背景：泌尿道癌症患者常是在檢查中被意外發現，且確診時幾乎都會有身心社會反應與痛苦，在治療期間會有不確定感及焦慮，長期下來對患者及家屬都是很大的精神負擔，若未及早評估此問題，則會影響患者的治療決策、預後和生活品質。另文獻尚欠缺泌尿道癌症患者手術前3個月一般與健康相關生活品質、心理痛苦、問題來源及不確定感的縱貫性變化及相關性。
目的：(1)描述泌尿道癌症患者一般與健康相關生活品質、心理痛苦、問題來源及不確定感的變化；及(2)檢查泌尿道癌症患者一般與健康生活相關活品質、心理痛苦、問題來源及不確定感之間的相關性。
方法：本研究為縱貫性、相關性研究設計，採方便取樣自嘉義縣某區域醫院泌尿外科病房，將於收案使用問卷來收集泌尿道癌症患者的社會人口學及臨床資料、痛苦程度與問題來源、疾病不確定感和一般與健康相關生活品質，並於手術後第二週收集痛苦程度與問題來源以及健康相關生活品質，手術前、手術後第一個月與第三個月分別再次收集痛苦程度與問題來源、疾病不確定感和一般與健康相關生活品質。資料分析將使用描述性統計、斯皮爾曼相關係數(Pearson correlation)。
結果：泌尿道癌症患者從手術前、手術後2週、手術後1個月至手術後3個月的心理痛苦(p < .001)；實際(p = .007)、情緒(p < .001)、身體症狀(p = .006)之問題來源及不確定感(p < .001)平均數有統計上顯著的降低；健康生活相關生活品質的情緒功能(p < .001)功能及整體健康狀態/生活品質(p < .001)有統計上顯著的升高，而疲倦(p < .001)、失眠(p = .001)、食慾不振(p = .013)及便秘(p = .045)症狀平均數有統計上顯著的降低；一般生活品質的角色-生理(p = .002)、身體疼痛(p = .018)、社會功能(p = .021)及角色-情緒(p = .032)構面則從手術前、手術後1個月至手術後3個月有統計上顯著的升高；泌尿道癌症患者健康相關與一般生活品質與心理痛苦、問題來源及不確定感呈統計上顯著負相關，而泌尿道癌症患者的心理痛苦、問題來源與不確定感則呈統計上顯著正相關。
結論與建議：泌尿道癌症患者的心理痛苦與問題來源(實際、情緒及身體症狀)、不確定感、健康相關(情緒功能及整體健康狀態/生活品質、疲倦、失眠、食慾不振及便秘)與一般生活品質(角色-生理、身體疼痛、社會功能及角色-情緒構面)皆有顯著的變化；一般與健康相關生活品質與心理痛苦、問題來源及不確定感呈統計上顯著負相關，而心理痛苦、問題來源與不確定感則呈統計上顯著正相關。泌尿道癌症一般症狀都不明顯，故一旦發現得到癌症，易產生心理痛苦及不確定感，故期望本研究發現可提供護理人員照護泌尿道癌症患者的參考，早期提供患者所需的資訊及心理支持，並提供跨團隊的醫療服務品質。

Background: Urinary tract cancer patients are found accidentally during examination. They have biopsychosocial and spiritual reactions and distress, while they are diagnosed. They also have experienced uncertainty and anxiety during treatment. Thus, patients and family members have undergone huge emotional burden for a long period of time. If these problems were not assessed timely, they would affect patients’ treatment decision, prognosis, and quality of life. However, there is a lack of the longitudinal changes and associations among distress and problem resource list, uncertainty, quality of life, and health related quality of life in urinary tract cancer patients within three months of surgery.
Objective: (1) Understand changes of quality of life and health related quality of life, distress and problem list, and uncertainty in urinary tract cancer patients. (2) Examine the association among distress and problem resource list, uncertainty, quality of life, and health related quality of life in urinary tract cancer patients.
Method: This is a longitudinal study using a convenience sampling from a urological and surgical ward at a district hospital of Chiayi in Taiwan. The instruments of the Distress Thermometer and Problem List, Mishel Uncertainty Scale, European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-C30 v3, and SF-36 v2 were to measure at the baseline, two weeks after surgery, one month and three months after surgery. The data used descriptive statistics, Spearman’s rank correlation, Friedman test, and Wilcoxon Signed Rank test to analyze.
Results: The means of distress (p < .001), practical problems (p = .007), emotional problems (p < .001), physical symptoms (p = .006), and uncertainty (p < .001) have statistically significant decreased from before surgery, two weeks after surgery, one month after surgery, to three months after surgery in urological cancer patients. Means of emotional functioning (p < .001) and overall health status/quality of life (p < .001) of EORTC-QLQ-C30 have statistically significant increased. Means of fatigue (p < .001), insomnia (p = .001), appepite loss (p = .013), and constipation (p = .045) have statistically significant reduced. Means of the constructs of role-physical, bodily pain, social functioning, and role-emotional have statistically significant increased from before surgery, one month after surgery, to three months after surgery. Means of the EORTC-QLQ-C30, SF-36, distress, problem sources, and uncertainty were statistically significant negative associated, whereas means of distress, problem sources, and uncertainty were statistically significant positive correlated.
Conclusions and implications: Means of distress, problem sources (practical, emotional, and physical problems), uncertainty, EORTC-QLQ-C30(emotional functioning and overall health status and quality of life, fatigue, insomnia, appetite loss, and constipation), SF-36(role-physical, bodily pain, social functioning, and role-emotional constructs) were statistical changed. the EORTC-QLQ-C30, SF-36, distress, problem sources, and uncertainty were statistically significant negative associated, whereas means of distress, problem sources, and uncertainty were statistically significant positive correlated. Patients with urological caner often has non-specific symptoms. Once they are diagnosed with cancer; they often develop distress and uncertainty. We hoped these findings can provide a reference for nurses taking care of urological cancer patients. This also can early provide needed information and psychosocial support for urological cancer patients and provide medical service quality by a multidisciplinary team.

誌謝 I
中文摘要 II
ABSTRACT IV
目次 VI
表目次 I
圖目次 II
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究之重要性 3
第三節 研究目的 4
第四節 研究問題 4
第五節 研究假設 4
第六節 名詞界定 4
第二章 文獻查證 7
第一節 泌尿道癌症 7
第二節 泌尿道癌症患者的心理痛苦及問題來源 10
第三節 泌尿道癌症患者的疾病不確定感(UNCERTAINTY) 10
第四節 泌尿道癌症患者的生活品質 11
第五節 泌尿道癌症患者生活品質、心理痛苦及問題來源和不確定感間的相關性 12
第三章 研究方法 14
第一節 研究設計 14
第二節 研究架構 14
第三節 研究對象與場所 14
第四節 研究工具 15
第五節 測量 21
第六節 研究步驟 23
第七節 資料處理與分析 24
第八節 研究倫理考量 25
第四章 研究結果 26
第一節 收案人數與評估次數 26
第二節 泌尿道癌症患者社會人口學特徵及臨床特徵的分佈 26
第三節 泌尿道癌症患者心理痛苦及問題來源之變化 30
第四節 泌尿道癌症患者不確定感之變化 38
第五節 泌尿道癌症患者一般與健康相關生活品質的變化 41
第六節 泌尿道癌症患者一般與健康相關生活品質、心理痛苦、問題來源及與不確定感之間的關係 57
第五章 討論 65
第一節 泌尿道癌症患者心理痛苦及問題來源的變化 65
第二節 泌尿道癌症患者不確定感的變化 66
第三節 泌尿道癌症患者一般與健康相關生活品質的變化 67
第四節 泌尿道癌症患者一般與健康生活相關的生活品質、心理痛苦、問題來源及不確定感之間的相關性 70
第五節 研究限制 72
第六章 結論與建議 73
第一節 結論 73
第二節 建議 74
參考文獻 75
中文部分 75
西文部分 76

附錄 80
附錄一 泌尿道癌症患者的心理痛苦及問題來源、不確定感和生活品質的文獻整理 80
附錄二 樣本數估計 92
附錄三 自擬結構式問卷 93
附錄四 體能狀態(ECGO) 95
附錄五 察爾森共病症指標 96
附錄六 麻醉前的生理狀態分級 97
附錄七 痛苦溫度計及問題來源查檢表 98
附錄八 MISHEL的疾病不確定感量表 100
附錄九 中文版SF-36生活品質問卷 101
附錄十 歐洲癌症生活品質核心問卷(EORTC-QLQ-C30) 105
附錄十一 佛教慈濟醫療財團法人大林慈濟醫院研究倫理委員同意證明 107
附錄十二 問卷使用同意書 109
附錄十三 手術前泌尿道癌症患者各量表與次量表分數間之相關性 113
附錄十四 手術後兩週泌尿道癌症患者各量表與次量表分數間之相關性 116
附錄十五 手術後一個月泌尿道癌症患者各量表與次量表分數間之相關性 118
附錄十六 手術後三個月泌尿道癌症患者各量表與次量表分數間之相關性 121

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