論文摘要
論文名稱：疼痛教育對改善居家癌症病人疼痛處理的成效
研究所名稱：私立台北醫學大學護理學研究所
研究生姓名：張敏娟
畢業時間：八十九學年度第二學期
指導教授：林佳靜教授
本研究之目的是探討疼痛教育是否可以降低癌症病人對服用止痛劑的障礙因子、增進癌症病人服用止痛劑之遵從性、降低癌症病人疼痛強度及降低疼痛對生活之干擾程度。研究對象為診斷為癌症的病患，且目前正使用止痛劑，個案須七天內可能出院，並於出院後仍會繼續服用之。研究地點為台北市某治癌中心。
本研究以中文版止痛劑擔心量表、簡明疼痛量表、服藥遵從性測量問卷收集37位癌症疼痛病人資料，以隨機取樣方式將個案分為實驗組18位與控制組19位，其中實驗組予疼痛教育的措施，並予前﹑後測，控制組除未給予疼痛教育外，其餘皆與實驗組相同，資料所得以描述性統計、t-test及paired-t test統計法分析之。
研究結果發現在降低癌症病人對服用止痛劑的障礙因子方面，實驗組的平均止痛劑障礙後測顯著低於前測，控制組則未有差異；再以t-test檢定實驗組與控制組間前、後測平均差異得知，兩組間除了”好病人”此障礙因子無達顯著差異外，其餘的障礙因子於實驗組的前、後測平均差異皆大於控制組。
在服藥遵從性方面，實驗組在未接受疼痛教育措施前得分為滿分（4分）的有22％人（N=4），於接受教育措施後得滿分者則增加為72%人（N=13），而於控制組方面則無變化皆為16％人（N=3）得滿分。
在降低癌症病人疼痛強度方面，實驗組之平均疼痛強度後測顯著低於前測，控制組則未有差異；再以t-test檢定實驗組與控制組間前、後測平均差異得知，兩組間的各程度疼痛強度平均差異均未達統計上之顯著差異。
在降低疼痛對生活之干擾程度方面，實驗組與控制組之平均疼痛干擾後測皆顯著低於前測；再以t-test檢定實驗組與控制組間前、後測所得平均差異得知，兩組間的各細項的疼痛干擾之平均差異均未達統計上之顯著差異。
綜合上述，本研究發現了給予癌痛病人有關於疼痛及止痛劑的疼痛教育可促使病人改變其對止痛劑錯誤的認知、降低不必要的擔心及有良好的服藥遵從性，本研究雖未能如預期中得到接受疼痛教育的實驗組能較未接受疼痛教育的控制組，於疼痛強度及疼痛干擾上有顯著的統計上差異的結果，但研究中卻也顯示了接受疼痛教育的實驗組於疼痛強度及疼痛干擾後測得分上顯著的低於前測，此結果顯示了實驗組的癌痛病人達到了較好的疼痛控制及減低了其居家的疼痛干擾。
現今是一個講究高效率、高品質及低成本的醫療環境，而疼痛教育的措施正是符合時代潮流的低成本、有效且具有護理獨立自主性的護理措施，值得大家一同推廣及身體力行的。

Abstract
Title of Thesis: Effects of A Pain Educational Program on Improving the Pain Management of Cancer Pain for Home Care Cancer Patients
Institution: Graduate Institution of Nursing, Taipei Medical University
Author: Min-Chuan Chang.
Thesis directed by: Chia-Chin Lin, Ph.D., Professor
The purpose of this study to study whether the pain educational program could reduce the barriers to taking analgesics, improve the medication compliance, decrease the degree of pain and lower the impacts on daily life in home care cancer patients. The sample was recruited from a cancer center and who had been diagnosed as cancer and had been taking pain medications continually after discharge.
The Barriers Questionnaire—Taiwan Form (BQT), Brief Pain Inventory-Short Form (BPI) and compliance Self-report assessment tool were used in this study. Total of 37 patients were recruited by convenience sampling, including experimental group of 18 and control group of 19. Data were analyzed by descriptive, t-test and paired t-test.
The results indicated that there was a significant difference between pre-test and post-test on the barrier to taking medicine for the experimental group. There is no difference for control group in this part.
There was a difference between control group and experimental group on the barrier of taking medicine, except for “good patient” item.
Experimental group had increased the number of correct rate from 22％ to 72％after pain education. The control group had no change, remained 16％.
The degree of pain was reduced after the pain educational program for the experimental group, but there was no difference for the control group.
Furthermore, there was a significant difference on pain interference for experimental group and the t-tests showed no difference for both groups. In conclusion, the pain educational program improved the knowledge, reduced the level of pain and improved medication compliance.
Pain educational program could be a valuable nursing strategy for improving the Quality of cancer pain management.

目錄
頁數
致謝…………………………………………………………… Ⅰ
中文摘要……………………………………………………… Ⅱ
英文摘要…………………………………………………….… Ⅴ
目錄…………………………………………………………… Ⅶ
圖表次目……………………………………………………… Ⅹ
第一章緒論…………………………………………………. 1
第一節研究動機……………………………………….. 1
第二節研究重要性…………………………………….. 3
第三節研究目的……………………………………….. 6
第二章文獻查證……………………………………………. 7
第一節癌症疼痛………………………………………. 7
第二節疼痛控制現況及對病人的影響………………. 10
第三節麻醉性止痛劑於癌症疼痛上所扮演的角色…. 13
第四節不良疼痛控制的原因及病人對止痛劑的迷思.. 15
第五節服藥遵從性…………………………………….. 18
第六節疼痛教育……………………………………… 20
第三章研究架構………………………………………... 26
第一節研究架構………………………………………… 26
第二節研究假設………………………………………… 27
第三節名詞解釋………………………………………… 28
第四章研究方法……………………………………………... 30
第一節研究設計………………………………………… 30
第二節研究場所與對象…………………………….…. 31
第三節研究工具………………………………………..35
第四節資料收集過程…………………………………..40
第五節資料分析………………………………………..41
第五章結果………………………………………………….. 42
第一節描述性統計……………………………………. …. 42
第二節疼痛教育措施之成效…………………………. 52
第六章討論………………………………………………… . 61
第一節癌症病人對止痛藥物的障礙因子……………. 61
第二節癌症病人服用止痛劑之遵從性……………… 64
第三節癌症病人的疼痛強度與生活的干擾程度……. 66
第四節疼痛教育是否可以降低癌症病人對
止痛藥物的障礙因子………………………… 68
第五節疼痛教育是否可以降低癌症病人疼痛強度.. 70
第六節疼痛教育是否可以降疼痛對生活之干擾程度. 72
第七章結論……………………………………………….. 74
第八章研究限制及建議………………………………….. 76
第一節研究限制…………………………………….. 76
第二節研究建議…………………………………….. 77
參考資料……………………………………………………. 80
中文部分………………………………………………. 80
英文部分………………………………………………. 82
附錄…………………………………………………………. 90
附錄一 同意書……………………………………….. 90
附錄二 基本資料…………………………………….. 91
附錄三 簡明疼痛量表……………………………….. 92
附錄四 中文版止痛劑擔心量表…………………….. 94
附錄五 服藥遵從性測量(服藥自我報告)………….. 96
圖表目次
表一 基本資料……………………………………………. 33
表二 各量表於本研究中之Cronbach’s α值一覽表……. 38
表三 癌症病人對止痛藥物的障礙因子分析一覽表…… 44
表四 服藥遵從性得分描述性統計分析…………………. 46
表五 實驗組與控制組(前測)之各項疼痛程度一覽表…. 48
表六 實驗組與控制組(前測)之各項疼痛干擾一覽表….. 50
表七 實驗組與控制組(後測)之各項疼痛干擾一覽表….. 51
表八 實驗組與控制組之止痛藥物的各障礙因子前、後測
(後測-前測)平均差異之t-test檢定………………… 54
表九 各組間(實驗組與控制組)之各類變項前、後測得分
差異之配對t檢定(paired t-test)…………………….. 55
表十 實驗組與控制組之各程度疼痛強度前、後測(後測
-前測)平均差異…………………………………….. 57
表十一實驗組與控制組之疼痛干擾得分前、後測(後測
-前測)平均差異…………………………………….. 60

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