癌症疼痛特質不確定感與心理困擾之相關性探討

The relationship of cancer pain characteristics, uncertainty and psychological distress in Taiwanese cancer patient

蔡琇文(Tsai Shiu-Wen)

指導教授 ： 賴裕和 ； 陳美伶 ； 陳主智

臺北醫學大學/藥學院/藥學研究所/碩士(1998年)

摘要

疼痛為影響癌症病人身心層面的主要問題之一. 然而目前國內對 癌痛如何影響病人的心理狀況及二者之間關係的研究相當有限. 所以 本研究目的在探討癌症病患的疼痛生理-感覺層面特質 ( 疼痛強度, 持續時間,型式,部位 ) 疾病不確定感與焦慮,憂鬱之間的相關性. 研 究採橫斷式相關設計, 以立意取樣的方式於台北巿四所教學醫院進行 資料收集; 研究工具包括疼痛評估量表, Mishel''s 疾病不確定感量 表, 醫院焦慮憂鬱量表及 Karnofsky 功能狀況量表, 資料主要以描 述性統計及分層迴歸方法分析. 本研究共訪得有及無癌痛病患各60名, 結果顯示 : (1) 疾病嚴重度愈高, 年齡愈小及疼痛最痛強度愈大時, 疾病不確定感程度愈高; 進一步以分層迴歸控制年齡及疾病嚴重度的 變異量後, 疼痛最痛強度仍可有意義地預測疾病不確定感 ; (2) 疾 病嚴重度, 疾病不確定感及最痛疼痛強度愈高時, 其焦慮程度愈高; 進一步以分層迴歸控制疾病嚴重度和疾病不確定感後,疼痛最痛強度 仍可有意義地預測焦慮; (3) 疾病嚴重度及平均疼痛強度愈高時, 其 憂鬱程度愈高, 進一步以分層迴歸控制疾病嚴重度的變異量後, 平均 疼痛強度仍可有意義地預測憂鬱. 本研究結果建議疼痛強度, 包括最 痛疼痛強度及平均疼痛強度為直接影響病人心理困擾的重要因素, 臨 床上應給予適當的護理措施, 積極減輕病人的疼痛強度, 以減低病人 的生理及情緒困擾, 提昇其生活品質.

關鍵字

癌痛特質 ； 不確定感 ； 焦慮 ； 憂鬱

並列摘要

The impact of cancer pain on patient''s quality of life is abvious. However, in Taiwan, there are limited studies examining the relationships between cancer pain and patients psychological status. The prupose of this study is to examinine the relationship of the sensory - physiological characteristics of cancer pain, uncertainty, depression, and anxiety. A cross - sectional correlation design was used to guide the study. Eligible subjects were recruited by purposive sampling from onclolgy outpatient and inpatient wards in four teaching hospitals in Taipei. The research instruments include pain assessment form, Mishel''s Uncertainty in Illness Scale For Adult (MUIS-A), Hospital Anxiety and Depression Scale (HADS), and Karnofsky Performance Status Scale. Data were analyzed by both descriptive statistics and hierarchical regression. One hundreds and twenty subjects were recruited which includes 60 patients with pain and 60 patients without pain. There were significant differences in uncertainty, depression, and anxiety in patients with or without cancer pain. The regression analysis showed : (1) patients with younger age, higher disease severity, and higher worst pain intensity score perceived more illness uncertainty ; (2) patients with higher disease severity, higher uncertainty, and worst pain intensity score perceived more anxiety ; (3) patients with higher disease severity, and higher average pain intensity score perceived more depression ; (4) after controlling for age and disease severity, the worst pain intensity score was still the significant predictor of patient''s perception of uncertainty and anxiety ; and (5) after controlling for the disease severity, the average pain intensity score was still significant predictor of patient''s of depression. The results suggested that worst pain intensity and average pain intensity are directly related to patient''s psychological distress. Health care professional need to put more efforts to controll for cancer pain intensity to decrease the developing of negative psychological distress.

並列關鍵字

cancer pain ； pain intensity ； psychological distress ； uncertainty ； depression ； anxiety