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  • 學位論文

攝護腺癌病人接受放射線治療之健康照護需求及其滿意度與生活品質

Health-related Care Needs, Satisfaction and Quality of Life of Prostate Cancer Patients with Radiotherapy

指導教授 : 胡文郁
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摘要


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。

並列摘要


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.

參考文獻


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