早期肺癌術後患者的症狀嚴重度、心理困擾與照護需求之探討

Symptom Severity, Psychological Distress and Care Needs in Early Stage Lung Cancer Patients After Surgery

黃怡靜(I-Chin Huang)

指導教授 ： 賴裕和

國立臺灣大學/醫學院/護理學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.02966

摘要

肺癌是所有癌症中最具生命威脅性的一種，幸運地是，由於現今癌症篩檢的醫療發展，使得患者能被早期診斷出肺癌並接受手術；然而，早期肺癌患者的困擾與需求情況卻少見於相關學術研究中，因此，本研究目的為：(1) 探討早期肺癌患者之症狀嚴重度、心理困擾 (焦慮、憂鬱與不確定感) 與照護需求之現況，(2) 並進一步探討照護需求的相關性；並以橫斷式設計，以台灣北部某醫學中心中選取符合收案條件 (術後三個月至五年內) 的可開刀的肺癌患者，由經過訓練的護理人員採結構式問卷進行資料收集，包括中文版的癌症生活品質核心問卷、肺癌生活品質問卷、醫院焦慮憂鬱量表、Mishel疾病不確定感量表、中文版的支持性照護需求調查簡表與基本資料表。
總共有150位受試者參與，研究結果為： (1) 一般而言，患者呈現為輕度的症狀嚴重度，但前五大症狀困擾為呼吸困難、睡眠困擾、其他部位痛、咳嗽與疲倦；(2) 有16至20%的受試者有焦慮與憂鬱的傾向；(3) 有中度至高度的不確定感；(4) 有低至中度照護需求，以中位數排序則為「健康系統與資訊需求層面」、「心理需求層面」、「病患照護與支持需求層面」、「整體照護需求層面」、「生理與日常生活需求層面」與「性需求層面」；(5) 整體照護需求是高症狀嚴重度、焦慮得分高、低收支情況、已婚與組織型態有顯著的相關，此五項預測變項共可解釋整體照護需求49.4%的變異量。此研究結果可提供早期肺癌術後患者的照護需求資訊，以期增加患者之生活品質。

關鍵字

早期肺癌 ； 手術 ； 症狀嚴重度 ； 心理困擾 ； 照護需求

並列摘要

Lung cancer is one of the most life-threatening cancers. Fortunately, due to the current medical advancement in cancer screening, patients are able to be diagnosed in early stage of lung cancer and receive operation. However, limited information has known about the distress and needs of these patients. The purposes of this study are to (1) examine the levels of symptom severity, psychological distress (anxiety, depression, and uncertainty), and care needs; and (2) factors related to care needs in operable lung cancer patients. A cross-sectional study was conducted to recruit operable lung cancer patients (3 month to 5 year after their surgery) in a medical center in Northern Taiwan. Patients were assessed by trained nurses with structured interview by several instruments, including EORTC Core Quality of Life Questionnaire (QLQ-C30) with 13-item Lung Cancer-Specific Questionnaire Module (LC-13), Hospital Anxiety and Depression Scale (HADS), Mishel’s Uncertainty in Illness Scale Chinese Version (MUIS), 34-item Short-form SCNS in Chinese version (SCNS-SF34-C), and Background Information Form (BIF).
A total of 150 subjects were recruited. The results showed that (1) in general, patients experienced mild symptom severity with the top five symptoms as dyspnea, sleep disorder, pain of other places, cough, and fatigue; (2) there are about 16 to 20% of subjects were identified as anxiety or suspected as anxiety and depression or suspected as depression, respectively; (3) patients had moderate to high levels of uncertainty; (4) patients had relatively low to moderate levels of care needs, ranking as their mean scores as health system and information needs, psychological needs, patients care and support needs, physical and daily living needs, and sexual needs; and (5) Patients’ overall care needs were associated to higher symptom severity, higher anxiety level, lower income, having married, diagnosis as non-small cell lung cancer which explained 49.4% variance. The results provide the information to develop evidence based services to meet operable lung cancer patients’ care needs and further to facilitate their life quality.

並列關鍵字

Lung Cancer ； Symptom severity ； Distress ； Anxiety ； Depression ； Uncertainty ； Care needs

參考文獻

劉敏慧、胡瑞桃、郭李堂、王兆弘、董道興 (2008)．心臟衰竭病患自我照顧能力與症狀困擾、社會支持、憂鬱之研究．實證護理，4(4)，277-288。

陳麗帆、周繡玲、周雨青、楊燦、簡戊鑑、白璐、孫建安、曾知浩、朱基銘 (2009)．使用比較資料探勘演算法預測非小細胞肺癌患者預後因子、存活情形及其效能．腫瘤護理雜誌．9(2)，33-47。

羅惠敏、徐南麗、邱慧洳、廖惠娥、劉欣怡 (2004)．癌症病患症狀困擾與不確定感關係之探討．慈濟護理雜誌．3(1)，72-80。

孫嘉玲、蔡仁貞、林佳靜 (2006)．膀胱癌病患的生活品質、社會支持及症狀困擾．新台北護理期刊．8(2)，11-19。

鄭素月、賴裕和、張利中、吳齊殷 (2002)．探討乳癌病患的症狀困擾、自我效能、社會支持與生活品質之關係．新台北護理期刊，4(1)，9-21。