背景與目的：癌症防治包括預防、篩檢和治療三大策略。行政院衛生署國民健康局為降低大腸直腸癌發生率及早期發現個案，從基層社區推動大腸直腸癌糞便潛血免費篩檢檢查，加強醫療院所全面推動癌症篩檢，經由適當的篩檢及瘜肉移除以降低大腸直腸癌的發生率及死亡率，本研究將從健康利用情形探討大腸直腸癌糞便篩檢之重要影響因素。
研究方法：本研究以R. M. Andersen model健康服務利用行為模式為研究問卷之理論架構，於中部某醫學中心進行收案。以SPSS 18.0軟體進行統計分析，利用卡方檢定有否執行免費大腸直腸癌糞便潛血篩檢兩組民眾的健康服務利用差異，並以羅吉斯迴歸預測影響民眾大腸直腸癌糞便潛血篩檢之重要因素。
研究結果：研究問卷共發出500份，總回收共351份，回收率為70.2
%，有效問卷共344份。以卡方統計檢定有否執行大腸直腸癌糞便潛血免費篩檢之兩組人其健康服務利用之差異:傾向因素中職業（p<0.01）、健康行為之運動（p<0.05）、喝酒（p<0.01）及抽菸（p<0.01），健康認知之執行篩檢可消除恐懼感（p<0.05）、篩檢預防的重要性（p<0.05）、篩檢費時（p<0.001)；能用因素中知道大腸直腸癌糞便潛血篩檢資訊（p<0.01）均達統計之顯著差異；需要因素中曾接受口腔黏膜篩檢（p<0.001）及子宮頸抹片篩檢（p<0.001）等均達統計上之顯著差異。以羅吉斯迴歸預測影響大腸直腸癌糞便潛血篩檢之重要因素，結果發現為不認同篩檢費時者（p<0.05）、曾接受口腔黏膜篩檢（p<0.05）及知道篩檢資訊（p<0.05）是影響大腸直腸癌糞便潛血篩檢之重要因素。
結論與建議：預防篩檢醫療服務可提昇相關民眾早期發現與治療，並減低癌症照護醫療成本。曾接受口腔黏膜篩檢，執行大腸直腸癌糞便潛血篩檢比例較高，可以在推動癌症篩檢項目時，將符合各項篩檢條件之民眾，同時推動免費大腸直腸癌糞便潛血篩檢。研究結果顯示知道篩檢資訊者參與癌症篩檢比率較高，因此建議政府衛生單位可以多加宣導篩檢相關資訊。
Objective: Cancer prevention includes three strategies: prevention, screening and treatment. In order to lower the incidence of colorectal cancer and to improve early detection of disease, Bureau of Health Promotion, Department of Health, R.O.C. (Taiwan) has promoted free fecal occult blood screening in the communities and enhanced propagation of screening programs in general health care institutes. Through adequate cancer screening and removal of polyp, the incidence and mortality of colorectal cancer could be reduced. This study explored the important factors that affect fecal occult blood screening and its medical care use.
Methods: A structural questionnaire was designed on the basis of the behavioral model for health service utilization proposed by Andersen RM. This questionnaire was used during hospitalization and outpatient visit in a medical center in Mid-Taiwan. This study used a cross-sectional survey design with the purposive sampling method to collect cases. SPSS window version 18.0 was used for statistic analysis. Factor analysis, descriptive statistic, chi-square test and logistic regression were performed to predict the major affecting factors of colon cancer screening.
Result: This study collected data from 500 subjects who were asked to participate in the survey. 68.8% (N=344) of participants agreed to complete the questionnaire. This study revealed three important factors: (1) People who think that colorectal cancer screening was not a time-consuming test, preferred to undergo screening. (2) People who had received oral cancer screening, tended to accept colorectal cancer screening (p<0.05); (3) People who were acquainted with the information of cancer screening were likely to receive colorectal cancer screening. These three factors were statistically significant (p value <0.05) in this study.
Conclusions: Community preventive and screening services improve early detection of disease and treatment, hence reduce medical costs in cancer care. In this study, individuals who had received oral cancer screening previously showed preference for screening for colorectal cancer.
This study suggested that it is more efficient to provide all cancer screening to subjects who meet the criteria. People are willing to receive screening if they are more acquainted with the information of cancer screening. Thus, government health units should put more efforts into distribution of information regarding cancer screening.
