晚期肺癌病人接受化療期間的症狀困擾、情緒困擾與睡眠品質之相關性研究

A Correlational Study of Symptom Distress, Mood Distress and Sleep Quality in Patients with Advanced Lung Cancer During Chemotherapy

白雅菁(Ya-Ching Pai)

指導教授 ： 蔡麗雅

中山醫學大學/醫學院/護理學系/碩士(2019年)

https://doi.org/10.6834/CSMU201900042

摘要

肺癌病人的症狀、情緒與睡眠是常見的癌症照護議題，卻少有研究能完整呈現整個療程中三者的關係。本研究目的在於了解晚期肺癌病人化療期間的症狀困擾、情緒困擾及睡眠品質相關性。採縱貫性研究，方便取樣，結構性問卷進行調查，收案期間由2017年7月到2018年11月，來自中部某醫學中心共32位病人。完整追蹤一個化療療程，故重複測量四次，收案時間點為化療前、化療後第一週、化療後第二週及化療後第三週。問卷包含個案基本屬性，在症狀困擾使用安德森症狀量表，情緒困擾使用醫院焦慮憂鬱量表、睡眠品質使用中文版匹茲堡睡眠量表。以SPSS 19.0軟體進行資料統計及分析。
本研究結果顯示晚期肺癌病人化療期間：(1)整體症狀困擾為輕度困擾；症狀嚴重度屬輕微，嚴重度較高項目為疼痛、疲憊、睡眠紊亂，其中疲憊、睡眠紊亂、胃口差症狀嚴重度波動幅度較大；症狀干擾生活程度屬輕微，干擾生活程度較高的項目為一般活動、生活樂趣。整體症狀困擾、症狀嚴重度與症狀干擾生活程度皆於化療後第一週達到高峰，之後化療後第二至三週逐漸改善。(2)情緒困擾：平均焦慮程度介於「無焦慮困擾」及「有焦慮傾向」間；平均憂鬱程度為「無憂鬱困擾」，四個監測時間點尚屬平穩。(3)睡眠品質在四個監測時間點皆屬品質差，在化療後第一週睡眠品質最差，接著隨著時間逐漸改善。(4)症狀困擾、情緒困擾及睡眠品質呈現正相關性。(5)症狀困擾為睡眠品質的重要影響因素，可預測睡眠品質。
晚期肺癌病人在化療期間的症狀困擾及睡眠品質具波動性，但情緒尚屬平穩，可藉由了解波動變化及時提供醫療及照護措施，在臨床癌症照護中，降低症狀困擾，以改善晚期肺癌病人的睡眠品質。

關鍵字

晚期肺癌 ； 症狀困擾 ； 情緒困擾 ； 睡眠品質

並列摘要

The purpose of this study was to investigate the symptoms distress, mood distress, and sleep quality of advanced lung cancer patients under chemotherapy, and to explore predictors of sleep quality. The study was a longitudinal and convenience sampling research design. We enrolled 32 patients with advance lung cancer from a medical center in Taiwan from July 2017 to November 2018. We collected data before the chemotherapy, 1 week, 2 week, and 3 weeks after chemotherapy. Data were collected using the structured questionnaire that included the demographic, disease characteristics, M. D. Anderson Symptom Inventory-Lung, Hospital Anxiety and Depression Scale, Chinese Pittsburgh Sleep Quality Index. The statistical analysis was conducted by SPSS version 19.0.
The research results showed：(1) The level of overal symptom severity is slight, pain, fatigue, and disturbed sleep scores were high. The level of overal symptom interfere is slight, general activity and enjoyment of life scores were high. (2) The degree of mood distress is slight, and mostly patients did not have anxiety and depression. (3) Sleep quality was poor during chemotherapy. (4) There was a moderate correlation between symptoms distress, mood, and sleep quality. (5) The symptoms distress was a predictor of sleep quality.
The mood of patients with advanced lung cancer during chemotherapy was still stable. However, symptoms distress and sleep quality were fluctuating. We provide nursing care according to this result. Reduce symptoms distress improve sleep quality in patients with advanced lung cancer.

並列關鍵字

advanced lung cancer ； symptoms distress ； mood distress ； sleep quality

參考文獻

趙慧玲、黃惠如、謝碧晴、蘇慧芳(2013)．癌症病人情緒困擾及其相關因素探討．輔仁醫學期刊，11 (3)，205-214。

中文文獻

王淑怡、姚如玲、蔡俊明、郭漢彬、林佳靜(2008)．非小型細胞肺癌病人之睡眠品質及其影響因素之探討．新臺北護理期刊，10 (1)，51-63。doi: 10.6540/ntjn.2008.1.006

吳淑芬、井慶芸、李燕、董弘一、阮建維、趙東波(2015)．不同時期結直腸癌病人症狀困擾、憂鬱與生活品質關係之探討．護理雜誌，62 (6)，68-80。doi: 10.6224/jn.62.6.68

李昕宜、許玉娟、陳佳慧(2014)．癌症生存者之困擾症狀．臺灣醫學，18 (3)， 355-360。doi: 10.6320/fjm.2014.18(3).12