臺灣博碩士論文加值系統

惡性腫瘤連續33年為十大死因之首，其中口腔癌發生率逐年上升，平均死亡年齡為55-56歲，與其他癌症患者平均死亡年齡相較下提早10年，是一個需要重視之疾病。而口腔癌的治療以手術為主，病患在罹病過程中除了面對不同程度上的治療合併症，同時也必須面對心理不確定感等。國內外研究發現口腔癌術後患者在健康訊息方面的需求最高，其中又以治療相關訊息為主，最常見訊息來源為醫護人員。當訊息需求被滿足時，可有效降低對於未知事件的焦慮及不安。由於國內外較少針對口腔癌術後治療給予可及性、便利性之衛教，因此本研究目的主要在探討提供APP衛教介入後對口腔癌術後病患需求及生活品質之改善成效。
本研究採類實驗型研究設計，使用方便取樣，自2017年1月1日至12月31日於新北市某醫學中心口腔外科及耳鼻喉科病房取得符合條件且同意參與之口腔癌術後患者納入為研究對象，以APP介入資訊衛教措施後3個月回診再以自填結構性問卷收集資料，問卷包括個人基本屬性資料、癌症需求量表短版（CNQ-SF）、頭頸癌生活品質量表（EORTC QLQ-H&N35）以及科技接受模式（Technology Acceptance Model, TAM），並將結果進行統計分析，了解各變項之分布情形以及影響關係。
研究結果：1.實驗組口腔癌患者接受APP介入後生活品質較介入前提升，但實驗組與對照組無統計上顯著差異。2.照護需求方面生活日常需求、心理層面需求、人際溝通需求及照護支持需求有顯著性下降，但對於健康訊息需求無顯著性差異。3.病患接受APP介入後提升APP使用意向，並達統計上顯著差異。
探討口腔癌術後患者以APP衛教介入術後需求及生活品質之成效，期望能提升口腔癌術後病患的生活品質及照護需求，並將其研究結果提供醫護人員術後照護之參考。

The malignant tumor has been consecutively ranked as number one of the top ten causes of death over the past 33 years, and the incidence of an increase in oral cancer year by year. The average age of death was 55-57. With this average age compared to other cancer patients under 10 years of early life, it’s necessary to care about the burden of disease from oral cancer. The main treatment of oral cancer is surgery and a combination of radiotherapy and chemotherapy. Patients often got severe treatment complications with varying degrees of physical functions and uncertainty due to poor cognition or less clarification in a complex course of treatment that affects medical decisions in the illness process. Both domestic and foreign research show that the majority of oral cancer patients expressed the need for and attention to health information. “Treatment information” was the most needed and important. When information needs are met, it can effectively reduce the anxiety and unease of unknown events. Relevant domestic and foreign research do not provide accessibility and convenience of health education for post-operative patients with oral cancer.
This study aimed to explore using an APP in post oral cancer surgery to affect patients' needs and quality of life.
　Quasi-experimental research design used purposeful sampling from January 1 to December 31 of the Far Eastern Memorial Hospital oral maxillofacial surgery ward and the otolaryngology ward requirement met post-treatment oral cancer patients who agreed to participate. Self-administered structured questionnaires, including basic personal information, cancer needs table short version (CNQ-SF), head and neck cancer quality of life scale (EORTC QLQ-H&N35) and Technology Acceptance Model, TAM were used to collect information. Results were statistically analyzed to understand the distribution of variables and their relationships.
　The study results revealed that there was no statistically significant differences in quality of life by patients between intervention and control group,　However, learning ability and anxiety of two groups were not significantly different.
　Using an APP intervention in post-operative patients with oral cancer may be the better way to promote health and enhance one’s quality of life.

致謝 i
中文摘要 ii
Abstract iv
目錄 vi
第一章 緒論
第一節 研究背景 1
第二節 研究動機與重要性 2
第三節 研究目的 4
第二章 文獻查證
第一節 口腔癌流行病學、分類、治療方式 5
第二節 口腔癌術後相關生活品質之相關研究 14
第三節 健康資訊衛教以行動健康科技方式介入 19
第三章　研究方法
第一節　研究架構 26
第二節　研究問題與假設 27
第三節　研究設計、場所及對象 29
第四節　研究樣本數 30
第五節　名詞界定 30
第六節　研究倫理考量 31
第七節　資料收集過程 32
第八節　研究工具 34
第四章 研究結果
第一節 口腔癌術後患者之人口學變項與疾病相關變項 38
第二節 口腔癌術後生活品質描述分析 41
第三節 口腔癌術後照護需求描述分析 46
第四節 口腔癌術後生活品質與照護需求綜合分析 57
第五節 APP介入對口腔癌術後使用意向之成效 58
第五章 討論
第一節 口腔癌患者基本屬性及疾病屬性 63
第二節 APP介入對口腔癌病患生活品質之成效 64
第三節　APP介入對口腔癌病患健康照護需求之成效 66
第四節 APP介入對口腔癌病患使用意向 68
第六章 結論與建議
第一節 結論 70
第二節 建議 72
第三節 研究限制 73
參考文獻 74

附錄
附錄一　臨床試驗許可書 88
附錄二　口腔癌APP介面 89
附錄三　個人基本資料問卷 93
附錄四　癌症需求量表（CNQ-SF）96
附錄五　頭頸癌生活品質量表（EORTC QLQ-H&N35） 98
附錄六 科技接受模式量表 100

圖目錄
圖1 口腔癌APP衛教樹狀圖 23
圖2 科技接受模式 25
圖3 研究架構 26
圖4 研究步驟流程圖 33
圖5 CONSORT流程圖 37
圖6 TAM模式之相關性 60
圖6-1中介效果 60

表目錄
表1口腔癌期別 9
表2-1口腔癌術後病患人口學特性 39
表2-2口腔癌術後病患之疾病相關 40
表3-1介入前生活品質量表之描述性分析 41
表3-2介入後生活品質量表之描述性分析 42
表3-3使用APP組在前測及後測之生活品質比較 43
表3-4影響生活品質量表之因素 44
表4-1介入前照護需求指標 46
表4-2 介入後照護需求指標 47
表4-3 APP介入前後對口腔癌術後照護需求之成效 48
表4-4影響生理日常生活需求之因素 50
表4-5影響心理層面需求之因素 51
表4-6影響人際溝通需求之因素 52
表4-7 影響照護支持需求之因素 54
表4-8影響健康訊息需求之因素 55
表5-1 醫療資源使用之描述性分析 58
表5-2介入前APP接受度 59
表5-3介入後APP接受度之描述 59
表5-4 TAM模式之相關性 60
表 5-5-1中介效果 61
表 5-5-2中介效果2 61
表5-6口腔癌APP滿意程度之答題情形 62

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