臺灣博碩士論文加值系統

本研究旨為以自我決定理論分析影響大腸直腸癌病人尋求治療時程之相關因素，採橫斷性研究，以北部某一腫瘤專科醫院，初次接受治療之大腸直腸癌病人為研究對象，使用結構性問卷及方便取樣，於研究對象初次接受治療之住院期間進行資料收集。本研究共收案111 名大腸直腸癌病人，研究工具包括基本資料問卷，基本需求滿意問卷、健康照護情境氣氛問卷、病人尋求治療動機問卷、醫院病人焦慮與憂鬱量表、和癌症恐懼量表。資料以SPSS 18.0 統計軟體處理，統計方法包括描述性統計分析（平均值、標準差、百分比）及推論性統計分析(t-test, one-way ANOVA,
correlation, multiple regression, Tobit model)。
研究結果發現大腸直腸癌病人有延遲尋求治療情形，延遲診斷天數平均為154.77 天（SD=210.09）。相關性統計結果顯示男性、無健檢者、及憂鬱與延遲診斷天數有顯著之相關性 （p <0.05)。而未婚、離婚或喪偶者、勝任感較低、尋求協助動機較弱、及診斷期別為0-1 期者與延遲治療天數有關（p <0.05) 。然內在動機、尋求協助動機和焦慮程度有顯著的相關（p <0.05)。沒有健檢者、自主性需求滿意度與憂鬱相關（p <0.05)。另外年齡較大者對癌症恐懼則相對較低。
回歸統計與tobit model 分析發現，延遲診斷天數之預測因子為性別（F=5.163, p <0.01)和健檢習慣（F=5.109, p <0.01)。而延遲治療之預測因子為勝任感（F=5.068, p <0.05)、婚姻狀態（F=5.384, p <0.01)、及尋求協助之動機型態（F=5.744, p <0.01)。而焦慮的預測因子為內在動機（F=14.769, p <0.01)。憂鬱之預測因子為焦慮（F=91.433, p <0.01)。害怕之預測因子為焦慮（F=109.058, p
<0.01)和內在動機（F=58.426, p <0.01)。本研究結果可做為照護大腸直腸癌病人的參考，期許未來能有更多相關研究或介入性措施，以協助大腸直腸癌病人早期尋求治療。

The purpose of this study was to determine the delay diagnosis and delay treatment factors of colorectal patient based on the Self-Determination Theory. Participants were 111 colorectal patients recruited from a cancer center in northern Taiwan. A
convenience sample was used to recruited patients. Research questionnaires included Basic Need Satisfaction in General, the Health-Care Climate Questionnaire, the Treatment Motivation Questionnaire, the Hospital Anxiety and Depression Scale, and
the Cancer Fear Scale. Statistical analysis included descriptive statistics (mean, SD, %,n) and inferential statistics (t-test, one-way ANOVA, correlation, multiple regression,and Tobit model).
Results indicated that colorectal cancer patients have an average delayed diagnosis day was 154.77 天（SD=210.09）. The Pearson Correlation results indicated that Male, no routine health screener and depression were significantly related to delayed
diagnosis days. Delay treatment was significantly related to unmarried, divorced, less competency and the early stage cancer patients (p < 0.05). Anxiety was significantly related to intrinsic motivation and help-seeking motivation (p < 0.05). Routine health
screener had less depression (p < 0.05). Older patients had less fear then the younger one (p < 0.05).
Multiple regression and Tobit model analyses demonstrated that gender（F=5.163, p <0.01) and routine health
screening（F=5.109, p <0.01) was predictor of the delay diagnosis, and delayed diagnosis was significantly predicted by competence（F=5.068, p <0.05), marital status（F=5.384, p <0.01) and help-seeking motivation（F=5.744, p <0.01). Gender（F=6.432, p <0.01) was the predictor in total delayed time. Anxiety was predicted by intrinsic motivation（F=14.769, p <0.01). Depression was predicted by anxiety（F=91.433, p <0.01). The fear was predicted by anxiety（F=109.058, p <0.01) and intrinsic motivation（F=58.426, p <0.01).
Findings of this study provide references for evaluate the colorectal patient’s mood, psychological need and motivation during the time of period from suspected colorectal symptoms to receive diagnosis and the first treatment.

目 次
中文摘要 ………………………………………………………………………………….. i
英文摘要 …………………………………………………………………………………. ii
目次 ………………………………………………………………………………………. iii
表次 ……………………………………………………………………………………….. vi
圖次 ……………………………………………………………………………………….. vii
第一章 緒論
第一節 研究動機與重要性 ……………………………………………………………. 1
第二節 研究目的 ………………………………………………………………………. 4
第三節 名詞解釋……………………………………………………………………… 5
第二章 文獻探討
第一節 大腸直腸癌介紹 ………………………………………………………………. 7
第二節 自我決定理論概述…………………………………………………………….. 11
第三節 尋求治療時程概述…………………………………………………………….. 15
第四節 探討大腸直腸癌病人尋求治療時程之相關研究……………………………... 17
第五節 情緒因素與尋求治療時程相關………………………………………………... 21
第六節 以自我決定理論為架構之相關研究…………………………………………... 25
第三章 研究方法
第一節 研究架構………………………………………………………………………... 29
第二節 研究設計……………………………………………………………………… 30
第三節 研究對象及場所………………………………………………………………. 31
第四節 研究工具……………………………………………………………………….. 32
第五節 研究步驟……………………………………………………………………… 37
第六節 資料分析方法………………………………………………………………… 38
第七節 倫理考量……………………………………………………………………….. 39
第四章 研究結果
第一節 大腸直腸癌人口學、尋求治療天數及疾病特性結果分析…………………. 41
第二節 以自我決定理論分析大腸直腸癌病人之基本心理需求及尋求治療動機… 53
第三節 大腸直腸癌病人之健康照護情境滿意度分析………………………………. 63
第四節 大腸直腸癌病人情緒狀態……………………………………………………... 67
第五節 以自我決定理論探討影響大腸直腸癌病人尋求治療天數之相關因素…… 74
第六節 探討影響大腸直腸癌病人尋求治療天數之預測因子……………………… 78
第七節 以多畢模式再檢驗影響大腸直腸癌病人尋求治療天數之預測因子………. 84
第八節 以自我決定理論探討影響大腸直腸癌病人情緒之預測因子……………… 85
第九節 探討影響大腸直腸癌病人尋求治療動機之預測因子………………………. 87
第十節 以徑路分析考驗自我決定理論及尋求治療天數與變項間之關係………… 89
第五章 討論
第一節 人口學屬性及疾病特性分析…………………………………………………. 98
第二節 大腸直腸癌病人尋求治療時程現況與相關因素分析……………………… 99
第三節 自我決定理論…………………………………………………………………. 103
第四節 情緒…………………………………………………………………………… 107
第五節 大腸直腸癌病人尋求治療時程及情緒之預測因子………………………… 110
第六節 以自我決定理論為架構，探討情緒、及影響大腸直腸癌病人尋求治療相
關因子之徑路分析……………………………………………………………111
第六章 結論與建議
第一節 結論…………………………………………………………………………… 113
第二節 研究限制……………………………………………………………………… 117
第三節 研究建議……………………………………………………………………… 118
參考文獻
中文部分 ……………………………………………………………………………… 119
外文部分 ……………………………………………………………………………… 121
附錄
附錄一 基本資料問卷……………………………………………………………….. 128
附錄二 基本需求滿意問卷…………………………………………………………… 130
附錄三 健康照護情境氣氛問卷…………………………………………………….. 133
附錄四 病人尋求治療動機問卷……………………………………………………… 135
附錄五 醫院內病人焦慮憂鬱量表…………………………………………………… 139
附錄六 癌症恐懼量表………………………………………………………………… 141
附錄七 醫院內受試者同意書………………………………………………………… 142

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