臺灣博碩士論文加值系統

背景及研究目的
肺癌患者於疾病進程與治療期間常經歷許多衝擊，並產生未滿足的照護需求，然而，現況對於早期肺癌術後患者的罹病經驗了解程度相當有限，因此，本研究的主要目的為:（1）探討早期肺癌患者於術後三個月的症狀與功能狀態、疾病衝擊以及照護需求之現況；（2）探討照護需求的相關因素（潛在相關的變項包括:人口學特性、疾病治療特性（疾病分期、手術術式、癌症組織型態）、症狀嚴重度、身體活動功能以及疾病衝擊（侵入經驗、逃避反應、高度警覺））。
研究方法、工具及分析
本研究採橫斷性量性研究法，主要探討早期肺癌術後患者之（1）症狀嚴重度、（2）身體活動功能、（3）疾病衝擊、（4）照護需求、（5）疾病和基本資料。依據上述探討變項，採用以下研究工具測量:（1）歐洲癌症治療與研究組織生活品質量表及肺癌模組；（2）Karnofosky氏身體功能量表；（3）事件衝擊量表修訂版；（4）支持性照護需求量表；（5）疾病及基本資料。蒐集之結果將採用描述性統計、斯皮爾曼相關性（Spearman’s correlation）以及迴歸模型進行分析。本研究以G-power之F test統計法估算樣本數，預估測量108位早期（I-IIIA期）肺癌術後患者。
結果
本研究結果顯示早期肺癌術後患者之症狀嚴重度屬輕度程度，其中嚴重度較高之前五項症狀為咳嗽、失眠、疲憊、其他部位疼痛以及呼吸喘/困難；而疾病衝擊部分，整體來說屬於輕度疾病衝擊，各疾病衝擊面向當中，以逃避反應程度最高，接著為侵入經驗以及高度警覺層面；針對照護需求現況，整體來說有低至中度照護需求，依程度排序分別為「健康系統與資訊需求層面」、「心理需求層面」、「病患照護與支持需求層面」、「生理與日常生活需求層面」與「性需求層面」，而最具照護需求的項目為「可被告知能讓自己變更好的事情」。
「整體照護需求層面」與症狀嚴重度（r=0.43, p<0.01）、身體活動功能（r=-0.23, p<0.05）、整體疾病衝擊（r=0.49, p<0.01）、侵入經驗（r=0.43, p<0.01）、逃避反應（r=0.36, p<0.01）、高度警覺（r=0.55, p<0.01）有所相關，進一步以羅吉斯迴歸分析探討其預測因子，為教育程度、癌症分期、癌症組織型態、症狀嚴重度以及高度警覺。
討論與結論
早期肺癌患者雖有較長之存活期，但仍可能於追蹤期間存在許多症狀困擾以及感受到疾病之衝擊，尤其需注意患者逃避反應以及高度警覺層面之症狀，以避免造成情緒癒治之困難及高度照護需求未滿足之困擾。而健康系統與資訊層面則有較高需求未滿足之情形，未來應加強對於該族群疾病與治療相關資訊的規劃，以期給予早期肺癌患者適切的協助，降低需求未滿足之狀態，提升照護之品質。

Background and purpose
Lung cancer patients often experience great impact and many unmet supportive care needs during the course of the disease and during treatment. However, the current status of the experience of patients with early lung cancer is limited. Therefore, the main objectives of this study are: (1) to explore the symptoms and functional status, impact of disease and care needs of patients with early lung cancer at three months after surgery; (2) to analyze the related factors of care needs, including demographic characteristics, disease treatment characteristics (stage, operation type, histological form of cancer), physical function (symptom severity, performance status) and impact of disease (intrusion, avoidance, hyperarousal).
Method and materials
This is a cross-sectional study conducted in a medical center in Northern Taiwan. This study focused on (1) symptom severity, (2) performance status, (3) impact of disease, (4) care needs, and (5) demographic information and disease characteristics of early stage lung cancer patients. Those variables that we wanted to explore were assessed by (1) The European Organization for Research and Treatment of Cancer QLQ-C30 and Lung Cancer module (EORTC QLQ-C30; LC 13); (2) Karnofosky performance scale (KPS); (3) Impact of Event Scale-Revised (IES-R); (4) Supportive care needs survey-screening tool 9 (SCNS-ST9); and (5) Background and Disease / Treatment Information Form (BDIF). The results of the collection were analyzed by using descriptive statistics, Spearman''s correlation, and regression models. In this study, the sample size was estimated by G-power F test statistic, and 108 patients with early stage (I-IIIA) lung cancer were estimated recruited.
Results
The results of study showed that early stage lung cancer patients after surgery experienced mild symptom severity with top five severe symptoms as cough, insomnia, fatigue, pain in other parts and dyspnea. The level of impact of disease which patients experienced was also mild and the levels of IES-R sub-dimensions as their descending order were avoidance, intrusion and hyperarousal, respectively. According to the results, in general, patients had low to moderate levels of care needs, ranking as their mean score as "Health System and Information Needs", "Psychological Needs", "Patient Care and Support Needs", "Physical and Daily Living Needs" and "Sexual Needs", while the most care needs are " To be informed about things you can do to help yourself get well."
Patients’ overall care needs were associated to symptom severity ( r=0.43, p<0.01)、physical function (r=-0.23, p<0.05), overall impact of disease (r = 0.49, p <0.01), intrusion (r = 0.43, p <0.01), avoidance ( r=0.36, p<0.01) and hyper-arousal (r = 0.55, p <0.01), and further explore the predictive factors by using the Logistic regression analysis, cancer staging, histological types of cancer, symptom severity, and hyper-arousal were predictive factors of care needs.
Conclusion
Although patients with early stage lung cancer have a longer survival period compared with advanced cancer, they may still have several symptoms and perceive impact of disease during follow-up period. We need to pay attention in particular on the patient with higher avoidance and hyper-arousal symptoms to prevent them from the difficulties of emotional healing and high levels of unmet care needs. In addition, we need to strengthen the planning of information on the disease and treatment in order to give appropriate assistance to patients with early stage lung cancer and to reduce the unmet needs of health system and information for improving the quality of care.

中文摘要 i
英文摘要 iii
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 5
第三節 研究假設 6
第二章 文獻查證 7
第一節 肺癌疾病病因及治療簡介 7
第二節 肺癌患者的生理功能變化與疾病衝擊 10
第三節 照護需求 16
第四節 肺癌病人照護需求之影響因素 25
第三章 研究方法 28
第一節 研究設計與研究架構 28
第二節 名詞解釋及操作型定義 29
第三節 研究設計、研究對象及倫理 31
第四節 研究工具 33
第五節 資料分析方法 36
第四章 研究結果 38
第一節 早期肺癌術後患者之人口學特性與疾病治療特性 38
第二節 早期肺癌術後患者之症狀、身體功能及疾病衝擊現況 40
第三節 早期肺癌術後患者之照護需求現況 43
第四節 早期肺癌術後患者之照護需求的差異分析及相關性 44
第五節 早期肺癌術後患者照護需求與預測因子 47
第五章 討論 49
第一節 早期肺癌術後患者之人口學與疾病治療特性 49
第二節 症狀及活動功能現況探討 51
第三節 疾病衝擊現況探討 53
第四節 照護需求現況探討 56
第五節 照護需求之相關因素及其預測因子 60
第六章 結論與建議 64
第一節 結論 64
第二節 研究限制 66
第三節 建議 67
參考資料 69
 
表目錄
表 1 國際肺癌TNM分期系統定義（Goldstraw et al., 2007） 8
表 2、人口學特質 89
表 3、疾病治療特性 90
表 4、症狀嚴重度 91
表 5、疾病衝擊總分 92
表 6、疾病衝擊症狀項目 93
表 7、照護需求層面 94
表 8、照護需求項目排序 95
表 9、人口學、疾病特性與照護需求之差異分析 96
表 10、人口學、疾病特性與照護需求之差異分析(續) 98
表 11、照護需求之相關性分析 100
表 12、五大照護需求層面主要預測因素 101
表 13、整體照護需求主要預測因子 102
 
圖目錄
圖 1 Stevens及Gabbay需求、要求、供應模式 21
圖 2 探討早期肺癌術後患者身心適應相關因素之研究架構圖 28
圖 3 研究資料收集過程流程圖 32

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