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  • 學位論文

膀胱過動症患者對膀胱狀況之感受與症狀困擾相關性探討-以問題取向因應行為和情緒反應為中介變項之比較

Exploration of Relationship between Patient Perception of Bladder Condition and Symptom Bother in Patients with Overactive Bladder: A Comparison of Problem-Focused Coping and Emotional Reaction as the Mediator

指導教授 : 孫秀卿
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摘要


膀胱過動症(Overactive Bladder,OAB)是由症狀診斷而不是客觀測量,因此,患者的主觀感受在OAB患者之嚴重度評估很重要。症狀之感受會影響情感層面和因應措施,進一步影響症狀困擾程度,並嚴重降低患者的生活品質。綜合過去國內外研究發現造成膀胱過動症患者症狀困擾包含許多因素,但其情緒反應與問題取向因應行為對於膀胱狀況之感受及症狀困擾程度之間所扮演的角色則未有研究探討。本研究目的為比較膀胱過動症患者問題取向因應行為與情緒反應對於膀胱狀況之感受與症狀困擾程度之間所扮演的中介角色。本研究採橫斷式研究設計,自2019年07月至2020年04月於某北部區域教學醫院泌尿科和婦產科門診進行收案,針對年齡為20 歲以上之膀胱過動症個案進行資料蒐集,利用結構式問卷收集資料,包括個人基本屬性資料表、疾病相關資料、膀胱過動症症狀問卷(Overactive Bladder Symptom Score)、病人對膀胱狀況之感受、膀胱過動症調查問卷(Overactive Bladder Questionnaire)。資料分析中使用描述性統計個案之個人基本屬性、疾病相關資料;以t-test及皮爾森相關係數分析相關統計方式分析研究研究變項之相關性;再將上述與症狀困擾相關之變項投入階層迴歸分析模式分析,找出影響症狀困擾之重要因素及進一步分析問題取向因應行為和情緒反應是否扮演中介變項的角色。共完成86位個案,研究結果顯示:(1)膀胱過動症患者對膀胱狀況之感受以輕微困擾問題居多,而最常見的症狀困擾為頻尿;(2)影響膀胱過動症患者症狀困擾之重要預測因素為情緒反應和膀胱過動症之嚴重度;(3)膀胱過動症患者最常採取的問題取向因應行為是「每到一個新的地方便立即尋找最近的廁所」,而情緒反應居首的為「感到苦惱」;(4)問題取向因應行為與情緒反應於患者對膀胱狀況之感受及症狀困擾之間皆扮演中介變項的角色;然而,情緒反應完全中介兩者之關係,而問題取向因應行為則為部分中介。此研究結果顯示情緒反應在OAB患者的症狀困擾上扮演更重要的中介角色,臨床上膀胱過動症治療措施常以症狀改善為主要目標,而忽略心理層面照顧。因此,建議臨床醫護人員需要觀察和評估患者心理層面的情緒反應,並適時提供心理照護,降低症狀困擾,進而提升膀胱過動症患者的生活品質。

並列摘要


Overactive bladder (OAB) is diagnosed by self-reported symptoms rather than objective measurement; therefore, it is important to evaluate subjective reporting symptom distress from the patients. The perception of symptoms will affect the emotional response and coping behaviors and further influence the level of symptom bother and decrease quality of life. Based on literature review, there are many factors causing symptom bother in patients with overactive bladder. However, the role of emotional reactions and problem-focused coping between patient perception of bladder condition and symptom bother in overactive bladder patients has not been confirmed. The purpose of this study was to identify the mediating role of problem-focused coping and emotional reaction between perception of bladder condition and symptom bother among patients with overactive bladder. A cross-sectional study design was conducted to recruit the overactive bladder patients from one medical hospital outpatient clinics in Taipei from July in 2019 to April in 2020. Eligible participants were those are 20 years old or older with overactive bladder. A set of structured questionnaires were used to collect data including the basic information, the disease status, the Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC) and the Overactive Bladder Questionnaire (OAB-q). The data were analyzed by descriptive statistics and inferential statistics including t-test and Pearson’s correlation analysis. Besides, multiple hierarchical regression analysis was used to analyze if the problem-focused coping and emotional reaction as the mediator. A total of 86 OAB patients were recruited in this study. The results of this study showed that approximately one of two patients with overactive bladder having some minor problems caused by their bladder condition. The greatest symptom bother was urinary frequency. The important predictors affecting the symptom bother of patients with overactive bladder were emotional reaction and severity of overactive bladder. The most common problem-focused coping was that “caused patient to locate the closest restroom as soon as they arrive at a place they have never been.” The top one of emotional reaction was caused patient distress. Problem-focused coping was a partial mediator in the relationship between patient perception of bladder condition and symptom bother. Emotional reaction full mediated in the relation between patient perception of bladder condition and symptom bother. The result indicates that emotional reaction play a more important mediating role compared to the role of problem–focused coping. However, the emotional care has been ignored in clinical care due to the care goal for the OAB patients generally to controlling symptom. Therefore, it is recommended that medical workers need to observe and evaluate patient’s emotional reactions and provide psychological care as early as possible to reduce symptom bother and improve the quality of life of patients with overactive bladder.

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