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研究生:陳青梅
研究生(外文):Ching-Mei Chen
論文名稱:停經婦女面臨荷爾蒙治療之決策樹模式初探
論文名稱(外文):The decision tree model of menopausal women with hormone replacemment therapy :An exploratoy study
指導教授:余玉眉余玉眉引用關係
指導教授(外文):Yu-Mei Yn Chao
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2001
畢業學年度:89
語文別:中文
論文頁數:163
中文關鍵詞:停經婦女荷爾蒙補充治療決策準則決策樹數模式
外文關鍵詞:menopaausal womenhormone replacement therapydecision criteriadecision tree model.
相關次數:
  • 被引用被引用:14
  • 點閱點閱:346
  • 評分評分:
  • 下載下載:90
  • 收藏至我的研究室書目清單書目收藏:1
摘 要
本研究目的在探討停經婦女在面臨荷爾蒙補充治療時,其決策考量準則及決策樹模式為何。研究者以Gladwin(1989)之決策模式建立理論,做為本研究設計之架構。
研究分兩階段進行,第一階段為「模式建立期」,研究者採用臨床田野研究法(參與性觀察participant observation),以立意取樣對更年期門診已停經婦女進行資料蒐集,於選定對象後,研究者以主護護理師身份於接受檢查時開始與之接觸,提供所需要的護理指導及服務,並於個案每次返診取藥時了解其面臨服藥的決策想法。資料取得包括深入的決策訪談(家訪、電訪)及互動間自發性語言及非語言行為意義。共選取17 位受訪者,每位研究對象接觸3~7次不等,並將訪談記錄作為分析依據,運用內容分析法(content analysis)萃取出決策準則,形成決策樹模式。第二階段為「模式測試期」,將研究結果透過同族群背景但有不同決策的兩類受訪者共22人,每位研究對象接觸1~2次。以參與觀察及深入訪談,透過受訪者回溯其決策過程,依其「Yes」或「No」的回答方向做為決策路徑的分析,以驗證決策準則萃取的確實性及決策模式預測的可靠性。
研究結果:在『第一階段模式建立期』,共歸納出十三項決策準則,前九項為「共通性的決策準則」-即做決策的考量因素;後四項為「限制性條件的決策準則」-為改變決策的變因,並依十三項決策準則之優先順序建構出具邏輯性的決策樹。而由決策樹模式圖中的共通性決策準則發現進一步萃取,可歸納出六項決策行為特徵,這些特徵乃決策樹的中心主軸,主導決策路徑的發展。分別為:(一)釐清自我處境,評斷服藥的必要性;(二)對荷爾蒙補充的認知、態度、價值觀;(三)評估服藥的風險性;(四)衡量對自我健康的利弊得失;(五)參考權威意見;(六)考量自我對服藥的堅持度。
經過『第二階段模式測試期』,針對十三項決策準則測試結果發現,影響婦女接受HRT的重要關鍵準則為:(1)荷爾蒙已經不足;(2)不排斥荷爾蒙補充治療;(3)擔心錯過服藥會造成將來身體危害;(4)重視專家權威的意見;(5)服藥後未出現不良反應。而影響婦女不接受HRT的重要關鍵準則為:(1)沒有明顯的更年期症狀;(2)擔心服藥帶來副作用或危害;(3)無法提高對服藥的信心度。這些準則也應證了模式建立期所歸納出的六項決策行為特徵。其次透過個案不同的「決策行為特徵」等因素,可歸納出三種不同的決策型態並建立其特性;分別為:(一)積極順從型,佔28.2﹪、(二)預防危害型,佔56.4﹪、(三)抗拒型,佔15.4﹪。
由測試結果中更發現,「限制性條件的決策準則」在最終決策過程扮演相當重要的決定性關鍵,也影響了決策模式的預測性,其中以”長期服藥後產生的變化”-『時間變化因素』,及”對服藥信心度的改變”-『訊息改變因素』,其難以掌握及未知的特性所帶來的影響最大。
整體而言,發展出的決策樹模式可達86.4﹪的預測率,符合決策模式預測標準,即此決策樹可預測85~90﹪以上族群中個人的選擇。
關鍵詞: 停經婦女、荷爾蒙補充治療、決策準則、決策樹模式
ABSTRACT
The purpose of this study is to explore the decision criteria and decision tree model for menopausal women with hormone replacement therapy (HRT), based on Gladwin''s (1989) structural approach.
In the initial phase of study-model building, clinical field research (participant observation) was employed with purposive sampling to collect menopausal women’s data. Acting as a primary nurse: The researcher contacted the subjects since they took menopause check-up in clinic, provided them with any clinical help they needed, and asked them for reasons every time they come back for more pills. Data are collected through in-depth interviews with samples, including home visit and by telephone, as well as from other spontaneous verbal or non-verbal behaviors noted during the course of interactions. There are 17 subjects, each was contacted 3 to 7 times, all related data are recorded for content analysis. In the second phase of study-model testing, primary results drawn from the initial phase are tested on 22 menopausal interviewees from similar background but with two different choices of HRT, each was contacted 1 to 2 times. From their answers-"yes" or "no" to HRT and related questions, the decision model is analyzed and derived, in order to verify the accuracy of its criteria and reliability of the predictive model.
There are 13 criteria generated concluded from the initial phase of study. The first 9 of which are classified as "common factors"-reasons to ponder during decision-making; and the rest is classified as "limiting factors", which may overwhelm the common factors. A logical decision tree model is derived from the 13 criteria with priority adjusted. Among then, 6 characteristic items of decision-making are further derived from the “common factors”, including one''s situation and the necessity of taking HRT pills; one''s attitude towards HRT; risks of taking HRT pills; pros and cons of HRT in terms of health; authoritative opinions; one''s steadiness with taking HRT pills. These items make up themes of the decision tree, and determine the development of the decision model.
In the second phase of study, 5 critical criteria determining women''s acceptance of HRT are found: (1) hormone insufficiency; (2) no repulsion with HRT; (3) worries of health-hazards without HRT; (4) emphasis on experts’ authoritative opinions; (5) no unpleasant side effects. At the same time, 3 criteria critical to women''s rejection of HRT are found as well: (1) no apparent menopausal disorders; (2) worries of health hazards with HRT; (3) confidence with HRT remains low. These critical criteria fit into the 6 characteristic items as shown above, and lead to three different kinds of decision models, which are: full compliance type (28.2%), hazard prevention type (56.4%), resistance type (15.4%).
Model testing conducted during the second phase of study proves that, “limiting factors” carry significant weight and affect the applicability of the predictive model, especially when "changes after taking HRT pills for a long time" (time factor) and "changing of confidence towards taking pills" (information factor) are involved.
The HRT decision tree model thus developed, with an accuracy of up to 86.4%, generally meet the requirement for a predictive model, and could be employed to predict the decision made by 85-90% of the choices of individuals in the group.
Keywords : menopausal women;hormone replacement therapy;
decision criteria;decision tree model
目 錄 頁 數
誌謝……………………………………………………………………..Ⅰ
摘要……………………………………………………………………..Ⅲ
目錄……………………………………………………………………..Ⅶ
第一章 緒論……………………………………………………….....1
第一節 研究動機及重要性………………………………………….1
第二節 研究問題的陳述…………………………………………….3
第三節 名詞界定…………………………………………………….4
第二章 文獻查證………………………………………………….. ..5
第一節 停經婦女與荷爾補充治療………………………………...5
第二節 婦女對更年期及服藥態度之相關研究…………………...8
第三節 停經婦女對於荷爾蒙補充之決策探討…………………..10
第四節 決策概念與相關研究方法………………………………..14
第三章 研究方法…………………………………………………....21
第一節 研究方法……………………………………………….. .21
第二節 研究對象…………………………………………………..24
第三節 研究情境…………………………………………………..25
第四節 資料收集…………………………………………………..26
一、 嘗試研究……………………………………………......26
二、 正式研究……………………………………………......29
三、 資料收集過程………………………………………......30
四、 資料記錄……………………………………………......34
第五節 資料分析…………………………………………………..34
第六節 資料收集與分析之嚴謹度………………………………..43
第四章 研究結果與分析………………………………………..... 46
※第一階段:決策準則及路徑模式建立期…………………...... 46
第一節、 研究個案的基本及相關資料…………………………....46
第二節、 研究結果與分析………………………………………....50
壹、決策過程行為與思維之形式……………………….......50
貳、決策準則形成與邏輯決策樹建立………………….......61
參、停經婦女面臨荷爾蒙補充治療的決策型態分析….......86
※第二階段:決策路徑模式測試期…………………………….....90
第三節、決策路徑模式測試結果及分析……………………….....90
壹、路徑模式測試方式及個案相關資料……………….......90
貳、決策準則與路徑模式測試結果…………………….......97
一、個案決策準則與路徑測試結果………………...........97
二、決策路徑模式之預測及分析…………………..........106
三、決策路徑模式圖之修正……………………............110
第五章 討論…………………………………………………….....114
第一節、研究結果與發現之討論………………………………....114
壹、決策準則與決策模式之探討………………………......114
貳、研究發現之相關討論………………………………......123
第二節、本研究結果與相關研究之比較…………………….…...128
第六章 結論與建議…………………………………………….....135
第一節、結論………………………………………………………..135
第二節、護理學上的應用…………………………………………..141
第三節、研究的限制及對未來研究的建議……………………....143
參考文獻……………………………………………………………..145
附錄…………………………………………………………………..150
附錄一 訪談指引…………………………………………………..151
附錄二 訪談同意書…………………………………………………152
附錄三 模式建立期訪談實錄………………………………………153
附錄四 決策準則查核表(Criteria check-list)…………….159
附錄五 模式測試期訪談實錄………………………………………160
圖表目次
表3-1 「個別性決策準則」萃取辨識示例……………………...37
表3-2 嘗試研究期三條主要的決策路徑及決策型態………..….38
表3-3 排除「非關鍵性的決策準則」示例……………………….40
表3-4 萃取改變決策的-「限制性決策準則」示例…………….41
表3-5 決策行為特徵的萃取……………………………………….42
表4-1 婦女接不接受荷爾蒙補充之決定………………………….48
表4-2 十七位研究對象基本及相關資料………………………….49
表4-3 個別性決策準則…………………………………………….58
表4-4 停經婦女面臨荷爾蒙補充治療之決策型態……………….86
表4-5 二十二位測試對象基本及相關資料……………………….96
表4-6 測試階段婦女接不接受荷爾蒙補充之決策過程………….95
表4-7 二十二位研究對象決策路徑選擇結果一覽表…………….98
表4-8 二十二位研究對象決策路徑測試結果總表……………….99
表5-1 相關研究之比較……………………………………………133
表6-1 六項決策特徵與十三項決策準則…………………………136
表6-2 婦女服用HRT之決策型態分析…………………………...140
圖3-1 研究方法與資料收集過程之流程圖……………………….23
圖3-2 研究資料收案次數與個案門診治療期間之相關圖……….33
圖4-1 決策路徑雛形圖(六位個案)…………………………….59
圖4-2 停經婦女面臨荷爾蒙補充治療之決策樹模式圖………….63
圖4-3 停經婦女面臨HRT之決策樹模式圖預測結果……..…….109
圖4-4 決策樹模式圖之修正……………………………………..113
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