유방암 환자 네비게이터 교육 프로그램 개발

Abstract

This study aimed to develop an education program for breast cancer patient navigators in South Korea considering the country’s cultural characteristics, before introducing the navigator program, to mitigate the healthcare inequality suffered by breast cancer patients deprived of the corresponding treatment. This study used the data of "The Development of Patient Navigator Program to Reduce Disparities in Cancer Care(Han, 2014)”, was a secondary analysis. Han's project is National R&D Program for Cancer Control supported by the Ministry of Health and Welfare and National Cancer Center. The logic model that includes the input, output, and outcome process was applied as follows. First, in the stage of understanding the context (or conditions), the literature on the characteristics and needs of breast cancer patients were reviewed, and the obstacles to their procurement of healthcare services as well as the necessity of patient navigators for breast cancer patients were investigated to understand the characteristics and needs of breast cancer patients who have been neglected in terms of being given cancer treatment, who are the targeted subjects of the navigator services. Second, in the stage of designing the program, a draft of an educationprogram for breast cancer patient navigators was formed through an advisory conference participated in by professional groups, reviews of the preceding studies, and diverse research meetings. Third, the implementation of the education program was analyzed by dividing the inputs and outputs based on the logic model; the inputs were the education program’s budget, instructors, managers, place and equipment, and advertisement of the education program for patient navigators, and outputs were the participation rate of patient navigators and the progress of the program implementation. Fourth, the evaluation of the education program was divided into formative evaluation and outcome evaluation. Formative evaluation was carried out through the participation rate of patient navigators, the internal evaluation, participatory evaluation, the degree of the program participants’ achievement of their individual goals in participating in the program and the educational satisfaction. As for the outcome evaluation, the degrees of achievement in the acquisition of knowledge about the patient navigator program and its educational goals were evaluated through the one-group pretest-posttest design, and the degree of the program participants’ achievement of their individual goals in participating in the program and the educational satisfaction was analyzed using descriptive statistics. In the results of the formative evaluation, First, the degree of the program participants’achievement of their individual goals in participating in the program was 58.7%. Second, Through internal assessment and participatory assessment, the structure and content of the education program was analyzed, and change direction was established. Third, the average degree of the program participants’ achievement of their individual goals in participating in the program was 8.08; 60% of the program participants exceeded the degree of achievement of the goals that they set before the program. Fourth, the program participants’ average degree of satisfaction with the curriculum was 3.99, and their average degree of satisfaction with the program courses was 4.59. The outcome evaluation, the degrees of achievement in the acquisition of knowledge about the breast cancer patient navigator program and its educational goals significantly increased in the aspect of statistics. In the results of this study, the final draft of the educationprogram for breast cancer patient navigators was completed by modifying the curriculum and courses using the logic model. This study was meaningful in that it presented the necessity of cultivating breast cancer patient navigators as an alternative for the improvement of healthcare equality by identifying and providing assistance to cancer patients deprived of treatment, and developed an education program for breast cancer patient navigators that reflects the cultural characteristics of South Korea.;본 연구의 목적은 우리나라 암치료소외계층의 의료불평등 완화를 위한 네비게이션 프로그램 도입에 앞서 문화적 특성을 반영한 유방암 환자 네비게이터 교육프로그램을 개발하는 것이다. 본 연구는 보건복지부·국립암센터에서 지원한 암정복추진연구개발사업의 연구프로젝트인 “암치료 소외계층을 위한 한국형 환자 네비게이터 프로그램 개발(한인영, 2014)”연구의 자료의 일부를 활용한 이차 분석 연구이다. 이 연구에서는 네비게이터 교육 프로그램 개발을 위해 투입·산출·성과 과정을 거치는 로직모델(Logic Model)을 아래와 같이 적용하였다. 첫째, 상황 단계에서는 네비게이터 서비스 대상자인 암치료소외계층 유방암 환자의 특성과 욕구를 파악하고자 문헌고찰, 의료장애요인, 유방암 환자 네비게이션프로그램 필요성 인식 및 요구도를 조사하였다. 둘째, 프로그램 설계 과정에서는 전문가 자문회의와 선행연구 고찰, 연구회의 등의 방법을 통하여 네비게이터 교육프로그램 초안을 구성하고자 하였다. 셋째, 교육 프로그램 실행은 로직 모델에 근거하여 프로그램 투입과 산출로 나누어 분석하였는데, 투입은 예산, 교육 강사, 교육의 진행 및 관리자, 교육장소 및 장비, 교육 대상자 모집이 포함되었으며, 산출은 네비게이터 교육 프로그램 참여율, 네비게이터 교육 프로그램 진행이 포함되었다. 넷째, 교육 프로그램 평가는 형성평가와 결과평가로 세분화하였다. 형성평가는 교육 프로그램 참여율, 내부평가와 참여평가(2회에 걸친 간담회와 교육 대상자의 모니터링), 교육에 대한 개별 목표 달성도, 교육 만족도를 통해 평가하였다. 결과평가는 단일 집단 사전·사후 설계를 통해 네비게이션 프로그램 지식 습득 및 교육 목표 달성정도를 분석하였다. 형성평가 분석결과, 첫째, 교육 프로그램 참여율은 85.7%였다. 둘째, 내부평가와 참여평가를 통해 교육 프로그램의 구성 및 내용을 분석하고 변화 방향을 설정하였다. 셋째, 교육 대상자들의 개별 목표 달성도는 8.08점(±1.39)으로 교육 대상자의 60%가 교육 전에 세운 목표를 초과 달성하였다. 교육 구성의 만족도는 3.99점(±0.79)이었으며, 교육별 만족도는 4.59점(±0.52)이었다. 결과평가 분석결과, 네비게이션 프로그램 지식의 습득 평가(t=-2.174, P=.038) 및 교육 목표 달성도는 통계적으로 유의미하게 증가하였다(t=-9.001, P=.000). 로직모델을 바탕으로 유방암 환자 네비게이터 교육 프로그램을 개발하는 과정을 통해 교육의 구성 및 내용을 수정하여 최종 네비게이터 교육 프로그램을 제안하였다. 본 연구는 암치료소외계층의 의료 형평성 제고를 위한 대안으로 유방암환자 네비게이터 인력 양성의 필요성을 제시하고 우리나라 문화적 특성이 반영된 유방암 환자 네비게이터 교육 프로그램을 개발하였다는 점에서 연구의 의의가 있다.