臺灣博碩士論文加值系統

目的：利用傳統測量與現代測量理論評估歐洲癌症治療與研究組織生活品質核心問卷（EORTC QLQ-C30）與攝護腺癌生活品質問卷（EORTC QLQ-PR25）兩份問卷應用在攝護腺癌（prostate cancer）患者的心理計量特質。
材料與方法：本研究共計收案91名攝護腺癌（prostate cancer）患者，利用傳統測量與項目反應理論（item response theory, IRT）比較分析問卷各題目的特質，以適合度指標（infit statistic）檢驗各向度是否符合單一向度的假設，並檢驗每一題目的難度、門檻值範圍、適中性，以及問卷的信度；然後，再檢驗各題目在治療前後、不同疾病嚴重度或不同年齡族群中之心理計量特質是否相同。
結果：問卷四向度內大多數的題目皆符合單一向度的假設，但題目難度分布的範圍除了性功能範疇稍難以外，其餘範疇題目對本研究之攝護腺癌患者而言均偏簡單而容易達成；問卷並不能有效區分不同疾病嚴重程度的患者，但發現有疼痛問題的患者，其整體生活品質較有影響。問卷詳列範疇平均分數與細項得分有助於提供更多臨床實證。接受根除性手術的患者手術後會產生排尿功能與治療相關的症狀，且身體功能、角色功能、社會功能等範疇等也連帶受影響；而放射治療組僅會發生排尿功能與治療相關的症狀，與治療相關的症狀在治療三個月後回復，而排尿功能則在治療六個月後也回復了；然手術組在這兩項直到治療後6個仍有區辨力。
結論：兩問卷應用在攝護腺癌患者題目難度偏簡單且信度稍弱，與臨床指標的關連性較差，EORTC QLQ-PR25對臨床指標之區辨力較佳；症狀範疇的題目較能區辨反應性，以現代測量理論所估計的EORTC QLQ-C30及EORTC QLQ-PR25各題目難度與攝護腺癌患者健康相關生活品質的分佈情形，將可作為發展短式電腦適性測量的基礎，研究結果亦可提供臨床醫師用於診間診斷時瞭解究竟有哪些題目能夠用來預測攝護腺癌患者在功能及症狀相關之生活品質的改變情形。

Objective: The aim of this study was to apply the classical test theory (CTT) and the modern test theory (MTT) to evaluate the psychometric characteristics of the European Organization for Research and Treatment of Cancer 30-item core quality of life questionnaire (EORTC QLQ C-30) and QLQ-prostate specific 25-item (EORTC QLQ-PR25) module in prostate cancer patients.
Materials and Methods: There were 91 prostate cancer patients included in this study. We analyzed the characteristics of each item of the EORTC QLQ-C30 and EORTC QLQ-PR25 by CTT and IRT (item response theory). The infit statistics of Rasch model was used to examine the unidimensionality of each domain, and also evaluate the item difficulty, the range of item threshold, item targeting and the reliability of the two questionnaires. Furthermore, patients were measured before therapy and at 1, 3 and 6 months after the start of therapy and then compared each health-related quality of life (HRQoL) score of the post-therapy groups with the baseline scores. Finally, the item psychometric properties were examined for different groups stratified by age and disease severity.
Results: Most of the items within each domain fitted the assumption of unidimensionality. The range of item thresholds for EORTC QLQ-C30 and EORTC QLQ-PR25 could not cover the range of the patients’ ability. The mean difficulties of functional domain of EORTC QLQ-PR25 were more difficult and the other domains were too simple for the prostate cancer patients. The HRQoL scores of EORTC QLQ-C30 and EORTC QLQ-PR25 could not discriminate patients from age and disease severity. The chronic pain in patients markedly reduced the global health-related quality of life. After radical prostatectomy for prostate cancer, prostate-specific antigen (PSA) of patients would return to the baseline but their HRQoL scores were rapidly reduced in most of the domains of EORTC QLQ-C30 and EORTC QLQ-PR25. Urinary and sexual functioning would not return to the baseline until 6 months after the therapy. While radiotherapy was used, patients were affected only in their sexual functioning domain and treatment-related symptom domain and it took just 3-6 months to return to baseline HRQoL.
Conclusions: In general, both questionnaires showed a lower reliability in each domain and the mean difficulties were too simple for the prostate cancer patients. EORTC QLQ-PR25 has better discriminant ability on clinical indices than EORTC QLQ-C30. The symptom domain showed better discriminant validity. The distributions of item difficulty of EORTC QLQ-C30 and EORTC QLQ-PR25 and person ability can be used as the bases of developing short-form computer-adapted testing. The results can also be used by clinicians in daily clinical practice to determine items that can predict the impairment of quality of life related to function and symptom for prostate cancer patients.

誌謝 i
中文摘要 iii
英文摘要 v
目錄 vii
第一章 緒論
第一節 研究背景與研究動機 1
第二節 研究的重要性 6
第三節 研究目的 7
第四節 研究問題與研究假設 8
第二章 文獻探討
第一節 攝護腺癌之流行病學 10
第二節 攝護腺癌之臨床表現及病理學 12
第三節 傳統與現代測驗理論之比較 20
第四節 項目反應理論介紹 23
第五節 Rasch模式介紹 25
第三章 研究方法
第一節 研究設計 29
第二節 研究對象 30
第三節 研究工具 31
第三節 資料統計與分析 35
第四章 研究結果
第一節 基本人口學變項之統計 40
第二節 問卷心理計量特質分析 41
第三節 問卷得分與臨床指標之相關性 49
第五章 討論
第一節 問卷的心理計量特質分析 55
第二節 測量結果與臨床指標的相關性 57
第六章 結論與建議
第一節 結論 61
第二節 研究限制 62
第三節 應用與建議 63
參考文獻 64
表格目錄
表一 患者基本資料 70
表二 傳統測量與現代測量在問卷功能範疇之比較 71
表三 傳統測量與現代測量在問卷症狀範疇之比較 73
表四 治療前手術組與放射治療組在問卷功能及症狀範疇及題目之比較 76
表五 開刀組功能範疇與有顯著性題目之術前與術後追蹤之比較 77
表六 開刀組症狀範疇與有顯著性題目之術前與術後追蹤之比較 78
表七 放射治療組問卷各範疇與有顯著性題目之術前與術後追蹤之比較 79
表八 以年齡層鑑別治療前各項分數之差異 80
表九 以PSA鑑別治療前各項分數之差異 81
表十 以Gleason score鑑別治療前各項分數之差異 82
表十一 以危險族群鑑別治療前各項分數之差異 83
表十二 以疼痛程度鑑別治療前功能範疇各項分數之差異 84
表十三 以疼痛程度鑑別治療前症狀範疇各項分數之差異 85
圖目錄
圖一 四個題目的單一參數項目特徵曲線 24
Figure 2 Category probability curve for a rating scale item with four thresholds 27
Figure 3 Person-threshold map for Function domain of EORTC QLQ-C30 86
Figure 4 Person-threshold map for symptom domain of EORTC QLQ-C30 87
Figure 5 Person-threshold map for function domain of EORTC QLQ-PR25 88
Figure 6 Person-threshold map for symptom domain of EORTC QLQ-PR25 89
附錄
EORTC QLQ-C30問卷 90
EORTC QLQ-PR25問卷 92

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