臺灣博碩士論文加值系統

歐洲癌症治療與研究組織(EORTC)癌症生活品質核心問卷(QLQ-C30)與肺癌生活品質問卷(QLQ-LC13)為一個被普遍使用且具有良好信效度的癌症病人健康相關生活品質之測量工具，由於它直接測量此類病人的利益及廣面療效的特性，已經廣被選用來評估臨床試驗主要及次要的照護結果，特別是當生命的長短或疾病的緩解與健康相關生活品質間有所交換時，如惡性癌症的化學治療。
本研究目的在探討中文版癌症生活品質核心問卷(QLQ-C30)與肺癌生活品質問卷(QLQ-LC13)之心理測量學特質並評估問卷的信效度及反應性。
此研究為包括橫斷面和追蹤性的研究，資料收集期間自民國九十三年九月中旬至民國九十四年五月中旬。在橫斷面的研究中，研究起始點的資料進行測試量表假設前提之心理測量學特性評估，及進行生活品質問卷之信效度評估。在偵測手術前後變化的反應性，則是採用追蹤性的研究設計。
橫斷面研究結果，顯示測量工具中的功能性構面與症狀問題等量表構面，提供肺癌病患生活品質評估工具為一可信且有效的測量。在構面的信度評估，除了認知功能構面及社會功能構面外，其他構面的內部一致性信度良好，Cronbach’s α值介於0.70~0.95。
在效度方面，因素效度的結果與原先所設定的量表構面大致上相同。各個量表構面都有很好的輻合效度；除了「認知功能」、「社會功能」及「疼痛」外，鑑別效度也幾乎達到100％。臨床效度評估顯示「疲倦」症狀構面相對於其他量表有較高區分不同組別的肺癌病患的能力，而在肺癌問卷部份，則是以「脫髮」症狀有較高的區分能力。
追蹤性研究設計，評估手術病患在手術前後的反應性。在核心問卷中，以「疼痛」症狀構面相較於其他量表構面及症狀描述有較高偵測手術前後生活品質分數差異的能力；在肺癌問卷中，則是以「胸痛」症狀題目有較高的偵測能力。
本研究結果顯示所使用之中文版「歐洲癌症治療與研究組織生活品質核心問卷」與「肺癌生活品質問卷」，是一具備相當好的信度與效度之測量工具，應可廣泛的運用於肺癌病患生活品質的評估，除了提供醫療人員如何測量、評估及改善肺癌病患照護品質的參考之外，亦可用於評估不同肺癌治療方式的療效，其不同治療之侵入性對於肺癌病患生活品質的影響，提供醫療人員臨床工作之參考，藉以提升整體的醫療照護品質。

Previous studies indicate the European Organisation for the Research and Treatment of Cancer Core Quality of Life Questionnaire ( EORTC QLQ-C30) and the Lung Cancer Module (QLQ-LC13) are good reliability and validity instruments measuring health-related quality of life（HQOL）. They are commonly used in clinical trail, especially when these exists trade-off between patients’ life and quality of life for medical care.
The purpose of this study is to investigate the estimates of psychometric characteristics of the Chinese versions of EORTC QLQ-C30 and EORTC QLQ-LC13, and evaluate the reliability, validity and responses among lung cancer patients.
The study adopted two study designs. The first one was a cross-sectional design to assess the psychometric characteristics, reliability and validity in lung cancer patients undergoing different medical care. The second one was a longitudinal to establish surgical the operation procedure on responseness of HQQL for lung cancer patients.
The study results of cross-sectional design show the scales of functioning and the symptoms are reliable and valid HQOL measurement in lung cancer patients. The Cronbach’s α for physical functioning, role functioning, emotional functioning, global health status/quality of life, fatigue, pain, nausea, vomiting and dysponea are between 0.70 to 0.95.
Each scale shows perfect convergent validity. Except for the scales of “cognitive functioning,” “social functioning,” and symptom of “pain,” the discriminate validity of the other scales almost came to 100％. Symptom of “fatigue” is highest ability to differentiate different lung cancers groups. For the lung cancer module, “hair loss” has the highest ability to differentiate different lung cancer groups.
In the longitudinal study design, symptom of “pain” in EORTC QLQ-C30 has the highest power to detect responsiveness of lung cancer patients’ quality of life change before and after surgery, and so does “Pain in chest” in lung cancer module.
The Chinese versions of the EORTC QLQ-C30 and QLQ-LC13 have good reliability and validity in measuring lung cancer patients’ HQOL. It should be used in clinical settings to assess lung cancer patients’ quality of life. For future research, they could be applied to evaluate the effectiveness of different treatments therapies, and to provide the information for clinicians on how to improve the quality of medical care.

目錄
摘要 i
ABSTRACT iii
目錄 v
表目錄 viii
圖目錄 ix
附表目錄 ix
第一章 緒 論 1
第一節 研究背景 1
第二節 研究目的 3
第三節 問題陳述 4
第四節 研究假設 5
第二章 文獻探討 6
第一節 生活品質的定義及層面 6
第二節 肺癌治療方式對生活品質的影響 8
第三節 肺癌生活品質測量工具 10
一、一般別生活品質測量工具 10
二、癌症別生活品質測量工具和肺癌生活品質測量工具 11
三、測量工具介紹之總結 32
第四節 評估測量工具應具備之特質 43
一、心理測量學特質 43
二、信度 51
三、效度 52
四、反應性 56
五、分數之解釋性 57
第五節 有關測量工具信效度相關研究 59
第三章 研究設計與方法 68
第一節 研究設計與架構 68
一、研究設計 68
二、研究架構 70
第二節 樣本或資料來源 71
一、研究對象 71
二、樣本數 72
三、資料收集 72
第三節 測量方法 74
第四節 分析方法 84
一、鑑別力 84
二、心理測量學特性之評估 84
三、建構效度 87
四、反應性－比較手術前與手術後一個月生活品質差異 88
第四章 結果 89
第一節 研究對象的基本特質 90
第二節 中文版「核心問卷」與「肺癌問卷」之 心理測量學特質 92
第五章 討論 122
第六章 結論與建議 128
第一節 結論 128
第二節 建議 130
第三節 研究限制 132
參考文獻 133


表目錄
表2-1 FACT生活品質測量工具介紹 17
表2-2 FACT生活品質測量工具次量表介紹 18
表2-3 EORTC QLQ-C30測量工具內部一致性相關研究 31
表2-4簡單敘述各常用癌症別健康相關生活品質量表之摘要表 36
表2-5簡單敘述各常用的肺癌健康相關生活品質量表之摘要表 40
表2-6 癌症生活品質測量工具相關信效度研究 63
表3-1「核心問卷」的構面、題數和內容 78
表3-2「肺癌問卷」構面、題數和內容 79
表3-3 肺癌分期中TNM 的定義 81
表3-4 STAGE分期法 82
表4-1 不同肺癌病患分組受訪者人口特質之比較 105
表4-2 不同肺癌病患分組受訪者癌症與治療相關變項之比較 106
表4-3 中文版「核心問卷」回答題目分佈與遺漏值分佈百分比 107
表4-4 中文版「肺癌問卷」題目反應分佈與遺漏值百分比 109
表4-5 中文版「核心問卷」各量表的描述性統計與分數分佈 110
表4-6 中文版「肺癌問卷」各量表的描述性統計與分數分佈 111
表4-7 中文版「核心問卷」各題平均值、標準差及題目與量表間的相關 112
表4-8 中文版「肺癌問卷」各題平均值、標準差及題目與量表間的相關 114
表4-9 中文版「核心問卷」與「肺癌問卷」量表特質 115
表4-10中文版「核心問卷」與「肺癌問卷」再測信度分析 116
表4-11中文版「核心問卷」各量表構面間的相關與內部一致性Cronbach’s值 117
表4-12中文版「核心問卷」因素分析 118
表4-13中文版「核心問卷」在不同肺癌病患分組的分數與相對效度 119
表4-14「肺癌問卷」在不同肺癌病患分組分數與相對效度 120
表4-15手術前與手術後一個月生活品質之檢定及相對效度 121

圖目錄
圖3-1 不同肺癌病患組別研究設計之組別及測量變項 69
圖3-2 手術前後研究設計之資料搜集時間點與測量變項 69
圖3-3 有關手術前後生活品質變化 70
圖3-4 不同肺癌病患組別之生活品質差異 70

附表目錄
附錄一：中文版歐洲癌症治療與研究組織癌症生活品質核心問卷
附錄二：中文版歐洲癌症治療與研究組織肺癌生活品質問卷

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