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研究生： 陳威榮
Chen, Wei-Jung
論文名稱： 峰終理論應用於職能治療訓練之效益:以台灣醫療院所為例
Application of Peak-End Rule in Occupational Therapy Program: Take A Hospital in Taiwan for Example
指導教授： 謝孟達
Shieh, Meng-Dar
學位類別： 碩士
Master
系所名稱： 規劃與設計學院 - 創意產業設計研究所
Institute of Creative Industries Design
論文出版年： 2016
畢業學年度： 104
語文別： 英文
論文頁數： 52
中文關鍵詞： 峰終理論 、職能治療 、顧客滿意度
外文關鍵詞： Occupational therapy, Peak-End rule, Satisfaction
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    • 每年接受職能復健的個案人數一直增加。研究指出，參與職能治療有助於提升個案的生活品質、剩餘能力保持與重返社會的機會。而病人滿意度是醫療績效評估中的重要一環，可以做為治療計畫效果的評估指標之一。唯目前國內的職能治療績效評估大多屬於事後型調查，統計得知結果後才被動地做出反應或修正。經濟學者Kahneman and Frederick (2002)提出的峰終理論(Peak-end Rule)證實，消費者傾向以消費過程中的高峰及結束前經驗來評斷整個過程。因此，若能設計或規畫良好的消費結束前經驗將有助於提升整體服務的滿意度。
    因此，本研究企圖應用終峰理論於精神分裂症的職能治療計畫中，主動改善治療績效，並探討其效果。本研究的問題有二：(1) 峰終理論是否適用於職能治療計畫中? (2)峰終理論用於職能治療計畫中的效果。本研於國內某精神科醫院中執行研究設計採用便利抽樣招募個案經歷物理介入與精神介入兩個不同的實驗階段。每個階段結束後，個案填寫顧客滿意自評問卷(Linkert 5 point scale)做為評估方式; 並從中隨機抽選進行個案訪談。此外，所有參與研究的臨床職能治療師亦接受事後訪問。研究所得之資料以SPSS12.0進行分析，人口學資料及問卷資料分別以T test(α=0.05)進行分析。
    根據問卷與訪談資料顯示，個案在經歷峰終理論介入後，其整體滿意度在心理介入階段提升達顯著差異(P=0.04 < 0.05)，而在物質介入階段雖有提升但未達顯著差異(P=0.06 > 0.05)。根據訪談資料顯示, 個案明顯察覺到他們在心理介入階段受到更多的關注、說明，並對此感到滿意；在物理介入階段, 多數個案在收到刺激物(口罩)時亦覺得開心及受用。唯若僅能從上述二種介入擇一選擇時，多數個案比較希望接受到更多的心理介入。從治療師的訪談中也得到類似的回答。綜合結果發現可能的原因有兩個。相較於心理介入來說，物理介入(口罩)的實際價格較低，且獲得以後，就很容易習慣拿取這類的小物品。本次實驗所選用的刺激物(口罩)價值感較低。另一個原因是，部分參與者並沒有使用口罩的習慣，拿到口罩以後反而分享給他人或家庭成員使用。雖然收到時會覺得高興，這樣的快樂情緒與職能治療的連結感較弱。

    Many patients undergo rehabilitative treatments in Taiwan each year. According to the literature, an occupational therapy program (OT program) may improve patients’ quality of life, residential abilities, and chance of returning to social life. Patient satisfaction is an important index in benefit management of an OT treatment program. Although most OT institutes perform common assessments, which are post-intervention assessments, they react passively to the results of these assessments. Kahneman identified the peak-end rule, which indicated that customers tend to judge past experiences by how they were at peak (pleasant or unpleasant) and how they ended (Kahneman & Frederick, 2002). If therapists provide good experiences at the end of the program, it may improve the satisfaction and increase the willingness to participate of the patient.
    The purpose of this study is applying the peak-end rule in occupational therapy program and checking its effects. The research questions are: ¬¬(1) Does the peak-end rule work in occupational therapy program? (2) What is the effect of peak-end rule applying in occupational therapy program? This study was implemented in one hospital in southern Taiwan. The quantitative data were collected via self-evaluation questionnaires (Linkert 5-point scale) co-made by researcher and institute. The participants went through two different kinds of intervention, physical intervention and psychological intervention, in one month. Thirty participations were recruited in this study. Additionally, four clinical therapists were interviewed. The data were analyzed by SPSS 12.0 statistics software. Demographic data was analyzed by t test (α=0.05). The data, which had been gathered from interview, were analyzed by open coding, secondary coding, and axial coding.
    The questionnaire data showed that the overall satisfaction of the OT program was improved. Comparing with the baseline data, the outcome of satisfaction in psychological intervention phase (P=0.04 < 0.05) is greater than in the physical intervention phase (P=0.06 > 0.05). According to the interviews, the participants felt that they had been better cared for and received more information in the psychological phase than in the original status. This supports the results. Most of the participants felt happy when they received the surgical mask at the end of the program. However, participants said if they could choose only one of them, they preferred the psychological intervention more than the physical one. Almost all the clinical therapists gave similar feedback. One of the reasons is that compared with psychological intervention, the physical intervention (surgical mask) is a low price product and seems lower "value". People easily become used to it the second or third time. Another reason is that some of the participants seldom use surgical masks. Although they were happy, there was a weaker emotional connection in the feedback to the OT program.

    中文摘要 I Abstract III Table of Contents V List of Figures VIII List of Tables IX Chapter1. Introduction 1 1.1. Research Background and Motivation 1 1.2. Aims of Research and Research Questions 9 Chapter2. Literature Review 11 2.1 Occupational Therapy Programs 11 2.2 Peak-End Rule 13 2.2.1 Definition of Peak-End Rule 13 2.2.2 Literatures of Peak-End Rule 14 2.2.3 Limitations of Peak-End Rule 15 2.3 The Serial Position Effect 16 2.4 Applying the Peak-End Rule in Occupational Therapy Program 17 Chapter3. Research Methodology 18 3.1 Methodology and Research Method 18 3.1.1 Experimental Research and Questionnaire 18 3.1.2 Variables 19 3.1.3 Scales 20 3.1.4 Statistic for Quantitative Date 21 3.2 Investigation and Interview 21 3.2.1 Interview Outline 22 3.2.2 Sampling and Data Gathering 22 3.2.3 Analysis of Qualitative Data 22 3.2.4 Code Name and Quotation 23 3.3 Mini-pilot Discussion 24 3.4 Research Design 26 3.4.1 Research Process 26 3.4.2 Time Schedule 29 3.4.3 Recruitment Criteria 30 3.5 Ethical Issue 31 Chapter4. Results and Findings 33 4.1 Hui-Min Hospital 33 4.2 Demographic Data of Participants 35 4.3 The Statistic Result of the Quantitative Data 36 4.4 Satisfaction of the Participants 37 4.5 Axis Coding Results of the Qualitative Data 39 Chapter 5 Discussion and Conclusions 47 5.1. Applying Peak-End Rule in Occupational Therapy Program 47 5.2 Satisfaction Gaps Between Patients and Therapists 48 5.3. Recommendations for applying the P-E Rule in OT Program 49 5.3.1. Invite Some Patients To Join The Decision-Making Group 49 5.3.2. The Notes for Providing Physical Interventions 49 5.3.3. Recommendations for Providing Psychological Interventions 50 5.4 Conclusion 50 5.5 Limitations and Suggestion for Further Study 51 5.5.1 Small Sample Size 51 5.5.2. Purposive Sampling 51 5.5.3 Single Hospital 51 5.5.4. Short Span 51 5.5.5. Without Testing the Peak Situation of P-E Rule 52 References 53 Appendix 57

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