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研究生:王韵宜
研究生(外文):Yun-Yi Wang
論文名稱:探討結直腸癌術後初次接受輔助性治療患者症狀困擾、自我概念與生活品質之相關性研究
論文名稱(外文):The Symptom Distress, Self-Concept and Quality of Life of post-operated Colorectal Cancer Patients undergoing Adjuvant Therapy
指導教授:陳麗糸陳麗糸引用關係
指導教授(外文):Lih-Mih Chen
學位類別:碩士
校院名稱:高雄醫學大學
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:2013
畢業學年度:101
語文別:中文
論文頁數:172
中文關鍵詞:結直腸癌輔助性治療症狀困擾自我概念生活品質
外文關鍵詞:colorectal canceradjuvant therapysymptom distressself conceptquality of life
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  • 被引用被引用:8
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根據台灣的癌症登記統計資料顯示,大腸直腸癌每年呈現快速增的趨勢,自民國95年起即成為我國發生人數最多的癌症,民國98年標準化發生率為每10萬人口41.4人,相較於民國84年的數據上升81%(國民健康局,2012)。依據台灣癌症登記小組(2007)統計資料顯示,結直腸癌的治療在手術治療之後,56.82%的患者會接受術後輔助性化學治療以減少疾病的復發率和提高存活率,而這些輔助性治療常會讓人經驗到多重不適症狀,並伴隨著急性或慢性之身體和角色功能的改變,進而影響生活品質。本研究即探討結直腸癌病友術後接受輔助性治療之症狀、自我概念和生活品質三者間的相關性。
本研究以縱貫式(Longitudinal)相關性之研究設計,採立意取樣的方式,針對南部三家醫學中心、一家區域醫院之20歲(含)以上經醫師確立診斷為結直腸癌第二~四期、手術後第一次接受輔助性治療的門診或住院患者作為研究對象,共84位。研究工具採用三份結構式問卷,包括:台灣版安德森症狀評估量表、成人修訂版結直腸癌自我概念量表和台灣中文版結直腸癌生活品質問卷,在手術後進行輔助性治療前一週和進行輔助性治療後第二、四、六、八週,進行共五次測試或訪談,共計施測五次。利用描述性統計和概化估計方程式(GEE)分析症狀困擾、自我概念與生活品質之相關性,並且分析各變項的重要解釋因子。
研究結果發現輔助治療所產生的主要症狀為疲憊、睏倦、沒胃口、噁心、睡不好等;而所產生的主要生活干擾為工作/家務、一般活動、享受生活等方面。手術後接續輔助性治療的期間,核心生活品質問卷之功能狀況構面相較於手術後(接受第一次輔助性治療前)有顯著的增加,表示角色、生理、社交等功能恢復,生活品質越好(B=3.803~4.772;p<.001);但是隨著輔助性治療次數增加,症狀強度(B=.456~.577;p<.001)、整體症狀困擾(B=.289 ~.424;p<.05)和核心生活品質問卷之症狀/問題構面 (B=2.398~2.851;p<.05)皆會隨著化學治療的次數增加而有顯著的增加,對生活品質相對造成一定的負向影響。
而結直腸癌患者於手術後初次接受輔助性化學治療期間就「症狀困擾」而言,「症狀強度」的重要解釋因子為性別(B=-2.81;p<.05)、教育程度(B=.581;p<.05)、癌症分期(B=.672;p<.05)、核心生活品質問卷之症狀/問題構面(B=.082;p<.001);「症狀干擾生活強度」的重要解釋因子為治療方式(B=-1.489;p<.05)、自我概念(B=.215;p<.05)、核心生活品質問卷之功能狀況構面(B=-.074;p<.001)、核心生活品質問卷之症狀/問題構面(B=.040;p<.001)、核心生活品質問卷之整體健康狀況構面(B=-.009;p<.05)、附加生活品質問卷之症狀/問題構面(B=-.025;p=.01);「整體症狀困擾」的重要解釋因子為教育程度(B=.554;p<.05)、癌症分期(B=.577;p<.05)、核心生活品質問卷之功能狀況構面(B=-.033;p<.001)、核心生活品質問卷之症狀/問題構面(B=.068;p<.001)、附加生活品質問卷之症狀/問題構面(B=-.015;p<.05)。就「自我概念」而言,其的重要解釋因子為婚姻狀況(B=-.243;p<.05)、手術方式(B=-.345;p<.05)、治療方式(B=-.888;p<.05)、核心生活品質問卷之整體健康狀況構面(B=-.08;p<.001)和附加生活品質問卷之功能狀況構面(B= -.019;p<.001)。就「生活品質」而言,「核心生活品質問卷之功能狀況構面」之重要解釋因子為有無造廔口(B= -4.102;p=.001)、整體症狀困擾(B= -1.886;p<.001)、核心生活品質問卷之症狀/問題構面(B=-.322;p<.001)、核心生活品質問卷之整體健康狀況構面(B=.082;p<.001)、附加生活品質問卷之功能狀況構面(B=.215;p<.001)、附加生活品質問卷之症狀/問題構面(B=-.364;p<.001);「核心生活品質問卷之症狀/問題構面」之重要解釋因子為性別(B=-1.928;p<.05)、職業(B=2.512;p=.005)、治療方式(B=10.524~10.645;p=.007~.009)、有無造廔口(B= -3.805;p=.002)、整體症狀困擾(B=3.773;p<.001)、核心生活品質問卷之功能狀況構面(B=-.312;p<.001)、核心生活品質問卷之整體健康狀況構面(B=-.046;p<.05)、附加生活品質問卷之症狀/問題構面(B=.227;p<.001);「核心生活品質問卷之整體健康狀況構面)」之重要解釋因子為婚姻狀況(B=-6.941;p=.005)、癌症分期(B=11.751;p<.05)、腫瘤部位(B=-6.148;p<.05)、自我概念(B=-4.667;p<.001)、核心生活品質問卷之功能狀況構面(B=.470;p<.001)、核心生活品質問卷之症狀/問題構面(B=-.270;p<.05)。
本研究除了可以讓醫護人員了解結直腸癌患者術後初次接受輔助性治療症狀困擾、自我概念和生活品質的相關性之外,對於主要干擾的症狀與日常活動,可提供臨床作為參考照護的實證資料,藉以進一步發展臨床評估和照護指引,以提升病友的生活品質。


Post-operative adjuvant chemotherapy is a choice to increase the survival rate after surgery of colorectal cancer patients. Patients received adjuvant chemotherapy may experience various uncomfortable symptoms, decreased self-concept and poor quality of life.This study tried to investigate the uncomfortable symptoms, self-concept and quality of life of post-operated colorectal cancer patients undergoing adjuvant chemotherapy. 84 colorectal cancer patients were purposive recruited in three medical center of southern Taiwan. Five self-reported questionnaires, Demographic/Medical Records, MDASI-T, FAP, EORTC QLQ C-30 & CR29 were answered by the patients on one week before the 1st course of chemotherapy and 24~48hrs after the 1st, 2nd, 3rd and 4th course of chemotherapy. Generalized estimating equations (GEE) had been used to estimate the associations among symptoms, self-concept, quality of life and demographic/medical records over times of post-operative adjuvant chemotherapy. The most common symptom before the 1st course of chemotherapy was “difficult to fall asleep”. The most common symptom after four courses was “fatigue” . The more courses of chemotherapy that patients received, the higher symptom scores they had,. The symptom scores after the 4th course of chemotherapy was significantly higher than the scores on one week before the 1st course of chemotherapy (p < .001). The self-concept scores of the patients were positively correlated to the scores of symptoms (p < .001). To develop specific and continue nursing care in each course of adjuvant chemotherapy will be an important task, and to enhance patient’s self-concept to adjust the stress during series adjuvant chemotherapy will be crucial as well.



第一章 緒論
第一節 研究背景、重要性及動機…………………………………1
第二節 研究目的……………………………………………………3

第二章 文獻查證與概念架構
第一節 文獻查證…………………………………………………….4
第二節 概念架構圖…………………………………………………15
第三節 研究假設……………………………………………………15
第四節 名詞定義……………………………………………………16

第三章 研究方法
第一節 研究設計…………………………………………………….18
第二節 研究情境/場所………………………………………………19
第三節 研究樣本及取樣特性與樣本數抽樣方法………………….19
第四節 研究工具與信效度………………………………………….20
第五節 資料收集過程……………………………………………….27
第六節 本研究工具之信度………………………………………….31
第七節 資料分析……………………………………………………32

第四章 研究結果
第一節 結直腸癌患者的基本人口屬性………………………….....34
第二節 結直腸癌患者的疾病特性……………………………….....36
第三節 結直腸癌手術後接受初次輔助性治療患者症狀、自我概念
和生活品質的現況與變化情形………………………….....38
第四節 結直腸癌手術後接受初次輔助性治療患者基本人口學特性
和疾病屬性與症狀困擾、自我概念和生活品質之改變趨勢
和變項間的相關性……………………………………….....57

第五章 討論
第一節 研究結果與研究目的或研究假設的關連性……………….87
第二節 研究結果的重要性…………………………………………103
第三節 研究限制……………………………………………………104

第六章 結論與建議
第一節 綜合重要研究發現…………………………………………105
第二節 在護理實務或教育上的意涵或應用………………………107
第三節 未來研究方向………………………………………………108

參考文獻
中文部分……………………………………………………………..110
英文部分……………………………………………………………..113


表1 本研究量表之信度…………………………………………….31
表2 資料分析統整表……………………………………………….33
表3 結直腸癌患者基本人口屬性資料…………………………….35
表4 結直腸癌患者疾病特性資料………………………………….37
表5 結直腸癌患者症狀強度、症狀干擾生活強度及整體症狀困擾
…………………………………………………………………40
表6 結直腸癌患者單一症狀強度………………………………….42
表7 結直腸癌患者單一症狀干擾生活強度……………………….43
表8 結直腸癌患者單一症狀強度排名…………………………….46
表9 結直腸癌患者單一症狀干擾生活強度排名………………….47
表10 結直腸癌患者自我概念……………………………………...48
表11 結直腸癌患者核心生活品質(C30)…………………………..52
表12 結直腸癌患者附加生活品質(CR29)………………………...55
表13 結直腸癌患者「症狀強度」概化估計方程式之單變量分析
………………………………………………………………..59
表14 結直腸癌患者「症狀干擾生活強度」概化估計方程式之單變
量分析………………………………………………………..62
表15 結直腸癌患者「整體症狀困擾」概化估計方程式之單變量分
析……………………………………………………………..65
表16 結直腸癌患者「自我概念」概化估計方程式之單變量分析
………………………………………………………………..68
表17 結直腸癌患者「核心生活品質問卷之功能狀況構面」概化
估計方程式之單變量分析…………………………………..71
表18 結直腸癌患者「核心生活品質問卷之症狀/問題構面」概化
估計方程式之單變異數分析………………………………..75
表19 結直腸癌患者「核心生活品質問卷之整體健康狀況構面」概
化估計方程式之單變量分析………………………………..78

表20 結直腸癌患者「附加生活品質問卷之功能狀況構面」概化
估計方程式之單變量分析…………………………………..82
表21 結直腸癌患者「附加生活品質問卷之症狀/問題構面」概化
估計方程式之單變量分析…………………………………..86


圖1結直腸癌手術後初次接受輔助性治療患者基本人口學特性和疾
病屬性與症狀困擾、自我概念和生活品質之關係概念架構圖
…………………………………………………………………..15
圖2 收案與測量方式流程圖……………………………………….30
圖3 症狀強度、症狀干擾生活強度與整體症狀困擾的改變趨勢
…………………………………………………………………41
圖4 結直腸癌患者之單一症狀強度的改變趨勢………………….44
圖5 結直腸癌患者之單一症狀干擾生活強度的改變趨勢……….45
圖6 結直腸癌患者之自我概念的改變趨勢……………………….49
圖7 結直腸癌患者之核心生活品質問卷中功能狀況、症狀/問題以
及整體健康狀況構面得分的改變趨勢……………………....53

圖8 結直腸癌患者之附加生活品質問卷中功能狀況以及症狀/問題
構面得分的改變趨勢………………………………..………..56

附件
附件一 研究工具同意書-1…………………………………………127
附件二 研究工具同意書-2…………………………………………128
附件三 研究工具同意書-3…………………………………………129
附件四 研究工具-1 個人基本屬性及疾病特性量表……………..130
附件五 研究工具-2台灣中文版安德森症狀評估量表…………...131
附件六 研究工具-3 成人修正版家族性腺瘤患者之自我概念量表
………………………………………………………………133
附件七 研究工具-四 生活品質量表- C30 & CR29……………….134
附件八 人體試驗委員會同意書-1-1(高雄醫學大學附設中和醫院)
………………………………………………………………138
人體試驗委員會同意書-1-2(高雄醫學大學附設小港醫院)
………………………………………………………………140
附件九 人體試驗委員會同意書-2(國軍高雄總醫院)……………..141
附件十 人體試驗委員會同意書-3(高雄長庚醫院)………………..142
附件十一 人體試驗委員會同意書-4(高雄榮民總醫院)…………..143
附件十二 受試者同意書-1(高雄醫學大學附設中和醫院)………..144
附件十三 受試者同意書-2(國軍高雄總醫院)……………………..148
附件十四 受試者同意書-3(高雄長庚醫院)………………………..151
附件十五 受試者同意書-4(高雄榮民總醫院)……………………..156


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羅惠敏、徐南麗、蕭正光、劉雪娥(2003)‧比較疼痛及非疼痛癌症病患不確定感、症狀困擾、社會支持與生活品質關係‧志為護理-慈濟護理雜誌,2(3),70-76。
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1. 王照元(2008).大腸直腸癌的輔助性化學治療.中華民國癌症醫學會雜誌,24(3),180-184。
2. 林嘉慧、林麗英、吳杼芸、林瑞玲、張春梅(2006) ‧門診病人接受化學治療之症狀困擾與處置經驗‧榮總護理,23(4),364-373。
3. 林春香、劉雪娥、王正儀(1996)‧大腸直腸癌症病患生活品質及其相關因素之探討‧護理研究,4(1),13-26。
4. 曾惠珍、王秀紅、金繼春、陳麗糸、簡淑媛(2000).出院後永久性結腸造口患者之壓力.護理研究,8(6),685-695.
5. 黃立婉、陳守善、牟致遠、姜正愷、林偵國(2001).肛門括約肌保留手術.臨床醫學,48(5),298-303。
6. 陳美華(2007).身體活動、自我概念和自尊關係之文獻回顧.台灣運動心理學報,(11),17- 39。
7. 陳美碧、謝麗鳳、林惠蘭、李淑貞、林純如、蔡欣玲(2004).癌症病人之生活品質及其預測因子.榮總護理,21(4),352- 362。
8. 梁金銅(2006).大腸直腸癌.臺灣醫學,10(4),488-492。
9. 梁金銅(2009).大腸直腸癌的腹腔鏡微創手術.臺灣醫學,13(3),253-257。
10. 張輝德、顧乃平(1995)永久性腸造口病人的心理社會行為反應與需要之初探.護理雜誌,42(2),42-54。
11. 劉易承、宋鴻樟、謝玲玲、唐瑞平、葉志清(2008)‧大腸直腸癌之風險預測模式與風險指標‧臺灣公共衛生雜誌,27(1),1-12。
12. 羅惠敏、徐南麗、蕭正光、劉雪娥(2003)‧比較疼痛及非疼痛癌症病患不確定感、症狀困擾、社會支持與生活品質關係‧志為護理-慈濟護理雜誌,2(3),70-76。
13. 羅惠敏、徐南麗、邱慧洳、廖惠娥、劉欣怡(2004)‧癌症病患症狀困擾與不確定感關係之探討‧慈濟護理雜誌,3(1),72-80。
14. 賴裕和(1998)‧門診接受化學治療病人之症狀困擾及居家護理需求探討‧護理研究, 6(4), 279-289。
 
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