探討非小細胞肺癌患者失志及其影響因素

The study of demoralization on patients with non-small cell lung cancer

吳增慈(Tseng-Tzu Wu)

指導教授 ： 顏文娟

中山醫學大學/醫學院/護理學系/碩士(2023年)

https://doi.org/10.6834/csmu202200285

摘要

背景：
肺癌在台灣為高發生率及高死亡率的重大疾病，病患在抗癌期間經常因自我壓力調適不佳而持續產生挫敗感，進而產生對生命無意義感的失志症狀。
目的:
瞭解非小細胞肺癌患者失志情形；探討影響非小細胞肺癌患者失志之影響因子及探討變項對非小細胞肺癌患者失志之解釋力。
方法：
本研究採取橫斷式相關性研究，以中部某醫學中心胸腔內外科病房及腫瘤內科病房為研究場所，利用方便取樣及結構式問卷調查進行資料收集，研究問卷內容包括基本資料、中文版失志量表（Demoralization Scale- Mandarin Version）、生理症狀困擾評估量表（FACT-Lung Symptom Index）、病人健康抑鬱量表（Patient Health Questionnaire-9）、短版社會支持量表（Interpersonal Support Evaluation List Short Form）、工具性日常生活功能量表（Instrumental Activities of Daily Living），並將所得資料以SPSS進行統計分析。
結果:
共有147位非小細胞肺癌患者進行問卷量表填答，結果發現教育程度、婚姻狀況、工作狀況、經濟狀況、罹患癌症時間對於失志有達到統計上顯著差異。失志與生理症狀困擾呈負相關（r=-0.54, p<.001），失志與社會支持呈負相關（r=-0.54, p<0.01），失志與憂鬱方面，呈正相關（r=0.48, p<0.01），失志與日常生活活動能力呈負相關（r=-0.17, p<0.05）。與失志相關的預測因子是: 教育程度、婚姻狀況、工作狀況、經濟狀況、罹患癌症時間、症狀困擾、社會支持、病人健康抑鬱、工具性日常生活活動能力，僅社會支持及憂鬱呈現顯著，社會支持會反向影響失志（β值=-0.27, p=0.000）；憂鬱情形會正向影響失志（β值=0.42, p=0.000）。變項內共同解釋失志感受有54%的變異量。
結論:
非小細胞肺癌患者憂鬱及社會支持為重要的解釋因子，建議未來方向可以長期追蹤的研究方式，更進一步驗證失志與變項之間的關係。

關鍵字

非小細胞肺癌 ； 癌症 ； 失志 ； 失志量表 ； 社會支持

並列摘要

Background
Lung cancer is a major disease with high incidence and high mortality in Taiwan. During treatment, patients suffer from continuous frustration due to poor self-adjustment which results in “life is meaningless” demoralization symptoms.
Purpose
The purposes of this study were (1) To understand the situation of demoralization in patients with non-small cell lung cancer (2) To explore the associated factors of demoralization on patients with non-small cell lung cancer (3) To explore the associated factors to explanation of the variance on demoralization in patients with non-small cell lung cancer.
Methods
This was a cross-sectional correlation study. The sample was collected from the thoracic surgery ward and the medical oncology ward of a medical center in central Taiwan with convenience sampling and a structured self-report questionnaire was conducted for data collection. The questionnaires included demographic data, Demoralization Scale- Mandarin Version (DS-MV), FACT-Lung Symptom Index (FLSI-12), Patient Health Questionnaire-9 (PHQ-9), Interpersonal Support Evaluation List Short Form (ISEL Short Form), and Instrumental Activities of Daily Living (IADL). Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson's product moment correlations and multiple linear regressions with SPSS.
Result
A total of 147 patients with non-small cell lung cancer completed the questionnaire. The results demonstrated that education, marriage, work, economy, and the time of suffering from cancer were statistically significant different for demoralization. Demoralization was negatively correlated with physical symptom distress (r=-0.54, p<.001), negatively correlated with social support (r=-0.54, p<0.01), and positively correlated with depression (r =0.48, p<0.01), there was negative correlation between demoralization and activities of daily living (r=-0.17, p<0.05). The predictors related to demoralization were Education, marriage, working status, economic status, time since cancer, symptom distress, social support, depression, instrumental activities of daily living. Social support and depression were significant variables, that social support negatively affect demoralization (β value = -0.27, p=0.000); and depression positively affect demoralization (β value=0.42, p=0.000). Among the variables, social support and depression together explain 54% of the variation in demoralization.
Conclusion
Depression and social support in patients with non-small cell lung cancer are important predictors of demoralization. It is suggested that the future direction can be a long-term follow-up research method to further verifying the relationship between demoralization and variables.

並列關鍵字

Non-Small Cell Lung Cancer ； Cancer ； Demoralization, Demoralization Scale-Mandarin Version ； Social support

參考文獻

中文部分:

方俊凱（2013）．癌症病人的失志症候群．臺灣醫學，17（2），149-154。https://doi.org/ 10.6320/FJM.2013.17(2).07

白雅菁（2019）．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〔碩士論文，中山醫學大學〕．華藝線上圖書館。https://doi.org/ 10.6834/CSMU201900042

李政洋、陳虹汶、李玉嬋、唐婉如、方俊凱（2011）．癌症照顧的自殺防治．內科學誌，22（5），335-343。https://doi.org/10.6314/JIMT.2011.22(5).05

李玉嬋、葉北辰（2014）．為癌症病人謀福的心理腫瘤學．諮商與輔導，345，51-57。https://doi.org/10.29837/CG