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研究生:廖淑貞
研究生(外文):liao shu-chen
論文名稱:癌症疼痛強度與憂鬱相關性之統合分析
論文名稱(外文):A Meta-Analysis of The Association Between Cancer Pain Intensity and Depression
指導教授:陳美伶陳美伶引用關係王秀紅王秀紅引用關係許光宏許光宏引用關係
學位類別:碩士
校院名稱:長庚大學
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:2002
畢業學年度:90
語文別:中文
論文頁數:127
中文關鍵詞:癌症疼痛強度憂鬱統合分析
外文關鍵詞:cancer pain intensitydepressionmeta-analysis
相關次數:
  • 被引用被引用:5
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  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:6
癌症疼痛與情緒困擾相關的研究已累積相當數量,但因研究設計、樣本對象、測量工具或測量方式不盡相同,以致於無法在疼痛與憂鬱兩者間的相關性得到一個一致性的結論,傳統的文獻回顧或再去做一個類似的研究均無法解決此問題。因此,本研究採用統合分析(meta-analysis)來瞭解癌症疼痛強度與憂鬱的相關強度及瞭解影響癌症疼痛強度與憂鬱相關強度的因素。研究問題為:在癌症病患中,疼痛與憂鬱的相關強度及其信賴區間範圍為何?使用不同類別之憂鬱測量方式、不同疾病嚴重度的病患以及不同類別的疼痛,其疼痛與憂鬱的相關強度及其信賴區間範圍各為何?研究對象為1966-2000年期間,有關癌症病患疼痛與憂鬱等相關主題之研究,包含期刊、書籍、博碩士論文。選樣標準為:需以中文或英文發表的文獻,每一篇文獻的樣本數至少要大於5,原始研究之對象必需為癌症病患,必需有測量疼痛強度、有測量憂鬱或心理困擾的程度以及必需有足夠的統計資訊(例如:樣本數、平均值、標準差、P值、 t 值、F值)以計算成效值(Effect size),經由電腦檢索及非電腦檢索過程後共有17篇文章納入本研究。研究工具包含編碼表及編碼簿,編碼者間的一致性(interrater reliability)為1,專家內容效度指標(Content Validity Index;簡稱CVI)為1。
結果發現疼痛與憂鬱的相關強度為0.224,信賴區間為-0.288到0.636,包含 0,無法確認癌症疼痛強度與憂鬱是否有關。17篇原始研究均採用自我陳述(self-report)的方式來收集疼痛與憂鬱的資料,因此無法得知使用不同類別之憂鬱測量方式,其疼痛強度與憂鬱的相關及其信賴區間為何。亦無法得知不同疾病嚴重度,其疼痛與憂鬱的相關強度及其信賴區間範圍各為何。「腫瘤引起的疼痛」其疼痛強度與憂鬱的相關為0.275,信賴區間為-0.603到0.852,跨越0;「腫瘤及治療引起的疼痛」其疼痛強度與憂鬱相關為0.212,其信賴區間為-0.644到0.832,也跨越0。「腫瘤引起的疼痛」及「腫瘤及治療引起的疼痛」兩者的信賴區間有重疊的現象,顯示不同類別的疼痛並不會影響疼痛與憂鬱的相關強度。不論是腫瘤疼痛或治療引起的疼痛、疾病嚴重度是轉移或未轉移、疼痛型態及不同的測量工具等因素均不會影響疼痛強度與憂鬱的相關。疼痛強度與憂鬱程度之間的關係可能受某中介因素所影響,而「對疼痛的認知」極有可能是中介因素之一。
臨床醫護人員應積極處理疼痛問題減少患者對疼痛產生負向經驗、提供相關的知識與訊息、協助病患尋求疼痛的正面意義、鼓勵病患參予疼痛的評估與處理等,以增加其正向經驗,減輕疼痛程度,緩解情緒反應。癌症疼痛的課程中應加強「疼痛多層面觀」的觀念,讓護理學生們在照顧癌症病患時能兼顧生理、感覺、情感、行為、認知及社會文化等層面,使得癌患照顧能夠達到全方位護理的理想。未來的研究可進一步確認是否認知確實會影響疼痛程度與憂鬱情緒的相關強度?疼痛與憂鬱間是否有其他中介因素存在?
Studies of cancer pain and emotional distress have been accumulating to a huge number. Due to different study designs, populations, measure instruments and types, an identical conclusion on the association between cancer pain intensity and depression still hasn’t been reached yet. This problem cannot be solved either by conventional literature reviews or similar new studies. For this reason, a meta-analysis study is implemented for better understanding of the association between cancer pain intensity, depression and the related factors among them as well. Study Problems: How is the association between cancer pain intensity and depression 95% convinced interval? How will the association between cancers pain intensity and depression 95% convinced interval be if disease stages and pain types are tested under different depression measurements among cancer patients.
Population: The studies regarding cancer pain and depression during 1966-2000 included journals, books, master thesis and doctoral dissertation. Criteria included: Chinese and English. Sample size should be at least no more than 5. The measurement of the pain intensity, depression and emotional distress from the cancer patients should be tested and enough statistics data is required. (For example: sample size, mean, stander deviation, p vale, t vale and F vale). The research adopted 17 articles, either retrieved or not retrieved by computer. Study instruments include coding form and coding book. Both interrater reliability and content validity index are good (1).
Study result: The association between cancer pain intensity and depression is 0.224. 95% convinced interval —0.288 ~ 0.636 including 0, so the association between cancer pain intensity and depression cannot be confirmed. Due to different measure types and disease stages, we cannot confirm the association between cancer pain intensity and depression, either. Tumor related pain and tumor-treatment related pain 95% convinced intervals were overlapped. It pointed out that different pain types won’t affect the association between cancer pain intensity and depression. Regardless of pain types caused by tumor or treatment, disease stages and measurements won’t affect the association between cancer pain intensity and depression. It might be affected by certain mediums. Cognitive pain is definitely one of them.
Clinical physicians and nurses should enthusiastically endeavor to solve the pain problems to decrease the negative pain experiences that patients have been through and help patients look for positive meanings out of pain. Educational programs have to be enhanced by implementing more multidimensional pain concepts. Nursing students should concern about physiology, psychology, affection, behavior, cognition and social culture as well while taking good care of cancer patients. Future study can affirm if cognition of pain affects the association between cancer pain intensity and depression, or if there is any medium factor between them.
目 錄
大綱 頁次
指導教授推薦書--------------------------------------------------------------------------------i
論文口試委員會審定書----------------------------------------------------------------------ii
授權書 -----------------------------------------------------------------------------------------iii
謝誌 --------------------------------------------------------------------------------------------iv
目錄 ------------------------------------------------------------------------------------------- vi
圖表目錄 --------------------------------------------------------------------------------------ix
中文摘要---------------------------------------------------------------------------------------xi
英文摘要--------------------------------------------------------------------------------------xiii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------------------------------------------------------------------------4
第四節 研究問題------------------------------------------------------------------------5
第五節 名詞界定------------------------------------------------------------------------6
第二章 文獻查證---------------------------------------------------------------------------8
第一節 疼痛 ----------------------------------------------------------------------------8
第二節 憂鬱----------------------------------------------------------------------------15
第三節 疼痛與憂鬱的關係 ---------------------------------------------------------20
第四節 統合分析 ---------------------------------------------------------------------24
第三章 研究方法-------------------------------------------------------------------------32
第一節 研究架構----------------------------------------------------------------------32
第二節 研究對象----------------------------------------------------------------------33
第三節 樣本收集過程----------------------------------------------------------------34
第四節 研究工具----------------------------------------------------------------------36
第五節 資料分析----------------------------------------------------------------------38
第四章 研究結果-------------------------------------------------------------------------42
第一節 資料檢索----------------------------------------------------------------------42
第二節 工具信效度-------------------------------------------------------------------45
第三節 基本特性----------------------------------------------------------------------52
第四節 樣本同質性-------------------------------------------------------------------60
第五節 預估安全篇數----------------------------------------------------------------61
第六節 癌症疼痛與憂鬱的關係---------------------------- -----------------------62
第五章 討論------------------------------------------------------------------------------81
第一節 資料檢索 ---------------------------------------------------------------------81
第二節 基本特性 ---------------------------------------------------------------------83
第三節 樣本同質性 ------------------------------------------------------------------85
第四節 癌症疼痛與憂鬱的關係- ---------------------------------------------------87
第六章 結論、限制與建議-------------------------------------------------------------90
第一節 結論 ---------------------------------------------------------------------------90
第二節 限制與建議 ------------------------------------------------------------------92
參考資料 ----------------------------------------------------------------------------------94
附錄 -----------------------------------------------------------------------------------------105
研究樣本------------------------------------------------------------------------------------125
圖表目錄
圖一:研究架構----------------------------------------------------------------------------32
表一:資料庫線上檢索結果-------------------------------------------------------------43
表二:資料庫人工檢索結果-------------------------------------------------------------44
表三:第一次編碼者間一致性測試----------------------------------------------------47
表四:第二次編碼者間一致性測試----------------------------------------------------49
表五:第三次編碼者間一致性測試----------------------------------------------------50
表六:研究識別----------------------------------------------------------------------------53
表七:樣本特性----------------------------------------------------------------------------55
表八:研究方法----------------------------------------------------------------------------57
表九:研究樣本描述----------------------------------------------------------------------63
表十:樣本的r值、p值、及轉換後95%信賴區間-----------------------------------65
圖二:轉換後r值及95%信賴區間----------------------------------------------------66
表十一:疼痛類別的相關強度----------------------------------------------------------68
表十二:疾病嚴重度的相關強度-------------------------------------------------------70
表十三:測量時間點的疼痛相關強度-------------------------------------------------72
表十四:不同疼痛測量工具的平均相關強度----------------------------------------74
表十五:憂鬱測量工具的相關強度----------------------------------------------------76
表十六:不同作者背景的平均相關強度----------------------------------------------78
表十七:不同發表國家的平均相關強度----------------------------------------------80
附錄目錄
附錄一:電腦檢索資料庫---------------------------------------------------------------105
附錄二:編碼表---------------------------------------------------------------------------108
附錄三:編碼簿---------------------------------------------------------------------------113
附錄四:第一次「編碼表」及「編碼簿」專家效度------------------------------119
附錄五:第二次「編碼表」及「編碼簿」專家效度------------------------------122
附錄六:研究樣本------------------------------------------------------------------------125
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