本研究旨在於瞭解門診護理人員推動四癌篩檢轉介低落之原因及介入跨專業團隊實施品管圈活動後所改善的成效(大腸癌、口腔癌、子宮子癌、乳癌)，並探討對策方案在護理人員阻礙因素認知與轉介率之成效。本研究以台北市立某聯合醫院門診單位護理人員48位為研究對象，進行提升四癌轉介管理個案的行動研究，活動期間為2013年6月至12月止，及2014年1月至9月改善後效果維持之研究。
本研究依據跨專業團隊合作，找出八大障礙因素:(1)因為沒有監測制度(2)不主動完成列印癌篩單張(3)不了解醫院推動癌篩政策與重要性(4)工作量太大，沒有時間篩選(5)不知道醫院在推動四癌的篩檢服務(6)無法有效提醒醫師列印癌篩單張(7)夜診缺乏癌篩場合，病人不想跑第二次(8)年長者，需要繞幾個地方檢查，沒人帶很困擾等。並透過跨專業團隊的溝通與協商共同擬訂五大對策，運用於醫師、護理人員、病人及環境流程面之改善。
研究結果:護理人員推動癌篩轉介阻礙因素認知由改善前93.75%至改善後為12.50%，因此提升了四癌篩檢轉介率由改善前的3.24%提升至10.60%。本研究以病人為中心，透過跨專業團隊合作，提高醫療照護品質，期能提供臨床醫療單位參考，使照護品質得以持續提升。
This study aims to understand the reason for low referral rate of four cancer (colorectal cancer, oral cancer, cervical cancer and breast cancer) screening examination, and the effectiveness of implementation by using Quality Control Circle (QCC) method with multi-disciplinary teams, and to discussing the countermeasure of the obstacles. This study is based on 48 nurses from one of the Taipei City Hospital. It’s an action-research about how to enhance the case management of four cancer screening examination. The event started from June till December In 2013 and survey for the effectiveness of post-programming has been done during January to September in 2014.
This study was based on a multi-disciplinary team collaboration, we have identified eight Obstacles: (1) No monitoring system; (2) Without takinginitiative to print out the Cancer screening sheet; (3) Without understandingwhat is the importance of purpose for the hospital to promote cancer screening and the policy of it; (4)Due to heavy daily work, there is no enough time for participating the four cancer screening project; (5) No announcement of promoting for four cancer screening program in hospital; (6) Unable to remind physicians to print out the Cancer screening sheet effectively; (7)Due to lack of cancer screening in evening occasions, patients don’t want to come twice; (8) Need to go around for several places in hospitalto do physical examination,brought much complicateprocedure of services for Seniors . This study, through interdisciplinary communication and consultation jointly, formulates five measures used for physicians, nurses, patients and to improve the process of the environment also.
The results of the study: The referral impediment of cancer screening promotion in nurses hasbeen decreased from 93.75% to 12.50%. Therefore, enhance the four cancer screening referral rate has improved from 3.24% to 10.60%. In this study, patients were centered. Through the collaboration of a multi-disciplinary team, the quality of medical care has improved. In order to improve the quality ofcancerscreening program,the findingand result of this study would be providing some suggestions and references for other medical units.
