肝癌患者對自我健康照護之知識態度與行為探討及其預後因子之存活分析

目的:探討住院中肝癌患者其自我健康照護知識、態度及行為之施行情形及影響存活之預測因子。方法: 採問卷調查與病歷資料收集，共收案344位住院肝癌患者；有效問卷共253份，問卷資料以t test、one-way ANOVA 及複迴歸分析探討其差異性與預測因素；而符合存活分析共83位，以Kaplan-Meier estimator及Cox proportional hazards model進行統計分析，探討影響存活之因子。結果：自我照護研究:發現「年齡」、「教育程度」、「職業」及「罹病時間」等因素在認知程度上達顯著差異，而態度方面:各變項均未達顯著差異，但多數患者均對自我照護抱持正向態度。將變項以逐步迴歸分析來探討，發現其「年齡」及「知識」共可解釋態度方面19.5%的總變異數；且經Pearson相關矩陣發現「知識」、「態度」及「自我保健行為」三者成正相關。存活研究:發現血清白蛋白值、甲型胎兒蛋白值及腫瘤結節個數可做為影響肝癌存活的預測因子。結論：衛生教育目前被廣泛地運用於臨床醫療領域中，而自我健康照護雖然包含內容極為廣泛，本研究證實知識的增進、正向態度有助於自我照顧行為的落實；而存活研究受限受限於樣本數過少及相關資料收集過程並不完整，僅發現三個預測因子。

關鍵字

態度；知識；自我健康照護；肝癌；存活分析

並列摘要

Objective: Investigate the hepatomatic inpatients’ knowledge, attitude, behavior toward self health care, and survival risk factors associated with hepatoma. Methods: Adopt questionnaire investigation and anamnesis collection. 344 hepatomatic inpatients were collected from t Hepatobiliary ward and Hepatobiliary surgery ward in certain medical center. 253 pieces of useful papers investigated by t test, one-way ANOVA and multiple linear regression to analyze their relationships. Eighty-three cases were analyzed with Kaplan-Meier estimator and Cox proportional hazards model for comparing survival functions and identifying the prognostic factors for patients with hepatoma. Results: The results indicated that “age”, “educational level” and “suffering from illness period” have significant effects on knowledge. We didn’t find significant changes in term of attitude, but most of patients can keep positive attitude toward self care. By multiple linear regression to analyze, the result showed that “age” and “knowledge” can explain the 19.5% of total variance of hepatomatic patients toward attitude. Using co-relational matrix, we found out that the three parts ““knowledge”, “attitude” and “self care behavior” are positively-related. From the result of survival analysis, we find out that albumin, AFP and tumor tubercle can be served as the prognostic factors that affect survival of hepatomatic patients. Conclusion：Health education is popularity using in the medical area and self health care covers lots of subject matter. This study showed that increasing knowledge and revealed positive attitude help self care behavior into practice. The survival analysis is limited to few samples and incomplete information collection that only three prognostic factors can be found to be associated with the survival.