12 Patient-Physician Relationship and Symptom Control adherence adherence Osterberg & Blaschke, 2005 ㈠㈡㈢ % Valeberg et al., % 53% Olden

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1 11 醫病關係對癌症病人服藥遵從性與症狀控制的影響周碧玲 1 林佳靜 2* 1 中華醫事科技大學護理系助理教授 2 臺北醫學大學護理學系教授暨護理學院院長摘要 : 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關鍵詞 : 癌症症狀處置醫病關係藥物遵從性 Parkin et al., % * adherence Burkhart PV, 2003 Osterberg & Blaschke, 2005 adherencecompliance compliance

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

2 12 Patient-Physician Relationship and Symptom Control adherence adherence Osterberg & Blaschke, 2005 ㈠㈡㈢ % Valeberg et al., % 53% Oldenmenger et al., 2007 tamoxifen Grunfeld, Hunter, Sikka, & Mittal, 2005 McCowan et al., ,816 tamoxifen 22.1% % Barron, Connolly, Bennett, Feely, & Kennedy, tamoxifen 49% Owusu et al., 2008 tamoxifen tamoxifen tamoxifen tamoxifen tamoxifen Lin, Zhang, & Manson, 2011 Partridge, Avorn, Wang, & Winer, cyclophosphamide prednisone 53% Lebovits et al., FU 5-Fluorouracil 75 86% 5-FU 93 94% 2008

2% Barron, Connolly, Bennett, Feely, & Kennedy, 20075 961 65tamoxifen 49% Owusu et al.

3 13 Kerse et al., 2004 Ward et al., Cleeland et al., Pain Management Index, PMIs 43% 12% Enting, Oldenmenger, Van Gool, van der Rijt, & Sillevis Smitt, 2007 Reid, Gooberman-Hill, & Hanks, 2008 physician barriers Maltoni, Albert et al., 2011 Bickell, Weidmann, Fei, Lin, & Leventhal, 2009 Osterberg & Blaschke, Paltiel et al., 2001 Hillen, De Haes, & Smets, 2011 Zachariae et al., 2003

Smitt, 2007 Reid, Gooberman-Hill, & Hanks, 2008 physician barriers Maltoni, 2008 171 Albert et al.

4 14 Patient-Physician Relationship and Symptom Control [Hu, H. W., Chen, M. L., & Liao, W. C. (2008). The adherence to oral chemotherapy in colorectal cancer patients: A pilot study. Chung Shan Medical Journal, 19(2), ] Albert, U. S., Zemlin, C., Hadji, P., Ziller, V., Kuhler, B., Frank- Hahn, B.,... Kalder, M. (2011). The impact of breast care nurses on patients satisfaction, understanding of the disease, and adherence to adjuvant endocrine therapy. Breast Care, 6(3), doi: / Barron, T. I., Connolly, R., Bennett, K., Feely, J., & Kennedy, M. J. (2007). Early discontinuation of tamoxifen. Cancer, 109(5), doi: /cncr Bickell, N. A., Weidmann, J., Fei, K., Lin, J. J., & Leventhal, H. (2009). Underuse of breast cancer adjuvant treatment: Patient knowledge, beliefs, and medical mistrust. Journal of Clinical Oncology, 27(31), doi: / jco Burkhart PV, S. E. (2003). Adherence to long-term therapies: Evidence for action. Journal of Nursing Scholarship, 35(3), 207. Cleeland, C. S., Gonin, R., Hatfield, A. K., Edmonson, J. H., Blum, R. H., Stewart, J. A., & Pandya, K. J. (1994). Pain and its treatment in outpatients with metastatic cancer. New England Journal of Medicine, 330(9), doi: /nejm Enting, R. H., Oldenmenger, W. H., Van Gool, A. R., van der Rijt, C. C. D., & Sillevis Smitt, P. A. E. (2007). The effects of analgesic prescription and patient adherence on pain in a Dutch outpatient cancer population. Journal of Pain and Symptom Management, 34(5), doi: /j.jpa insymman Grunfeld, E. A., Hunter, M. S., Sikka, P., & Mittal, S. (2005). Adherence beliefs among breast cancer patients taking tamoxifen. Patient Education and Counseling, 59(1), doi: /j.pec Hillen, M. A., De Haes, H. C. J. M., & Smets, E. M. A. (2011). Cancer patients trust in their physician - A review. Psycho- Oncology, 20(3), doi: /pon.1745 Kerse, N., Buetow, S., Mainous, A. G., Young, G., Coster, G., & Arroll, B. (2004). Physician-patient relationship and medication compliance: A primary care investigation. The Annals of Family Medicine, 2(5), doi: / afm.139 Lebovits, A. H., Strain, J. J., Messe, M. R., Schleifer, S. J., Tanaka, J. S., & Bhardwaj, S. (1990). Patient noncompliance with self-administered chemotherapy. Cancer, 65(1), doi: / ( )65:1<17::aidcncr >3.0.co;2-i Lin, J. H., Zhang, S. M., & Manson, J. E. (2011). Predicting adherence to tamoxifen for breast cancer adjuvant therapy and prevention. Cancer Prevention Research, 4(9), doi: / capr Maltoni, M. (2008). Opioids, pain, and fear. Annals of Oncology, 19(1), 5 7. doi: /annonc/mdm555 McCowan, C., Shearer, J., Donnan, P. T., Dewar, J. A., Crilly, M., Thompson, A. M., & Fahey, T. P. (2008). Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. British Journal of Cancer, 99(11), doi: /sj.bjc Oldenmenger, W. H., Echteld, M. A., de Wit, R., Sillevis Smitt, P. A. E., Stronks, D. L., Stoter, G., & van der Rijt, C. C. D. (2007). Analgesic adherence measurement in cancer patients: Comparison between electronic monitoring and diary. Journal of Pain and Symptom Management, 34(6), doi: /j.jpainsymman Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England Journal of Medicine, 353(5), doi: doi: /nejmra Owusu, C., Buist, D. S. M., Field, T. S., Lash, T. L., Thwin, S. S., Geiger, A. M.,... Silliman, R. A. (2008). Predictors of tamoxifen discontinuation among older women with estrogen receptor Positive breast cancer. Journal of Clinical Oncology, 26(4), doi: /jco Paltiel, O., Avitzour, M., Peretz, T., Cherny, N., Kaduri, L., Pfeffer, R. M.,... Soskolne, V. (2001). Determinants of the use of complementary therapies by patients with cancer. Jour-

The impact of breast care nurses on patients satisfaction, understanding of the disease, and adherence to adjuvant endocrine therapy. Breast Care, 6(3), 221 226. doi:10.1159/000329006 Barron, T. I.

5 15 nal of Clinical Oncology, 19(9), Parkin, D. M., Ferlay, J., Curado, M. P., Bray, F., Edwards, B., Shin, H. R., & Forman, D. (2010). Fifty years of cancer incidence: CI5 I IX. International Journal of Cancer, 127(12), doi: /ijc Partridge, A. H., Avorn, J., Wang, P. S., & Winer, E. P. (2002). Adherence to therapy with oral antineoplastic agents. Journal of the National Cancer Institute, 94(9), doi: /jnci/ Reid, C. M., Gooberman-Hill, R., & Hanks, G. W. (2008). Opioid analgesics for cancer pain: Symptom control for the living or comfort for the dying? A qualitative study to investigate the factors influencing the decision to accept morphine for pain caused by cancer. Annals of Oncology, 19(1), doi: /annonc/mdm462 Valeberg, B., Miaskowski, C., Hanestad, B., Bjordal, K., Moum, T., & Rustoen, T. (2008). Prevalence rates for and predictors of self-reported adherence of oncology outpatients with analgesic medications. The Clinical Journal of Pain, 24(7), Ward, S., Donovan, H., Gunnarsdottir, S., Serlin, R. C., Shapiro, G. R., & Hughes, S. (2008). A randomized trial of a representational intervention to decrease cancer pain (RIDcancerPain). Health Psychology, 27(1), Zachariae, R., Pedersen, C. G., Jensen, A. B., Ehrnrooth, E., Rossen, P. B., & Von Der Maase, H. (2003). Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. British Journal of Cancer, 88(5), doi: /sj.bjc Cancer Patients Adherence and Symptom Management: The Influence of the Patient-Physician Relationship Pi-Ling Chou 1 Chia-Clin Lin 2 * 1 RN, PhD, Assistant Professor, Department of Nursing, Chung Hwa University of Medical Technology; 2 RN, PhD, Professor & Dean, School of Nursing, College of Nursing, Taipei Medical University. Abstract: Appropriate management 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 patientphysician 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. Key Words: cancer symptom management, patient-physician relationship, medication adherence. Accepted for publication: December 6, 2011 *Address correspondence to: Chia-Clin Lin, No. 250, Wu-Hsing Street, Taipei City 11031, Taiwan, ROC. Tel: +886 (2) ; clin@tmu.edu.tw

Journal of the National Cancer Institute, 94(9), 652 661. doi:10.1093/jnci/94.9.652 Reid, C. M., Gooberman-Hill, R., & Hanks, G. W. (2008).

自傷行為 67 難化個人化及妄下結論等皆是有系統的邏輯謬誤吳陳 4 羅 6 憂鬱患者的症狀困擾自我情緒人際及生活品質若只靠個人意志是無法自行恢復通常需要藥物或心理治療才能恢復健康而照顧憂鬱症患者護理人員需維持溫暖接納與尊重的態度利用治療性溝通技巧引導表達感受以提高健

自傷行為 67 難化個人化及妄下結論等皆是有系統的邏輯謬誤吳陳 4 羅 6 憂鬱患者的症狀困擾自我情緒人際及生活品質若只靠個人意志是無法自行恢復通常需要藥物或心理治療才能恢復健康而照顧憂鬱症患者護理人員需維持溫暖接納與尊重的態度利用治療性溝通技巧引導表達感受以提高健 66 Self-Mutilation 日間病房反覆自傷之憂鬱症患者的護理經驗蔡佳吟余靜雲文獻查證摘要本文描述在日間病房照顧一位反覆出現自傷行為之憂鬱症個案的護理經驗筆者自8年月日開始照護個案發現個案6年月8日住院迄今無效性因應能力及自傷行為實質改善情形不佳故除了平時的復健與團體護理治療之外於8年月日至4月4日介入十次個別治療性會談與個案討論日記會談中運用認知行為改

12 Patient-Physician Relationship and Symptom Control adherence adherence Osterberg & Blaschke, 2005 ㈠ ㈡ ㈢ % Valeberg et al., % 53% Olden

12 Patient-Physician Relationship and Symptom Control adherence adherence Osterberg & Blaschke, 2005 ㈠㈡㈢ % Valeberg et al., % 53% Olden