methods: Oral cancer screening was preformed on 2035 participants in 2005. The screening result indicated 449 suspected positive cases who were further referred to specialties. A total of 180 out of 449 positive cases who refused to visit specialties were included as the target for this study. Statistical analysis was preformed using JMP software version 6. Results： Out of the 180 positive cases, there were 53.8% females, and 46.2% males. There were only 78 cases who agreed to participate in this study. Each participant received an oral examination by specialty and a personal interview. If necessary, biopsy was also performed on site. It was found that most had cigarette smoking, alcoholic drinking and betel quid chewing habits. Most of the family members of our participants were aware of the screening results and supported for further treatment (67%). However, most of the participants felt that the oral mucosal lesions would recovered themselves (39.7%) Most of the participants did not pay attention to the color of their own lesions (72.7%). Those replied that they would be willing to accept treatment when the clinic could be available during weekends (84%). Conclusions: This study surveyed all the reasons of unsuccessful referrals of positive oral cancer screening in 2005. Those who failed to seek specialty prior to our interviews had not only have family support, but also have encouragement from their families for seeking medical treatment immediately. The reasons for those who delayed referrals were busy, difficult to change their shift or difficult to get leave. Public awareness of oral cancer screening is still needed to be enhanced through the whole society. Keyword：oral mucosal disease, oral screening, and referral

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