檢視初次接受化學治療癌症老年病人壓力感受、因應行為與症狀困擾之相關性

To Examine the Relationships Between Perception of Stress, Coping, and Symptom Distress on Elderly Patients Undergoing Initial Chemotherapy

吳詩萍(Shih-Ping Wu)

指導教授 ： 許雅娟

長榮大學/健康科學學院/護理學系(所)/碩士(2014年)

https://doi.org/10.6833/CJCU.2014.00145

摘要

老年人有較高的癌症發生率，臨床上老年癌症病人在化學治療期間，除了忍受慢性病和癌症所產生的生理不適，亦得承受治療所帶來的症狀困擾，不僅可能帶來嚴重合併症而中斷治療，更會影響老年人接受治療之意願。本研究目的為檢視接受化學治療老年病人之壓力感受、因應行為與症狀困擾間的相關性。
採橫斷式、相關性研究設計，研究地點為南部某醫學中心之內外科病房，採立意取樣，以第一次接受化學治療60歲以上癌症老年病人為研究母群體，收案條件包括:1.60歲(含)以上經專科醫師診斷為癌症病人；2.住院中並接受第一次由靜脈注射化學治療者；3.完整接受第一次化學治療療程者；4.能以國或台語溝通者；5.能正確回答人、時、地。排除條件為: 1.未達柯氏量表(Karnofsky Scale)第零級和第一級者；2.病歷記載有憂鬱、焦慮、失智症病史者；3..排除因故中斷化學治療療程者；4.未知癌症病情者；5.不同意瀏覽病歷者。
採結構式問卷收集資料，共完成100位受試者，問卷包含五大部份，柯氏量表、收案對象之基本資料（年齡、教育程度、經濟狀況、罹患慢性病數目、腫瘤診斷分期、是否合併使用別種癌症治療方式、是否合併使用中醫治療）、壓力感受量表、因應行為量表以及症狀困擾量表。研究資料以 SPSS for Windows 19版統計套裝軟體進行描述性統計、皮爾森相關係數、ANOVA變異數分析和 t檢定等方法做資料處理。
結果發現本研究樣本的癌症老年病人壓力感受程度為正常(平均值＝13.89)。有七成八接受化學治療老年病人發生四種以上的症狀困擾，前五名嚴重的症狀困擾依序為: 疲倦(平均值＝2.55)、食慾影響(平均值＝2.07)、失眠(平均值＝1.91)、口乾(平均值＝1.88)、排便(平均值＝1.79)，最常見的症狀困擾前五項依序為：疲倦(88次)、口乾(66次)、食慾影響(57次)、失眠(50次)和排便(41次)。老年癌症病人較常使用「問題取向」因應行為(平均值＝3.19分)。而壓力感受愈大，較常使用「情緒取向」因應行為(r＝0.49，p <0.001)，較少使用「問題取向」因應行為(r＝-0.29，p ＝0.004)。愈常使用「情緒取向」因應行為者，其症狀困擾愈嚴重（r＝0.44, p <0.001）。在慢性病數目、腫瘤診斷分期、癌症治療方式與症狀困擾嚴重度無顯著差異性。
本研究結果期望能提供老年專科醫護相關人員，了解台灣癌症老年病人於接受化學治療時的壓力感受、因應行為以及症狀困擾情形，協助癌症老年病人能運用有效性之「問題取向」因應行為，藉由個別性和適切性措施來減輕其症狀困擾，最終提昇癌症老年病人的生活品質。

關鍵字

癌症 ； 老年 ； 化學治療 ； 壓力 ； 因應行為 ； 症狀困擾

並列摘要

Older adults are at much greater risk of developing cancer than those who are younger. Older cancer survivors suffer from comorbidity, physical discomfort, and chemotherapy-induced distress symptoms. These may lead to serious complications and interruption of treatment, as well as affect the willingness of older cancer sufferers to undergo treatment. The purpose of this study was to examine the relationships between perception of stress, coping, and symptom distress on elderly patients undergoing initial chemotherapy.
A cross-sectional and correlational research design was conducted in a medical center in southern Taiwan. The data were collected in medical and surgical wards via purposive sampling. Participants were:(1) aged ≥ 60 was diagnosed with cancer by physician; (2) inpatient and receiving initial chemotherapy via intravenous injection; (3) completed full initial chemotherapy; (4) able to communicate in either Chinese or Taiwanese; and (5) mentally alert. Exclusion criteria were: (1) the Karnofsky Scale has not reached class zero or first class; (2) medical records show depression, anxiety, and a history of dementia; (3) not fully completed initial chemotherapy; (4) not told of the diagnosis; or (5) refused medical chart review.
Structural questionnaires were used to collect data. A total of 100 questionnaires were completed and all were valid. The questionnaire included five parts: the Karnofsky scale, the demographic characteristics of the older cancer patients, Perceived Stress Scale, Coping Behavior Scale, and Symptom Distress Scale. Data were analyzed using the SPSS 19.0 statistical software package. Statistical methods included descriptive statistics, Pearson’s correlation, ANOVA analysis, and t-test.
The results showed that the perception of stress among cancer patients in this study is normal (mean = 13.89). Of elderly participants receiving chemotherapy, 78% exhibited more than four symptoms of distress, the top 5 severe symptoms of distress were: fatigue (mean = 2.55), poor appetite (mean = 2.07), insomnia (mean = 1.91), dry mouth (mean = 1.88), and altered bowel habits (mean = 1.79). The most frequent seen symptoms of distress were: fatigue (88 times), dry mouth (66 times ), poor appetite (57 times), insomnia (50 times) and altered bowel habits (41 times). Elderly cancer participants were more likely to used “problem-focused coping” (mean = 3.19). The greater the perception of stress, the more frequent the use of “emotional-focused coping” (r = 0.49, p <0.001), and the less the use of “problem-focused coping” (r = -0.29, p = 0.004). More frequently users of “emotional-focused coping” had tendency of serious symptoms of distress (r = 0.44, p <0.001). No significant difference was found for the number of chronic diseases, the stage of cancer, and the type of cancer treatment with symptom distress.
Findings will enable geriatric care providers to understand the perceptions of stress, coping, and symptom distress among Taiwan’s older cancer patients undergoing initial chemotherapy. Findings will also offer geriatric care providers the ability to implement individualized interventions based on effective problem-solving strategies that reduce the symptoms of distress and improve quality of life for elderly cancer patients.

並列關鍵字

Cancer ； Elderly ； Chemotherapy ； Stress ； Coping ； Symptom Distress

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