臺灣博碩士論文加值系統

癌症青少年與青年同時面對身體發展、疾病症狀等問題，復原力為面對重大壓力源的適應過程，疾病復原力模式已確認癌症青少年與青年復原力的影響因子，若症狀困擾能獲得緩解，則有助於癌症青少年與青年正向調適癌症造成的衝擊，因此，依據不愉快症狀理論設計整合照護，從生理、心理、與情境方面處理症狀困擾，並以知覺壓力、家庭支持、復原力、症狀困擾量表以及心率變異量評值整合照護的成效。
本研究採單組前後測設計，方便取樣年齡介於13-25歲，正在接受化學治療的癌症青少年與青年，前一段化學治療期間先作為對照期，給予常規照護，下一段化療期間作為實驗期，除常規照護外，另給予4天每日30分鐘之整合照護。問卷收集的時間分別為二段療程之化療前(T1、T4)、化療後4天(T2、T5)、化療後15天(T3、T6)。
本研究共收案26人，其中有3名個案因病情變化退出研究，僅有對照期資料進行分析。年齡為13-23歲(17.2±2.8)，69.23%為骨肉瘤。研究結果發現化學治療期間之癌症青少年與青年，二段化學治療之症狀困擾程度皆於化療後第4天呈現較高分，復原力、心率變異量則無明顯趨勢。復原力與家庭支持有正相關(r=.428, p<.001)，癌症青少年與青年之安德森癌症症狀量表(MDASI)分數方面，於化療後第4天，T2對照期(M=63.92, SD=33.63)較T5實驗期(M=55.61, SD=41.16)之分數為高，且達顯著差異(p=.03)；於化療後第15天，T3對照期(M=53.92, SD=32.17)也較T6實驗期(M=39.00, SD=31.36)之分數為高且有顯著差異(p=.04)。此外，家庭支持低分組於整合照護介入後，顯著提升復原力之程度，建議未來發展癌症青少年與青年的照護措施，可由減輕自覺症狀及提升其家庭支持度著手，藉以提升復原力。

Adolescents and young adults (AYA) experience more health problems, such as difficulties with developmental tasks and symptom distress, than do adults while suffering from cancer. Resilience is defined as the process of adapting well in the face of substantial stress. The Resilience in Illness Model (RIM) has confirmed the main factors contributing to resilience among AYA with cancer. If symptoms can be relieved, this process will contribute to helping AYA make positive adjustments to cancer. We designed an integrative nursing program for promoting resilience based on the theory of unpleasant symptoms to help the AYA deal with the physical, psychological, and situational problems associated with chemotherapy side effects. The effectiveness of integrative nursing was determined by inventories, including Perceived Stress Scale (PSS), Perceived Social Support from Families (PSS-Fa), Haase Adolescent Resilience in Illness Scale (HARIS), M.D. Anderson Symptom Inventory (MDASI), Symptom Distress Scale (SDS), and heart rate variability (HRV).
A pre/post design with convenience sampling was used. AYA aged 13 to 25 years who were undergoing chemotherapy were recruited. All participants completed a 15-day baseline observation period followed by a 15-day intervention phase. During the intervention phase, the integrative nursing was delivered. It consisted of 30-min interview over four days. AYA completed questionnaires at 6 time points: before the start of chemotherapy (T1 and T4)、the fourth day after chemotherapy (T2 and T5), and the 15th day after chemotherapy (T3 and T6).
In this study, we recruited 26 participants for the study (14 males), aged from 13 to 23 years (17.2 ± 2.8), and 69.23% of participants had osteosarcoma. However, three participants dropped out of the study during the observational period due to an unexpected worsening of their conditions. The results showed that the graph of MDASI resembled a reverse V shape, and no statistically significant differences in HARIS and HRV between phases were detected. HARIS was positively related to PSS-Fa (r=.428, p<.001). A significant difference between MDASI on the fourth day after chemotherapy (T2 observation period M=63.92, SD=33.63；T5 intervention phase M=55.61, SD=41.16；p=.03) and the 15th day after chemotherapy (T3 observation period M=53.92, SD=32.17；T6 intervention phase M=39.00, SD=31.36；p=.04). Furthermore, after receiving the integrative nursing, the lower family supports were perceived by participants, and the higher level of resilience the participants had.
These results suggest that healthcare professionals could foster resilience in AYA who are undergoing chemotherapy by strengthening the family support system and appropriately managing their stress. Additionally, further nursing interventions for promoting resilience in AYA with cancer should be designed.

正文目錄 I
圖目錄 III
表目錄 IV
附錄目錄 V
摘要 1
ABSTRACT 3
第一章 緒論 6
第一節 研究動機及重要性 6
第二節 研究目的 8
第三節 研究假設 9
第四節名詞定義 10
第二章 文獻查證 13
第一節 癌症對青少年與青年的影響 13
壹、青少年與青年的發展 13
貳、癌症對青少年與青年的影響 14
第二節 癌症青少年與青年的復原力 23
壹、復原力的定義 23
貳、復原力的相關理論 26
參、復原力相關研究 27
肆、疾病復原力理論 28
第三節 整合照護 31
第三章 研究方法 34
第一節 研究設計 34
第二節 研究對象與收案條件 38
壹、收案條件 38
貳、排除條件 38
第三節 研究工具 39
第四節 研究架構 44
第五節 資料分析 46
第六節 研究倫理 48
第四章 研究結果 49
第一節 研究對象基本資料分析 50
第二節 MDASI、SDS量表的分數分佈 52
第三節 癌症青少年與青年復原力的相關因子 60
第四節 整合照護之成效 63
壹、癌症青少年與青年整合照護內容 63
貳、整合照護前後復原力之差異 66
參、整合照護前後心率變異量之差異 72
肆、小結 76
第五章 討論 78
第一節 癌症對青少年及青年的影響 78
第二節 癌症青少年與青年復原力的影響因素 81
第三節 提升癌症青少年與青年之復原力 82
第六章 研究限制 85
第七章 結論與建議 86
第八章 參考文獻 89

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