中文簡短版癌症行為量表於結直腸癌患者之信效度測試

結直腸癌治療的進步使得存活者大幅增加，因而維持患者生活品質與減輕癌症導致的身心困擾日益重要。自我效能是個人調適癌症伴隨而來身心困擾的重要心理資源，故本研究進行14題簡短版癌症行為量表（The Cancer Behavior Inventory-Brief Version , CBI-B）之中文版信效度測試，以提供具信效度的中文版自我效能評估工具，協助識別調適不良的癌症患者，以發展合適的介入措施。本研究自2017年9月開始收案至2018年4月止，採立意取樣於台北兩家醫學中心之大腸直腸外科門診、腫瘤科門診、病房，共收案265人之診斷零至三期結直腸癌病患，填寫症狀嚴重度評估量表、中文版CBI-B、「流行病學研究中心憂鬱量表」（Center for Epidemiologic Studies Depression Scale，簡稱CES-D）及癌症生活品質量表(the Functional assessment of cancer therapy-general, FACT-G7) 等四份量表，一周後再填寫中文版CBI-B，以進行再測信度。經項目分析及探索性因素分析結果，量表刪除2題後全量表總計共為12題，萃取四個因素：維持獨立及正向態度、參與治療、症狀困擾的調適、情緒管理；其中以情緒調整之自我效能分數最低。以皮爾森積差相關分析 ( Pearson Correlation ) 分析中文版之CBI-B量表之聚合效度，結果顯示：症狀嚴重度量表總分（r = -0.189, p = 0.002）、憂鬱量表CES-D總分（r = -0.515, p < 0.001）與中文版之CBI-B量表，統計上有顯著負相關；與中文版癌症患者生活品質量表（r = 0.416, p <0.001）統計上有顯著正相關。比較症狀嚴重度較高、低兩組於中文版CBI-B量表的得分，t檢定結果有統計上顯著差異（p < 0.001），顯示具區辨效度。信度檢測結果，中文版CBI-B量表內在一致性Cronbach’s α 值0.789，一周再測信度採組內相關係數為0.789（p＜0.001）。迴歸分析顯示，結直腸癌患者自我效能與憂鬱具有統計上顯著關係(β=-0.508, p < 0.001)，亦即有憂鬱的結直腸癌患者的自我效能，較無憂鬱的患者低。迴歸分析模組解釋變異量R2為0.260。本研究結果顯示中文版CBI-B是具有良好信效度之評估自我效能量表，可方便簡易應用於結直腸癌之臨床實務及研究；結直腸癌患者於情緒調適的自我效能較低，故建議在臨床照護上需協助患者的負向情緒表達與宣洩、找到能帶給心理上感到慰藉的方法及尋求支持系統；憂鬱與結直腸癌患者自我效能有顯著相關，照護上建議早期評估辨識結直腸癌患者是否有憂鬱，以提供心理情緒困擾上的預防及介入處置，避免因疾病及治療產生憂鬱。

關鍵字

結直腸癌；調適；自我效能；癌症行為

並列摘要

Recent advances in the treatments of colorectal cancer (CRC) have greatly increased the number of survivors. Therefore, it is important to maintain the quality of life of patients and to reduce the physical and mental distress caused by cancer. Self-efficacy is an important psychological resource for individuals to adjust to physical and mental distress associated with cancers. The aim of this study was to conduct the psychometric testing of the 14-items brief version of the Cancer Behavior Inventory-Brief Chinese version (CBI-B/C), and to provide clinical staffs a reliable and valid Chinese version of the self-efficacy assessment that can identify poorly adjusted cancer patients in order to offer appropriate interventions for them. Totally, 265 patients with diagnosed CRC with stage 0 to stage III, who were recruited in two medical centers in northern Taiwan and enrolled from September 2017 to April 2018. Data were collected using the Symptom Severity (SS) scale, CBI-B/C, the Center for Epidemiologic Studies Depression Scale (CES-D) and the Functional assessment of cancer therapy-general (FACT-G7). Participants were asked to complete CBI-B/C after one week for assessing test-retest reliability. Exploratory factor analysis conﬁrmed four-factor structure after deleting 2 items with finally total 12 items: (1) Maintaining Independence and Positive Attitude, (2) Participating in Medical Care, (3) Coping with Symptom Distress, and (4) Managing Affect. The domain of Managing Affect had the lowest score. The Pearson’s correlation was used to analyze the convergent validity of CBI-B/C. The result indicated that the SS scales (r =-0.189, p =0.002) and the CES-D scales (r =-0.515, p <0.001) were negatively correlated, whereas FACT-G7 (r = 0.416, p<0.001) was positively correlated with CBI-B/C. Comparing the scores of the two groups with higher and lower SS scales in CBI-B/C, there was a significant difference in CBI-B/C between the two groups ( p < 0.001). The finding has demonstrated sufficient discriminant validity in the CBI/C. The CBI-B/C had acceptable internal consistency (Cronbach’s α = 0.789) and test-retest (1 week) reliability (intraclass correlation coefﬁcient =0.789). Regression analysis showed that there was a statistically significant relationship between self-efficacy and depression in patients with CRC ( β = -0.508, p < 0.001). The self-efficacy in depressive patients with CRC is lower than those patients without depression. The regression analysis model accounted for 26% of the variances. The results of this study showed that the CBI-B/C is a reliable and valid assessment of self-efficacy scale, which is easy and simple to apply into clinical practice and research. The level of physical activity and depression were the two important factors associated with the self-efficacy of colorectal cancer patients; therefore, we should focus on assessing the two factors and to develop interventions for increasing the level of physical activity and decrease the level of depression in practical care.

並列關鍵字

colorectal cancer ； coping ； self-efficacy ； cancer behavior

參考文獻

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中文簡短版癌症行為量表於結直腸癌患者之信效度測試

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