臺灣博碩士論文加值系統

結直腸癌為國內外癌症發生率的前三名，但隨著早期篩檢的推廣及醫療的進步，病人存活率有逐年增加之趨勢，需面臨長期與疾病共存的處境。身體活動可協助癌症病人改善症狀、生活品質、降低復發率與死亡率。然而，國內外結直腸癌病人身體活動量大多未達建議之標準。美國癌症醫學會建議結直腸癌病人之照護重點，應從診斷後即開始提供身體活動等健康行為的指導及介入，以利後續落實健康促進行為。而病人對身體活動等健康行為的理解與判斷，需仰賴本身健康識能的程度，才能認識身體活動對疾病照護的重要性，以及如何在生活中落實；充能程度也攸關著病人執行身體活動信心與動力，故本研究欲探討新診斷結直腸癌病患的健康識能、充能與身體活動的影響，以作為後續改善方案擬定的依據。
本研究採橫斷式研究設計，採立意取樣以診斷六個月內之結直腸癌病人為收案對象，並以癌症新診斷病人健康識能量表、病人充能量表及國際身體活動台灣自填短版量表之結構式問卷於北部某醫學中心進行收案。資料分析使用SPSS 20.0版軟體，以平均值、標準差、中位數等描述性統計檢視各變項的現況及分布，以Spearman’s correlation coefficients、Mann-Whitney U test、Kruskal-Wallis test、Chi-square test及Pearson correlation coefficient了解各變項與有無達到身體活動建議量間的相關性，再以binary logistic regression檢定身體活動量之預測因子。
研究結果顯示結直腸癌初診斷病人將近一半(49.55%)未達身體活動建議量，走路是病人較常執行的身體活動。罹患慢性病數目越多、自覺健康狀況越差、疲憊與神經病變影響日常生活程度分數越高，從事越少身體活動總量。而健康識能、充能與有無達到身體活動建議量雖未有統計上顯著差異，但仍發現健康識能及充能得分越高者，其身體活動有越好的趨勢。迴歸分析顯示疲憊影響日常生活程度是病人有無達到身體活動建議量的重要影響因素，每增加1分會顯著減少17.4%達身體活動建議量的機率(OR=0.826，95% CI：0.708-0.963)。
結直腸癌初診斷病人身體活動量有許多改善的空間，疲憊是主要的影響因素。身為第一線的醫療人員除應積極處理疲憊問題，也需把握每次接觸病人的機會，建立良好的夥伴關係，提供個別化及詳細的指導，增加病人對身體活動的了解與意識，從輕度或走路等易執行的活動開始嘗試，逐步建立規則的活動習慣，強化其信心，以達增加身體活動量之目的。

In Taiwan and other countries, the incidence rate of colorectal cancer is among the top three most commonly occurring cancers. With early screening and improved medical treatment, patients’ survival rates have increased annually. However, these patients need to face the long-term situation of having this cancer. Several studies have revealed that increased physical activity can help cancer patients reduce the recurrence rate, mortality rate, burden of symptoms, and may improve the quality of life. However, most colorectal cancer patients do not meet the recommended physical activity standard. According to the American Cancer Society, when patients were diagnosed as colorectal cancer , medical personnel should provide health behavior information, which may help these patients perform or continue maintain physical activities. Patients have to rely on their own health literacy to understand and decide regarding the physical activity and other health-related information, which may affect their implementation of these activities. Empowerment is also an important factor that affects the patients’ performance of physical activities. This study aimed to understand how health literacy, empowerment, and other factors affect colorectal cancer patients’ physical activities, as a basis for the follow-up improvement program.
This was a cross-sectional study, and the participants who were newly diagnosed with colorectal cancer within the first 6 months were recruited using the purposive sampling. Structured questionnaires, such as Cancer-Related Health Literacy Questionnaire (CHLQ), Patient Empowerment Scale (PES), and IPAQ Taiwan version of the short last 7 days self-administered format, were used to collect data in medical institutions of Northern Taiwan. All statistical analyses were performed using SPSS Statistics 20.0 for Windows (IBM Corp.,Armonk, NY). The descriptive statistics, such as the mean, standard deviation, and median, were used to analyze the status and distribution of variables. The Spearman’s correlation coefficients, Mann-Whitney U test, Kruskal-Wallis test, Chi-square test, and Pearson correlation coefficient were used to analyze the correlation between the variables and physical activity. Furthermore, the binary logistic regression was used to determine the predictors of physical activity.
The results showed that nearly half of the newly diagnosed colorectal cancer patients (49.55%) did not meet the physical activity guideline. Patients more often preferred walking. Lower physical activity was reported in patients who had more chronic diseases, poorer perceived health condition, more fatigue, and neuropathy symptom that affected their daily activities. Although health literacy, empowerment, and physical activity were statistically insignificant, patients with higher health literacy and empowerment scores were more physically active. The regression analysis showed that fatigue was the most important factor in predicting the newly diagnosed colorectal cancer patients’ performance of physical activities. As the fatigue affecting the physical activity score increased by 1 point, the chance of patients meeting the physical activity guideline was significantly reduced by 17.4% (OR = 0.826, 95% CI =0.708-0.963).
Improving the newly diagnosed colorectal cancer patients’ physical activity status still has a long way to go. The medical personnel’s main responsibility not only include active fatigue management, but also establishment of a good partnership with the patients. Medical personnel should also provide individual and detailed guidance on physical activities at every opportunity they can get while interacting with the patients. They should also improve the patients’ knowledge and awareness on the importance of performing these physical activities, and encourage them to begin light physical activities or walking, and gradually increasing their habits and confidence in to take up more intense physical activities; thereby, meeting the physical activity guideline.

致謝....................................................i
摘要...................................................ii
Abstract..............................................iii
目錄....................................................v
圖目錄................................................vii
表目錄...............................................viii
第一章 緒論............................................1
第一節 研究背景與現況....................................1
第二節 研究動機與重要性..................................3
第三節 研究目的.........................................5
第二章 文獻查證........................................6
第一節 結直腸癌症治療與身體活動量現況.....................6
第二節 健康識能之概念與測量.............................10
第三節 充能之概念與測量.................................18
第四節 身體活動之概念與測量.............................22
第五節 健康識能、充能與身體活動相關性....................26
第六節 結直腸癌初診斷病人身體活動之影響因素...............29
第三章 研究方法.......................................34
第一節 研究設計.........................................34
第二節 研究架構.........................................35
第三節 名詞解釋.........................................36
第四節 研究問題.........................................38
第五節 研究假說.........................................39
第六節 研究場域與對象....................................40
第七節 研究工具與信效度檢定..............................41
第八節 研究步驟.........................................46
第九節 資料處理及分析方法................................47
第十節 倫理考量.........................................49
第四章 研究結果........................................50
第一節 研究對象基本人口學屬性、醫療狀態、健康識能、充能與身體活動之現況...50
第二節 研究對象基本人口學屬性、醫療狀態、健康識能、充能與身體活動相關性...73
第三節 研究對象健康識能與充能之相關性.....................82
第四節 研究對象身體活動量之預測因子.......................83
第五章 討論............................................87
第一節 基本人口學屬性、醫療狀態、健康識能、充能及身體活動現況 ...87
第二節 基本人口學屬性、醫療狀態、健康識能、充能與身體活動量相關性...95
第三節 健康識能與充能之相關性...........................101
第四節 結直腸癌初診斷病人身體活動之預測因子..............102
第六章 結論、研究限制與建議...........................104
第一節 結論...........................................104
第二節 研究限制.......................................106
第三節 建議...........................................107
參考文獻..............................................110
附錄一 「癌症新診斷病人健康識能量表」授權同意書..........129
附錄二 「病人充能量表」授權同意書.......................130
附錄三 「國際身體活動台灣自填短版增修量表」授權同意書.....131
附錄四 研究問卷.......................................132
附錄五 專家效度名單...................................143
附錄六 「病人充能量表」專家意見及問卷修改內容.............144
附錄七 人體試驗審議委員會同意臨床試驗證明書...............148

圖目錄
圖3-2-1 研究架構.......................................35
圖3-7-2 「中文版病人充能量表」發展過程....................43
圖4-2-1 身體活動總量常態檢定圖...........................73
圖6-1-1 影響結直腸癌初診斷病人身體活動預測因子架構圖......105

表目錄
表2-1-1 AJCC結直腸癌症分期及五年存活率....................7
表2-2-1 健康識能量表統整表...............................16
表2-3-1 與慢性健康狀況相關之充能測量工具統整表............21
表2-4-1 18歲以上成年人常用身體活動測量工具統整表..........24
表3-7-3 IPAQ身體活動量分類..............................45
表3-9-1 描述性統計......................................47
表3-9-2 推論性統計(一)..................................47
表3-9-3 推論性統計(二)..................................48
表3-9-4 推論性統計(三)..................................48
表4-1-1 基本人口學屬性資料...............................51
表4-1-2 醫療狀態資料....................................53
表4-1-3 使用Oxaliplatin藥物神經病變狀況..................54
表4-1-4 健康識能量表得分狀況.............................56
表4-1-5 健康識能量表得分比例分佈.........................56
表4-1-6 不同人口學屬性研究對象健康識能量表得分狀況.........57
表4-1-7 「癌症新診斷病人健康識能量表」各題答對率...........58
表4-1-8 充能量表得分狀況................................64
表4-1-9 不同人口學屬性研究對象充能量表得分狀況............64
表4-1-10 過去一周身體活動概況...........................68
表4-1-11 過去一周身體活動狀況(min/week).................70
表4-1-12 過去一周身體活動量分組.........................70
表4-1-13 不同人口學屬性研究對象於過去一周各類身體活動狀況..71
表4-2-1 不同基本人口學屬性於過去一周各類身體活動之比較.....75
表4-2-2 人口學屬性與過去一周達成身體活動建議量之比較.......76
表4-2-3 不同醫療狀況於過去一周各類身體活動之比較...........78
表4-2-4 醫療狀態與過去一周達成身體活動建議量之比較.........80
表4-2-5 健康識能、充能與過去一周各類身體活動之比較.........81
表4-2-6 健康識能、充能與過去一周達成身體活動建議量之比較...81
表4-3-1 研究對象健康識能與充能之相關性....................82
表4-4-1 研究對象過去一周達成身體活動建議量之單變項羅吉斯迴歸...84
表4-4-2 研究對象過去一周達成身體活動建議量之多元羅吉斯迴歸..86

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