臺灣博碩士論文加值系統

背景與目的：惡性腫瘤居國人死因首位，接受化學治療者常有疲憊、情緒困擾及認知下降問題，但三者之間的相關性及對首次接受化學治療者的影響，缺乏探討。本研究旨在探討癌症患者首次接受化學治療後的疲憊感受、情緒困擾及認知表現的相關性及影響因素。
研究方法：採橫斷式描述相關研究設計，以立意取樣選取台灣基隆地區某教學醫院120位首次接受化學治療的癌症患者為研究對象，運用「人口學資料表」、「台灣版簡明疲憊量表」、「中文簡明版情緒困擾量表」及「中文版癌症治療認知功能評估表」等結構式問卷收集資料，再以SPSS for Windows 22.0版統計套裝軟體進行描述性統計、皮爾森積差相關係數分析、獨立樣本t檢定、單因子變異數分析、卡方檢定及多元迴歸分析。
研究結果：(1) 90.8%首次接受化療者，會出現疲憊感受，疲憊強度偏向中度，並且輕度的干擾日常生活；首次接受化療者有中度情緒困擾，尤以緊張－焦慮層面為主，認知障礙發生率約為17.5%，屬輕度障礙，以專注力的影響最為顯著。(2)疲憊感受與情緒困擾呈現顯著正相關(p< .001)，疲憊感受、情緒困擾皆與認知表現之間呈現顯著負相關(p< .001)。(3)不同的年齡、教育程度、婚姻狀況、職業狀況、平均月收入、癌症診斷及化療藥物使用等因子，在疲憊感受、情緒困擾及認知表現上有出現顯著差異性。(4)經逐步迴歸分析發現，疲憊感受影響因子為情緒困擾及Alkylating agents藥物治療，情緒困擾影響因子為疲憊感受及認知表現，認知表現之影響因子為情緒困擾、下消化道癌及婚姻狀況，其可解釋變異量分別為35%、45%及40%。
結論與實務應用：本研究發現癌患於首次接受化療後，易有偏中度疲憊感受、中度情緒困擾及輕度認知表現障礙，三者之間存有相關性且有多項影響因子。依據研究結果，建議腫瘤照護單位應及早設立共同評估指引，以利早期發現並追蹤問題。此外，本研究亦建議照顧首次接受化療患者時，應落實能量保存策略以改善其疲憊、加強化療前期衛教說明以降低焦慮，並提供專注力評估與簡潔具體的溝通方式以因應認知上的變化，進而提升癌症患者的照護品質。

Background and Purpose: Malignant tumors are the leading cause of death in Taiwan. While these tumors are usually treated with chemotherapy, most people undergoing chemotherapy treatment often suffer from fatigue, emotional distress and cognitive decline. Noticeably, there is a dearth of discussion on the impact of and correlation among fatigue, emotional distress and cognitive decline in those undergoing chemotherapy for the first time. This study aimed to explore the influencing factors of fatigue, emotional distress and cognitive performance in cancer patients after their first chemotherapy. It also aimed to explore the correlation among these factors.
Research Method: A descriptive cross-sectional research design was adopted, and 120 cancer patients who received their first chemotherapy at a teaching hospital in Keelung, Taiwan were selected as the research subjects. The “Demographic Data Sheet”, “Brief Fatigue Inventory-Taiwan Form”, “Profile of Mood States-Chinese Version” and “Functional Assessment of Cancer Therapy-Cognitive Function – Chinese Version” and other structured questionnaires were distributed to collect data. SPSS for Windows 22.0 statistical software package was used for descriptive statistics, Pearson product difference correlation coefficient analysis, independent sample t test, one-way ANOVA, chi-square test and multiple regression analysis.
Research Results: (1) 90.8% of those experienced fatigue, with a moderate fatigue intensity and mild interference in daily life, after their first chemotherapy. The subjects also experienced moderate emotional distress, mainly in relation to tension-anxiety. The incidence of cognitive impairment was 17.5%, which was a mild disorder, and the treatment’s effect on concentration was the most significant. (2) Fatigue was significantly positively correlated to emotional distress (p<.001), and there was a significant negative correlation between fatigue and emotional distress with cognitive performance (p<.001). (3) Factors such as age, educational level, marital status, occupational status, average monthly income, cancer diagnosis and chemotherapy drug use, among others, had significant differences in fatigue, emotional distress and cognitive performance. (4) The stepwise regression analysis showed that the influencing factors of fatigue were emotional distress and Alkylating agents drug treatment; and the influencing factors of emotional distress were fatigue and cognitive performance. The influencing factors of cognitive performance were emotional distress, lower gastrointestinal cancer and marital status; their explainable variances were 35%, 45% and 40%, respectively.
Conclusion and practical application: This study found that after their first chemotherapy, cancer patients tended to feel moderate fatigue and moderate emotional distress. They also had mild cognitive performance impairment. There were correlations among the three and there were multiple influencing factors for these effects. Based on the research results, it is recommended that, to improve the quality of care for cancer patients, cancer care units should establish joint assessment guidelines as soon as possible to facilitate early detection and tracking of side effects. In addition, this study suggests that when caring for patients undergoing chemotherapy for the first time, energy conservation strategies should be implemented to improve fatigue. Also, preliminary chemotherapy health education instructions should be strengthened to reduce anxiety. Furthermore, concentration assessment as well as concise and specific communication methods should be provided to respond to patients’ cognitive changes.

中文摘要 I
英文摘要 III
誌謝 V
目錄 VI
表目錄 VIII
圖目錄 IX

第一章 緒論 1
第一節 研究動機與重要性 1
第二節 研究目的 2
第三節 研究問題 2
第四節 研究假設 2
第五節 名詞解釋 3

第二章 文獻查證 4
第一節 癌因性疲憊介紹與影響因素 4
第二節 化學治療造成的情緒困擾探討 9
第三節 化學治療對認知表現上的影響分析 11
第四節 研究架構 14

第三章 研究方法 15
第一節 研究設計 15
第二節 研究對象與場所 15
第三節 研究工具與信效度 15
第四節 資料收集過程及研究倫理考量 19
第五節 資料統計與分析 21

第四章 研究結果 22
第一節 癌症患者首次接受化學治療後之人口學資料分析 22
第二節 癌症患者首次接受化學治療後的疲憊感受、情緒困擾及認知表現之現況 25
第三節 癌症患者首次接受化學治療後的疲憊感受、情緒困擾及認知表現之相關性 33
第四節 癌症患者首次接受化學治療後的人口學資料在疲憊感受、情緒困擾及認知表現之差異 36
第五節 癌症患者首次接受化學治療後的疲憊感受、情緒困擾與認知表現之迴歸分析 46
第六節 研究假設驗證 48

第五章 討論 49
第一節 癌症患者首次接受化學治療後之人口學資料 49
第二節 癌症患者首次接受化學治療後的疲憊感受、情緒困擾及認知表現之現況 50
第三節 癌症患者首次接受化學治療後的疲憊感受、情緒困擾及認知表現之相關性 54
第四節 癌症患者首次接受化學治療後的人口學資料在疲憊感受、情緒困擾及認知表現之差異 55
第五節 癌症患者首次接受化學治療後的疲憊感受、情緒困擾與認知表現之迴歸分析探討 58

第六章 結論與建議 60
第一節 結論 60
第二節 研究限制及建議 61

參考文獻 63
一、中文文獻 63
二、英文文獻 68

附錄 78
附錄一 台灣版簡明疲憊量表之授權同意書 78
附錄二 中文版簡明版情緒困擾量表之授權同意書 79
附錄三 中文版癌症治療認知功能評估表之授權同意書 80
附錄四 長庚醫院人體試驗倫理委員會臨床研究同意證明書 82
附錄五 癌症患者首次接受化學治療人口學資料在疲憊感受、情緒困擾及認知表現之差異(總分析結果) 83
附錄六 文獻相似度檢測分析報告 98

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