- 學位論文
探討肝膽胰癌症患者症狀困擾、症狀群集與生活品質的關係
Exploring the Relationships between Symptom Distress, Symptom Clusters and Quality of Life in Patients with Hepatobiliary-Pancreatic Cancer
摘要
肝膽胰癌症是一死亡率高且預後差的疾病，病患常出現症狀困擾和症狀群集，如果症狀困擾持續且無法提供適當處理，病患還會面臨生活品質改變的問題，本研究目的探討肝膽胰癌症病患症狀困擾、症狀群集及生活品質的關係，採縱貫性描述性相關研究設計，自2013年3月至2014年4月底，以方便取樣進行結構式問卷調查，於入院一週內及出院後兩個月各填一次，以肝膽胰癌症特定症狀困擾量表（EORTC QLQ BIL-21）及中文版生活品質量表(FACT-G)進行調查，收集高雄某醫學中心共101位肝膽胰癌症病患資料。 研究結果發現:出院前後肝膽胰癌症病患之症狀困擾為中等程度，出院前後的症狀困擾僅在疼痛有差異，在進食、黃疸、疲倦及焦慮則無統計差異；群集分析發現病患出現「肝膽胰功能障礙」及「感知與能量消耗」兩個群組；肝膽胰癌症病患的生活品質在出院前後為中等，出院後在生理健康方面有明顯的改善，社會/家庭健全、情緒穩定及功能健全等方面則無統計學差異；肝膽胰癌症患者於出院前、後症狀困擾、症狀群集與生活品質有顯著負相關。本研究結果提供研究及臨床照護上具體的參考，使臨床人員了解肝膽胰癌症患者症狀群集現象，運用症狀群集的概念進行全面性的評估。
並列摘要
Hepatobiliary - Pancreatic cancers have high mortality and poor prognosis. Patients often show symptom distress and symptom cluster; if symptom distress continues and does not receive appropriate treatment, they will also express the problem of the quality of life worsen. The purpose of this study was to explore the relationships between symptom distress, symptom cluster and quality of life (QOL) in Hepatobiliary- Pancreatic cancers patients. The study used a longitudinal descriptive correlational design, and data were collected from March 2013 to April 2014.Convenience sampling method was used and 101 patients recruited from a medical center at Kaohsiung. The questionnaires used in the study included scales of personal and disease characteristics, the European Organization for Research and Treatment of Cancer Bil 21 (EORTC Bil 21) and the Chinese version of functional assessment of cancer therapy -Generic scale ( FACT-G). Questionnaires were done one week after hospitalization and two months after discharge. The results were: the degrree of symptom distress for patients with Hepatobiliary - Pancreatic cancers was moderate. Comparing the degree of symptoms distress before and after discharge, only pain score had showed significant improvement. No significant difference was found in eating, jaundice, tiredness and anxiety. Results of cluster analysis revealed two clusters. Those were hepatobiliary -pancreatic dysfunction and perceived energy exhaustion. The degree of quality of life in patients with Hepatobiliary - Pancreatic cancer was moderate. Comparing the degree of quality of life before and after discharge, only physical well-being score showed significant improvement. No significant difference was noted in subscales of social-family well-being, functional well-being and emotional well-being. There were significant negative correlations between quality of life, symptom distress and symptom cluster between before and after discharge. The results of the study will serve as a reference for future research and clinical care. It can help health providers to understand the symptoms clustered of hepatobiliary - pancreatic cancers patients and used this concept for comprehensive assessment.