臺灣博碩士論文加值系統

本研究目的在探討前列腺癌病患於確立癌症診斷後與接受治療期間之決策相關困擾及其相關因素。採縱貫性研究設計，民國94年11月1日至95年5月18日間，以立意取樣方式，於北部某醫學中心之泌尿外科門診收取癌症分期在T1-T3期的前列腺癌個案為研究對象。收案期間共收集得50位樣本資料進行分析。研究工具包括基本資料表、國際前列腺症狀評分表、美國加州大學洛杉磯分校前列腺癌指標、疾病心理社會調適量表、癌症特定困擾量表、決策困難量表及決策後悔量表。所有資料分別以母數與無母數統計法進行描述性及推論性統計分析。結果顯示：
一、「在確立癌症分期接受治療前」樣本主要資訊來源為泌尿科醫師；最常的考慮因素為癌症是否根除；多數樣本偏好與醫師共享治療決策。
二、「確立癌症分期接受治療前」，家庭生活、非共居家人及社會環境 等方面的調適越差者，越容易感到決策困難；而其決策困難主要表現在對治療決定越感到不確定及感覺自己未獲得支持這兩方面。「確立癌症分期接受治療前」，感覺自己未獲得相關資訊的人，大都屬於教育程度較低或偏好治療方式完全由醫師決定的病人 。
三、「接受治療後一個月」，最早PSA值超過20ng/ml的前列腺癌病患，以及心理困窘與健康照顧方面調適較差的人，較易對治療決定感到不滿意，感到後悔。
四、「確立癌症分期接受治療前」與「接受治療後一個月」相比較，病患對治療決定的不確定感、對治療的瞭解程度、決策過程所獲得的支持程度沒有明顯的差別。
此研究結果能提供護理人員在協助此類病患進行治療決策時之參考依據，進而減少病患在進行治療決策時出現決策困擾。

The purpose of this study was to investigate the distress related to decision-making and its associated factors of prostate cancer patients who were just diagnosed and treated. It was a study with longitudinal design. From November 2005 to May 2006, total 50 clinical staging T1-T3 prostate cancer patients were included. All the patients were recruited by a purposive sampling from urology outpatient clinics in a medical center.Questionnaires used in this study included the Characteristic of Disease Scale, the International Prostate Symptom Score, the University of California, Los Angeles, PC Index, the Psychosocial Adjustment to Illness Scale, the Impact of Events Scale, the Decisional Conflict Scale, and the Decision Regret Scale. Data were analyzed by parametric and nonparametric tests. The major findings were:
1).”Before being treated”, urologist is the major source of information. Cancer eliminating is the most important factor affect decision-making. Most subjects prefer to share decision- making with their doctor.
2).”Before being treated”, subjects with poor domestic environment, extended family relationship, and social environment adjustment reported significantly overall decisional conflict, especially in the
subscales of uncertainty and felling unsupported. “Before being reated”, those uninformed subjects were the lower educated or preferred to be decided by physician completely.
3).“One month after treatment”, the prostate cancer patient with high initial PSA (over 20ng/ml), worse “psychosocial distress”, or worse adjusted to “health care orientation” felt unsatisfied and regreted to treatment decision.
4). There was no significant change of felling related to “uncertainty”, “uninformed”, and “unsupported” in decision making during research period.
The results of this study help the medical personnel understand the
experience of decision making of the prostate cancer patient. Thus, decrease the distress related to decision making becomes possible.

致謝…………………………………………………………………………………………… Ⅰ
中文摘要……………………………………………………………………………………… Ⅲ
英文摘要……………………………………………………………………………………… Ⅴ
目錄…………………………………………………………………………………………… Ⅶ
表目錄………………………………………………………………………………………… Ⅸ
圖目錄………………………………………………………………………………………… Ⅹ
附錄目錄…………………………………………… ………………………………………… Ⅹ

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 研究問題………………………………………………………………… 5
第四節 名詞定義………………………………………………………………… 6
第二章 文獻查證
第一節 前列腺癌之相關概念…………………………………………………… 8
第二節 心理困窘與癌症調適…………………………………………………… 22
第三節 病患之決策偏好、資訊來源、考慮因素……………………………… 27
第四節 決策相關困擾之相關概念……………………………………………… 30
第三章 研究方法
第一節 研究架構………………………………………………………………… 34
第二節 研究假設………………………………………………………………… 35
第三節 研究設計………………………………………………………………… 36
第四節 研究場所及對象………………………………………………………… 36
第五節 研究工具………………………………………………………………… 37
第六節 研究工具之內在信度及效度檢定……………………………………… 42
第七節 資料收集階段…………………………………………………………… 46
第八節 倫理考量………………………………………………………………… 52
第九節 資料統計與分析………………………………………………………… 52
第四章 研究結果
第一節 樣本基本資料與生理症狀及困擾分佈………………………………… 54
第二節 樣本的心理困窘及癌症調適分佈……………………………………… 65
第三節 樣本決策困難情形在各評估時間的變化及其影響因素……………… 75
第四節 樣本決策後悔情形及其影響因素……………………………………… 91
第五章 討論
第一節 決策偏好、考慮因素、醫療相關資訊來……………………………… 96
第二節 影響決策困難的因素及其變化………………………………………… 100
第三節 影響決策後悔的因素…………………………………………………… 105
第六章 結論與建議
第一節 結論……………………………………………………………………… 107
第二節 研究結果於護理上的應用……………………………………………… 109
第三節 研究限制與建議………………………………………………………… 111
參考文獻
中文文獻…………………………………………………………………………… 112
英文文獻…………………………………………………………………………… 115


〔表目錄﹞
表2-1 WW、RRP及EBRT後各合併症/副作用發生率與變化…………………………… 17
表2-2 HDR及LDR各副作用發生率與變化……………………………………………… 19
表3-1 前趨測試研究量表之內在信度…………………………………………………… 43
表3-2 正式測試研究量表之內在信度…………………………………………………… 44
表3-3 前趨測試樣本之基本資料………………………………………………………… 48
表3-4 對應研究假設之描述性統計法…………………………………………………… 53
表3-5 對應研究假設之推論性統計法…………………………………………………… 53
表4-1 人口相關變項分佈情形…………………………………………………………… 59
表4-2 疾病治療相關變項分佈情形……………………………………………………… 60
表4-3 T1與T3時美國加州大學洛杉磯分校前列腺癌指標得分分佈情形……………… 62
表4-4 T3時國際前列腺症狀評分表得分分佈情形……………………………………… 63
表4-5 T3排尿症狀嚴重度分佈情形……………………………………………………… 63
表4-6 各評估時間點問卷填答人數及資料常態檢定…………………………………… 64
表4-7 T1-T3時之疾病心理社會調適得分情形………………………………………… 71
表4-8 T2時癌症特定困擾量表得分分佈情形…………………………………………… 73
表4-9 T2時癌症特定困擾嚴重度分佈情形……………………………………………… 74
表4-10 T2與T3時決策困難量表得分分佈情形…………………………………………… 83
表4-11 T2與T3時決策困難程度分佈情形………………………………………………… 84
表4-12 T2與T3同時填答決策困難量表之得分分佈與改變之比較……………………… 85
表4-13 T2與T3時人口學相關變項對決策困難量表得分之影響………………………… 86
表4-14 T2與T3時人口學相關變項與決策困難量表得分之相關性……………………… 87
表4-15 T2與T3時疾病治療相關變項對決策困難量表之影響…………………………… 88
表4-16 T2與T3時心理困窘與癌症調適與決策困難量表之相關性……………………… 89
表4-17 推論統計中人口學及疾病治療相關變項的重新分組狀況……………………… 90
表4-18 T3時決策後悔量表得分分佈情形………………………………………………… 93
表4-19 T3時人口學及疾病治療相關變項對決策後悔量表得分之影響………………… 94
表4-20 T3時人口學與疾病治療相關變項、心理困窘及癌症調適與決策後悔之相關性 95

〔圖目表﹞
圖3-1 研究架構圖………………………………………………………………………… 34
圖3-2 資料收集流程圖…………………………………………………………………… 50
圖3-3 各收案時間點收案人數…………………………………………………………… 51

〔附錄目表﹞
附錄一 前列腺癌之TNM分類系統………………………………………………………… 132
附錄二 知情同意書………………………………………………………………………… 133
附錄三 各量表之使用同意書……………………………………………………………… 134
附錄四 專家效度名單……………………………………………………………………… 139
附錄五 專家效度鑑定邀請函……………………………………………………………… 140
附錄六 專家效度鑑定結果………………………………………………………………… 143
附錄七 人體試驗倫理委員會同意臨床試驗證明書……………………………………… 147
附錄八 護理部審查通過證明……………………………………………………………… 148

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