臺灣博碩士論文加值系統

乳癌患者接受治療時，會面對治療所引起各種身體、心理、社會等方面之症狀困擾，”希望狀態”常是內在激勵與克服症狀之重要因子，影響希望狀態的因素很多。本研究之目的在瞭解乳癌患者症狀困擾與希望狀態之情形，及探討症狀困擾與希望狀態之相關性，研究取樣於中部某醫學中心乳房外科門診及化療室之乳癌患者，收案時間自2009年6月至10月。本研究採橫斷式描述性研究設計，以方便取樣方式，結構式問卷調查法，獲有效樣本130份。研究工具包括：個案基本資料、症狀困擾量表、中文版赫式希望指標量表，使用SPSS 12.0版套裝軟體，描述性統計分析，以人數、百分比、平均值、標準差、排序進行分析；推論性統計分析，以克-瓦單因子等級變異數分析(Kruskal Wallis test)、史皮爾曼等級相關係數分析（Spearman’s correlation）及複迴歸分析(Multiple Regression)，分析人口學特性、疾病特性、症狀困擾與希望狀態之相關性。
研究結果發現：(1)乳癌患者症狀困擾總平均為44.7分，屬於輕度程度。(2)乳癌患者希望狀態總平均為37.3分，屬於中等程度。(3)自覺疾病嚴重度與症狀困擾，有顯著差異呈正相關；患者自覺疾病嚴重度愈高，其症狀困擾愈高。(4)年齡、婚姻狀況、自覺疾病嚴重度，與希望狀態總分具顯著差異，以年齡較輕者、有配偶者及自覺疾病嚴重度不嚴重者，其希望狀態程度愈高。(5)症狀困擾程度與希望狀態，呈顯著負相關。
建議降低乳癌患者之症狀困擾，是增強患者的希望狀態，提升病患”希望”程度，並依據患者主觀感受及個別性差異，提供患者護理指導與照護。期盼此研究可提供護理實務及護理教育之參考。

Facing treatment the of the breast cancer patients who have to confront the symptoms of treatment & the distress of the physical, spiritual & social activity, For them “Status of Hope” should be the main strength & internal resource to overcome those distress & symptoms, but there are a lots of factor influencing patient “ Hope” level.The purpose of this study is to understand the symptom distress and hope level of breast cancer patients, and to explore the correlations between demographic characteristics, characteristics of the disease, status of hope, and symptom distress of breast cancer patients. This study was conducted with the cross-sectional description of correlations and was designed with convenience sampling. The place was the Outpatient Breast Surgical Department and the Outpatient Chemotherapy Room at a certain medical center in Taichung. Structured questionnaires were used as the means of data collection. study period from July 2009 to October 2009. A total of 130 valid samples was collected. The research was based on the patient individual basic document table, the symptom distress scale, and the Herth Hope Index. The collected materials were calculated and analyzed statistically by coding and SPSS for the Window 12.0 edition. Descriptive statistics, percentage, averaging, and standard deviation were used to describe the backgrounds of the patients, the degree of symptom distress, and the degree of hope status. Wilcoxon rank sum Kruskal Wallis test, Spearman’s correlation and multiple regression were used to describe the correlations between demographic characteristics, characteristics of the disease, and the degree of symptom distress.
Findings from this research can be summarized as follows. (1). The average score of patients’ symptom distress is 44.7, which can be characterized as mild. (2). The average score of patients’ hope status is 37.3, characterized as moderate. (3). Concerning the variable of disease characteristics, self consciousness of disease severity and symptom distress are significantly different and show a positive correlation. The higher the patient’s self consciousness of disease severity is, the higher his/her symptom distress is. (4). Regarding the difference analysis of demographic characteristics and disease characteristics, there is a significant statistical difference between age, marital status, self consciousness of disease severity, and hope status. Patients of younger age, having a spouse, and low self consciousness of disease severity show higher hope state. (5). With the use of Spearman’s correlation, symptom distress and status of hope are found significantly different and show a negative correlation.
The findings of this research can assist nurses in understanding breast cancer patients’symptom distresses and status of hope and thus offer correct instructions to the patients. Moreover, the results may help nurses give individualized nursing to the patients based on different characteristics of the patients in order to reduce the patients’ symptom distresses and to enhance patients’ status of hope. The findings are beneficial to nursing practice and nursing education.

致謝 V
中文摘要 VI
英文摘要 VIII
圖表目錄
圖目錄 IV
表目錄 IV
第一章 緒論
第一節 研究動機及重要性 1
第二節 研究目的 4
第三節 研究問題 5
第四節 名詞界定 6
第二章 文獻查證
第一節 乳癌概述 9
第二節 症狀困擾 14
第三節 希望狀態 24
第四節 乳癌患者症狀困擾與希望狀態之相關研究 31
第三章 研究方法
第一節 研究架構 33
第二節 研究設計 34
第三節 研究場所與對象 35
第四節 研究工具 36
第五節 工具信效度檢定 38
第六節 研究倫理考量 42
第七節 研究步驟 43
第八節 資料處理與分析 44
第四章 研究結果
第一節 研究對象人口學特性及疾病特性分析 48
第二節 乳癌患者症狀困擾分析 51
第三節 乳癌患者人口學特性及疾病特性與症狀困擾之差異性關係 53
第四節 乳癌患者希望狀態分析 56
第五節 乳癌患者人口學特性及疾病特性與希望狀態之差異性關係 58
第六節 乳癌患者症狀困擾與希望狀態之相關性 61
第五章 討論
第一節 乳癌患者症狀困擾之情形 64
第二節 乳癌患者人口學特性及疾病特性與症狀困擾之差異性關係 66
第三節 乳癌患者希望狀態之情形 67
第四節 乳癌患者人口學特性及疾病特性與希望狀態之差異性關係 69
第五節 乳癌患者症狀困擾與希望狀態之相關性 71
第六章 總結
第一節 結論 73
第二節 建議與護理實務上運用 75
第三節 研究限制及未來研究方向 77
參考文獻
中文文獻……………………………………………………………………… 79
英文文獻……………………………………………………………………… 83
附錄一 乳癌患者症狀困擾與希望狀態之相關性問卷………………………… 92
附錄二 量表原作者問卷使用同意書…………………………………………… 95
附錄三 專家效度名……………………………………………………………… 97
附錄四 專家效度檢測表單……………………………………………………… 98
附錄五 人體試驗委員會通過同意………………………………………………104
附錄六 研究對象同意書…………………………………………………………105
附錄七 受訪者問卷調查同意書…………………………………………………106

圖表目錄
圖目錄
圖一 「乳癌患者症狀困擾與希望狀態之相關性探討」研究架構
表目錄
表2-1 乳癌之分期
表2-2 症狀困擾之評估量表
表3-1 SDS-CMF、HHI量表題目修改一覽表
表3-2 預測研究SDS-CMF、HHI量表之內在一致性
表3-3 正式研究SDS-CMF、HHI量表之內在一致性
表3-4 研究問題與統計方法
表4-1 人口學特性分佈情形
表4-2 疾病特性分佈情形
表4-3 症狀困擾量表得分及排序情形
表4-4 人口學特性在症狀困擾之差異性分析
表4-5 疾病特性在症狀困擾之差異性分析
表4-6 希望狀態程度分析
表4-7 希望狀態量表各層面單題得分及排序情形
表4-8 人口學特性在希望狀態總分之差異性分析
表4-9 疾病特性在希望狀態總分之差異性分析
表4-10 人口學特性、疾病特性及症狀困擾在希望狀態量表總分之複迴歸分析

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