臺灣博碩士論文加值系統

背景與目的：大腸直腸癌在全球癌症發生率排名第三，台灣發生率也逐步升高，若有足夠的健康識能可以在早期時發現癌症，進而能減少因晚期癌症所面對的手術、人工肛門及化學治療等治療不適所造成的失志情緒，並維持生活品質。因此本研究將探討大腸直腸癌人口學、失志、健康識能、生活品質等相關性。

方法：採橫斷性研究方便取樣於南部某區域教學醫院，以結構式問卷為工具，包括：「中文版失志量表」、「中文多面向健康識能量表」、「歐洲生活品質結腸與直腸癌問卷」，資料以SPSS26.0軟體進行統計分析，透過次數分布、平均數、百分比、標準差描述變項分佈，使用獨立樣本T檢定、單因子變異數分析、皮爾森積差相關分析變項間的關係，並用多元線性迴歸分析探討健康識能之預測因子。

結果：本研究共收案153名符合收案之大腸直腸癌病人，研究結果平均年齡為62.57歲，男性佔52.3%，女性佔47.7%，其失志和健康識能呈顯著負相關(p=.00)，失志和生活品質呈顯著正相關(p=.00)，而健康識能與生活品質並無顯著相關。大腸直腸癌病人之基本人口學中有無工作、年紀、學歷、年收入對於失志、健康識能與生活品質均呈顯著性相關(p<.05)。且在預測因子得出年齡及學歷對健康識能有預測力的，其總解釋變異量21.7%。

討論與結論：從研究結果得知失志與健康識能中的理解、溝通與互動、獲取健康資訊時呈負相關，當健康識能之能力越下降時失志程度越高。若能增加年輕且有基本學歷的民眾進行大腸直腸癌的疾病了解及篩檢參與率，有症狀時盡早治療，能更完善接受醫療照護，方能降低失志及提升生活品質。

Background and Purpose: Colorectal cancer ranks third in the global cancer incidence rate, and the incidence rate in Taiwan is also gradually increasing. If there is sufficient health literacy, cancer can be detected at an early stage, which in turn can minimize the demoralization caused by the discomfort of treatment such as surgery, artificial anus, and chemotherapy faced by advanced cancer, and maintain the quality of life. Therefore, this study will investigate the correlation between demographics of colorectal cancer, demoralization, health literacy, and quality of life.

Methods: A cross-sectional study was conducted with convenient sampling at a teaching hospital in southern Taiwan. Structured questionnaires were utilized, including the DemoralizationScale Mandarin Version(DS-MV), the Mandarin Multidimensional Health Literacy Questionnaire (MMHLQ), and the European Organization for Research and Treatment of Cancer(EORTC)QLQ-CR29. Data were analyzed using SPSS 26.0 software, employing descriptive statistics such as frequency distribution, mean, percentage, and standard deviation. Relationships between variables were examined using independent sample t-tests, one-way analysis of variance, Pearson correlation analysis, and multiple linear regression analysis to explore predictors of health literacy.

Results: This study included a total of 153 eligible colorectal cancer patients. The average age of the participants was 62.57 years, with 52.3% being male and 47.7% female. There was a significant negative correlation between demoralization and health literacy (p = .00), a significant positive correlation between demoralization and quality of life (p = .00), and no significant correlation between health literacy and quality of life. Among the demographic characteristics of colorectal cancer patients, employment status, age, education level, and annual income were significantly correlated with demoralization, health literacy, and quality of life (p < .05). Additionally, in the predictor analysis, age and education level were found to be predictors of health literacy,the total explained variance is 21.7%

Discussion and Conclusion: According to the results of the study, it was found that there is a negative correlation between demoralization and health literacy in terms of understanding, communication and interaction, and access to health information, and the degree of demoralization is higher when health literacy decreases. If we can increase the participation rate of young people with basic education in understanding and screening for colorectal cancer, so that they can be treated as soon as possible when they have symptoms, and receive better medical care, we will be able to lower the level of demoralization and improve the quality of life.

目錄
誌謝 i
中文摘要 ii
Abstract iv
目錄 vii
表目錄 x
圖目錄 xii
第一章 緒論 1
第一節 研究背景與現況 1
第二節 研究動機與重要性 2
第三節 研究問題 4
第四節 名詞解釋 4
第二章 文獻查證 7
第一節 大腸直腸癌症之現況概述 7
第二節 失志之概念與相關研究 11
一、失志(Demoralization)概念之定義及重要性 11
二、失志之測量工具 14
三、失志與大腸直腸癌症相關性 17
第三節 健康識能之概念與相關研究 21
一、健康識能（Health literacy）概念之定義及重要性 21
二、健康識能之測量工具 26
三、健康識能與大腸直腸癌症相關性 28
第四節 生活品質之概念 32
一、生活品質（Quality of life）概念之定義及重要性 32
二、生活品質之測量工具 34
三、生活品質與大腸直腸癌相關性 36
第五節 失志、健康識能與生活品質相關性 39
一、失志和健康識能相關性 39
二、失志和生活品質相關性 40
三、健康識能和生活品質相關性 42
第三章 研究方法 45
第一節 研究設計 45
第二節 研究架構 46
第三節 研究對象及場域與樣本數 47
第四節 研究工具與信效度檢定 48
第五節 研究步驟 57
第六節 研究倫理考量 58
第七節 研究假設及統計分析方法 58
第四章 研究結果 61
第一節　大腸直腸癌病人的基本人口學現況 61
第二節　大腸直腸癌症病人的失志、健康識能及生活品質之現況 66
第三節　大腸直腸癌症病人的失志、健康識能及生活品質之相關性 81
第四節　大腸直腸癌病人人口學在失志、健康識能及生活品質之相關 85
第五節　大腸直腸癌病人基本人口學對健康識能之預測力 113
第五章 討論與結論 118
第一節　大腸直腸癌病人之基本人口學背景分析 118
第二節　大腸直腸癌症病人之失志、健康識能及生活品質探討及分析 119
第三節　大腸直腸癌病人之人口學在失志、健康識能及生活品質探討及分析 123
第四節　健康識能的預測因子 125
第五節　結論 127
一、失志與健康識能 127
二、生活品質對失志與健康識能 127
三、人口學對失志、健康識能及生活品質的影響 127
四、健康識能的預測因子 128
第六節　研究限制 129
一、研究對象 129
二、研究資料收集過程 129
三、研究設計 130
第七節　研究建議 130
一、臨床實務之建議 130
二、教育訓練之建議 131
三、未來護理研究建議 131
參考文獻 133
附錄一 基本資料 154
附錄二 中文失志量表 155
附錄三 中文多面向健康識能量表 157
附錄四 EORTC QLQ-CR29台灣中文版 158
附錄五 中文失志量表量表授權同意書 160
附錄六 中文多面向健康識能量表（MMHLQ）授權同意書 161
附錄七 EORTC QLQ-CR29台灣中文版量表授權同意書 162
附錄八 人體研究倫理審查通過證明 163


表目錄
表一 AJCC大腸直腸癌分期 10
表二 失志各年代定義 13
表三 失志測量工具統整表 16
表四 失志相關性研究 19
表五 健康識能各年代定義 24
表六 健康識能測量工具統整表 27
表七 健康識能相關研究 31
表八 生活品質測量工具統整表 35
表九 生活品質相關研究 38
表十 描述性研究問題及統計方法 59
表十一 推論性統計研究問題及統計方法 59
表十二 基本人口學屬性表（N=153） 64
表十三 失志評分量表總分與各因素之相關性 68
表十四 失志評估量表總分及次量表現況 69
表十五　健康識能評分量表總分與各因素之相關性 74
表十六 健康識能評估量表總分及次量表現況 75
表十七 生活品質評分量表總分與各因素之相關性 78
表十八 生活品質量表總分及次量表現況 79
表十九 失志與健康識能之相關性(N=153) 82
表二十 失志與生活品質相關性(N=153) 83
表二十一 健康識能與生活品質相關性(N=153) 84
表二十二 性別與失志、健康識能及生活品質之T檢定(N=153) 90
表二十三 婚姻狀態與失志、健康識能及生活品質之T檢定(N=153) 92
表二十四 有無子女與失志、健康識能及生活品質之T檢定(N=153) 94
表二十五 有無與家人同住與失志、健康識能及生活品質之T檢定(N=153) 96
表二十六 有無工作與失志、健康識能及生活品質之T檢定(N=153) 98
表二十七 宗教信仰與失志、健康識能及生活品質之T檢定（N=153) 100
表二十八 年齡與失志、健康識能及生活品質之變異數分析(N=153) 102
表二十九 學歷與失志、健康識能及生活品質之變異數分析(N=153) 104
表三十 年收入與失志、健康識能及生活品質之變異數分析(N=153) 106
表三十一 癌症部位與失志、健康識能及生活品質之變異數分析(N=153) 108
表三十二 癌症期別與失志、健康識能及生活品質之變異數分析(N=153) 110
表三十三 模型摘要 115
表三十四 健康識能多元線性迴歸分析 115
表 三十五 健康識能逐步迴歸分析 117
 

圖目錄
圖 一研究架構 46
圖 二研究步驟 57


 

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