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研究生:林冠芸
研究生(外文):Kuan-Yuen Lin
論文名稱:甲狀腺癌病人術後工作衝擊探討
論文名稱(外文):Perceived Impacts on Employment in Operable Thyroid Cancer Patients
指導教授:賴裕和賴裕和引用關係
指導教授(外文):Yeur-Hur Lai
口試委員:陳坤源吳明勳張皓媛
口試委員(外文):Kuen-Yuan Chenwu larryHao-Yuan Chang
口試日期:2020-12-30
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2021
畢業學年度:109
語文別:中文
論文頁數:76
中文關鍵詞:甲狀腺癌症工作衝擊症狀焦慮憂鬱疲憊
外文關鍵詞:Thyroid CancerWork ImpactSymptomsAnxietyDepressionFatigue
DOI:10.6342/NTU202100213
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甲狀腺癌為台灣十大癌症之一,甲狀腺癌五年相對存活率高達98.3%,其中分化型的病人占95%為大宗,近年死亡率下降,發生率卻升高,且發生的年齡大多處於工作的年紀,而且大多數病人會面臨疾病及治療對工作造成的衝擊,然而目前針對這群甲狀腺癌病患工作衝擊之干擾因子的相關研究缺乏。本研究目的為(1)了解甲狀腺癌病人術後返回職場比率(2)了解甲狀腺癌對病人工作衝擊程度(3)探討甲狀腺癌症病人術後疲憊、憂鬱、焦慮、症狀嚴重度(4)探討甲狀腺癌病人術後疲憊、憂鬱、焦慮、症狀嚴重度、重要人口學特質、疾病治療特質與工作衝擊程度的相關性。本研究方法採橫斷式研究設計,收集155個病人於病人手術後三年內在門診進行收案及評估,並以結構式問卷蒐集資料,問卷內容包含返回職場障礙量表(Illness Perceptions Questionnaire)、醫院焦慮憂鬱量表(Hospital Anxiety and Depression Scale)、疲倦症狀評估量表(Fatigue symptom Inventory)、症狀嚴重程度量表(Symptom Severity Scale)和疾病基本資料表,收集之資料以敘述性統計、斯皮爾曼相關係數檢定、無母數統計和複回歸進行分析。本研究結果顯示甲狀腺術後病人有12%病人未返回職場,而正在工作的病人79.9%覺得受到影響,但衝擊程度為輕度,其中五項超過一半以上人會面臨的工作衝擊因素依序為(1)認為癌症及治療不可預測影響工作(70%);(2)癌症及治療導致有情緒的痛苦(62.7%);(3)因癌症及治療有疲倦或感覺精疲力盡(61%);(4)認為癌症及治療導致專注力下降(54.4%);(5)認為癌症及其治療導致有身體症狀(50.7%)。另外工作衝擊程度與性別與教育程度、疲倦程度、疲倦干擾程度、焦慮、憂鬱、症狀嚴重度相關,而工作衝擊程度主要的相關因子為症狀嚴重度(β=0.44, p<0.00)、疲勞程度(β=0.18, p<0.01)、焦慮(β=0.32, p<0.00),R2=0.61。整體而言甲狀腺癌症病人雖然工作衝擊程度較其他癌症別低,但仍有部分病人呈現中高度工作衝擊程度、焦慮、憂鬱和疲倦問題,建議未來門診篩檢針對這些病人,發展進一步的介入措施,讓病人順利維持工作。
Thyroid cancer is one of the top ten cancer in Taiwan. The 5-year survival of thyroid cancer is >98%. Differentiated thyroid cancer, which includes papillary and follicular histologies, is the most common type of thyroid cancer. It is increasing in incidence and is decreasing in mortality rate. The age of diagnosis of thyroid cancer is during working age. Many patients might face the impacts on employment because of the disease and its treatments. The purposes of this study are (1)recognizing how many thyroid patients return to work after operation. (2)recognizing the impacts on work in thyroid cancer (3) exploring fatigue, depression, anxiety, level of symptoms in thyroid cancer after operation (4)exploring the correlation between the work impacts and fatigue, depression, anxiety, level of symptom, demography, disease information. This study is cross-sectional study. We collected 155 patients who completed thyroidectomy within three years at outpatient clinic in a teaching hospital in Taipei. Patients completed a questionnaire including Illness Perceptions Questionnaire, Hospital Anxiety and Depression Scale, Fatigue symptom Inventory, Symptom Severity Scale and diseases information questionnaire. We analyzed data by Mann-Whitney U test, Kruskal Wallis test, Spearman's rank correlation coefficient, Descriptive Statistics, multiple linear regression. Results shows that 79.9% thyroid cancer patients post operated and employed at time of study‐entry were influenced but the level was light. The top five factors which let over half people might be impacted at work are as follows. (1)Unpredictability of cancer(70%) (2)Emotional distress(62.7%) (3) Fatigue(61%) (4) Lower concentration(54.4%) (5) Physical symptoms(50.7%). The correlation factors of work impacts are gender, fatigue interference, fatigue severity, anxiety, depression, symptoms severity. The main correlation factors is symptoms level (β=0.44, p<0.00)、fatigue severity (β=0.18, p<0.01)、anxiety (β=0.32, p<0.00), R2=0.61. In conclude, work impacts of thyroid patients are lighter than other cancer but some of them are median to moderate level of work impacts, anxiety, depression and fatigue. We suggest that we can develop interventions to help those patients to keep working.
口試委員會審定書 I
謝辭 II
中文摘要 III
英文摘要 V
第一章 緒論 1
第一節 研究背景及重要性 1
第二節 研究目的 3
第二章 相關文獻查證 4
第一節 甲狀腺癌之疾病簡介 4
第二節甲狀腺癌對病人造成的身心衝擊 8
第三節 癌症存活者工作衝擊及相關因素 12
第三章 研究方法 16
第一節 研究設計 16
第二節 研究假說 17
第三節 操作型定義與研究架構 18
第四節 研究工具 20
第五節 研究步驟 23
第六節 資料分析與處理 24
第七節 研究倫理考量 25
第四章 結果分析 26
第一節 返回職場比率及無返回職場病人之生理、心理現況 26
第二節 返回職場病人人口學特性及疾病治療特性現況分析 27
第三節 返回職場病人工作衝擊程度現況分析 28
第四節 返回職場病人生理問題現況分析 29
第五節 返回職場病人心理問題現況分析 30
第六節 返回職場病人工作衝擊與相關因素分析 31
第七節 返回職場及沒有返回職場的病人性質及生理心理狀況比較 32
第五章 討論 33
第一節 工作衝擊程度現況探討 33
第二節 工作衝擊程度相關因素 34
第六章 結論與研究限制 38
第一節 結論 38
第二節 研究限制 39
第三節 建議 40
第六章 參考資料 41
附錄及表格 61
表一、人口學特性 61
表二、疾病治療特性 63
表三、返回職場衝擊量表 64
表四、症狀嚴重度量表 65
表五、HADS醫院焦慮憂鬱量表結果 66
表六、疲倦量表分析 67
表七、返回職場衝擊程度與人口學、疾病診斷與治療之相關性 68
表八、返回職場衝擊程度與疲倦、焦慮、憂鬱、症狀嚴重度之相關性 70
表九、返回職場衝擊預測因子 71
表十 有無返回職場病人生理心理問題比較 72
附錄一、AJCC分期內容及其預期十年疾病存活率 73
附錄二、依據腫瘤清犯位置選擇手術方式 75
附錄三、淋巴結廓清術使用時機 76
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