臺灣博碩士論文加值系統

本研究目的為瞭解攝護腺癌病人在接受放射線治療期間和治療後健康相關生活品質的變化、健康照護需求及其滿意度。針對正在接受或已結束放射線治療的攝護腺癌病人進行問卷調查，在2008年3月至6月於北臺灣某醫學中心門診進行收案，共收案174位病人，使用之問卷評估工具包括：歐洲癌症研究與治療組織生活品質核心問卷(the European Organisation for Research and Treatment of Cancer C-30; EORTC QLQ-C30)、攝護腺癌特殊性問卷(EORTC QLQ-PR25)、簡版國際勃起功能量表(international index of erectile function-5; IIEF-5)和健康照護需求問卷。
重要研究結果為：(1)目前醫護人員所提供的照護主要以疾病訊息為主，而照護需求落差最高的則是心理社會靈性需求；病人最希望得到的照護需求項目為飲食衛教、協助溝通與諮詢及生理不適症狀的處置。(2)與放射線治療結束後病人相比，放射線治療期間病人的情緒功能較低、疲倦感、失眠、泌尿道症狀和荷爾蒙治療相關症狀較嚴重。(3)整體性健康生活品質的重要預測因子有泌尿道症狀、疲倦感、經濟狀況、自覺缺乏男人味的程度、慢性病數目、角色功能、社會支持來源，解釋力為45.4%。(4)健康照護需求滿意度的重要預測因子為生理症狀、心理社會靈性和疾病訊息需求落差、腹瀉、疼痛及第一級長期腸道反應，其解釋力為61.2%。(5) 醫護人員較少主動給予性生活相關衛教，病人對於性相關衛教的滿意度相對較低，目前仍維持性生活的病人比例僅有10.3%，病人自覺缺乏男人味的程度偏高。
本研究結果期望能促使醫護人員主動提供飲食和性功能的衛教、心理社會靈性的支持、疲倦及泌尿道症狀的緩解，以降低病人的照護需求落差，以提升病人的生活品質及對於照護需求的滿意程度。

The purpose of this study was to explore the quality of life, health-care needs, and health-care satisfaction of prostate cancer patients undergoing radiotherapy. The study involved 174 subjects at a medical center in northern Taiwan. Four data-collection instruments were used: the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC PR-25, international index of erectile function-5 (IIEF-5), and a health-care needs questionnaire.
The results were as follows: (1) The greatest unmet health-care needs were psychosocial and spiritual. In addition, patients expressed a need for health education regarding diet. They also needed assistance with communication with health-care professionals and management of physical symptoms. (2) Patients who were undergoing radiation treatment had poorer emotional functioning and worse fatigue, insomnia, urinary symptoms, and hormonal treatment-related symptoms than those who had completed radiation treatment. (3) Health-related quality of life was affected by urinary symptoms, fatigue, financial problems, reduced feelings of masculinity, chronic disease numbers, and lower levels of role functioning and social support (adjusted R2 = 0.454). (4) Health-care satisfaction was lower when subjects had more unmet health-care needs, diarrhea, chronic bowel reaction to radiation, and pain (adjusted R2 = 0.612). (5) Only 10.3% of subjects reported sexual activity within the preceding 4 weeks. Most patients felt less masculine as a result of their illness or treatment. Health-care professionals seldom initiated sexual health education, and the level of satisfaction with sexual health education was low.
The findings of this study indicate that medical staff members should provide more health education regarding diet and sexual activity, offer more psychosocial and spiritual support, and better manage fatigue and urinary symptoms in patients with prostate cancer. Reducing the level of unmet needs would improve patients’ quality of life and increase their health-care satisfaction.

口試委員會審定書 i
誌謝 ii
中文摘要 iii
英文摘要 iv
目錄 vi
圖目錄 ix
表目錄 x
第一章 緒論
第一節 研究動機 1
第二節 研究目的 3
第三節 名詞定義 4
第二章 文獻探討
第一節 攝護腺癌 5
一、攝護腺癌的發生率及危險因子 5
二、攝護腺癌診斷及分期 5
三、攝護腺癌的治療方式 6
第二節 攝護腺癌的放射線治療 8
一、體外放射線治療 8
二、體內放射線治療 12
三、治療效果 12
第三節 健康照護需求 14
一、需求定義及分類 14
二、健康照護需求的定義及分類 15
三、健康照護需求現況 16
第四節 健康相關生活品質 19
一、生活品質概念 19
二、健康相關生活品質概念 23
三、攝護腺癌病人健康相關生活品質的現況 30
第三章 研究方法
第一節 研究架構 36
第二節 研究設計 38
一、選樣條件 38
二、分組 38
第三節 研究工具 39
一、基本資料 39
二、健康相關生活品質問卷 39
三、簡版國際勃起功能量表 40
四、健康照護需求問卷 40
第四節 資料收集過程 43
第五節 資料分析 44
一、描述性統計 44
二、推論性統計 44
第六節 研究倫理考量 45
一、自主(Autonomy) 45
二、隱私(Confidentiality) 45
三、利益不傷害(Beneficence/Non-maleficence) 45
第四章 結果
第一節 受試者基本資料 46
第二節 健康照護需求、滿意度及生活品質現況 51
一、健康相關生活品質現況 51
二、健康照護需求現況 55
第三節 不同治療時期病人之生活品質與健康照護需求 67
一、健康相關生活品質 67
二、健康照護需求及滿意度 70
三、放射線治療治療前後生活品質與健康照護需求的變化 72
四、本研究病人的生活品質與EORTC參考組相較之差異 74
第四節 健康照護需求落差、滿意度與生活品質間的相關性 75
一、健康照護需求程度、協助程度、需求落差與滿意度間的相關性 75
二、照護需求、協助程度、需求落差、滿意度與生活品質間的相關性 77
第五節 健康相關生活品質與健康照護需求滿意度的相關因素 80
一、整體性健康相關生活品質之相關因素 80
二、身體功能程度之相關因素 81
三、症狀程度之相關因素 84
四、健康照護需求滿意度之影響因素 86
第六節 性生活現況與影響因素 87
一、性生活現況 87
二、性生活衛教需求 91
第五章 討論
第一節 健康相關生活品質之重要預測因子 92
第二節 健康照護需求滿意度之重要預測因子 95
第三節 放射線治療對性生活的影響 98
第六章 結論與建議
第一節 結論 100
第二節 護理應用與限制 101
第三節 研究限制 103
參考文獻
中文文獻 104
英文文獻 106
附錄
附錄一 個人基本資料及疾病、治療資料 111
附錄二 EORTC QLQ-C30問卷 113
附錄三 EORTC QLQ-PR25問卷 115
附錄四 簡版國際勃起功能量表( IIEF-5) 117
附錄五 健康照護需求問卷 118
附錄六 EORTC QLQ-C30問卷使用同意書 121
附錄七 EORTC QLQ-PR25問卷使用同意書 122
附錄八 健康照護需求問卷專家效度名單 124
附錄九 臺大醫院研究倫理委員會審查同意書 125

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