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  • 學位論文

探討血液腫瘤病人接受造血幹細胞移植後生活品質之重要預測因子

An Exploration of the Important Predictive Operator of Quality of Life in Patients with Haematological Malignancy Following Haematopoietic Stem Cell Transplantation

指導教授 : 胡文郁
共同指導教授 : 劉俊煌 唐季祿

摘要


本研究目的旨在探討血液腫瘤病人接受造血幹細胞移植後之人口特性、疾病特性、不確定感、希望狀態與生活品質之相關性,以了解其生活品質的預測因子。採描述性橫斷式相關性(cross sectional)設計,以立意取樣,使用結構性問卷,以郵寄及門診訪談方式,於臺灣北部地區二醫學中心之血液腫瘤科門診接受造血幹細胞移植治療出院後之血液腫瘤病人進行資料收集,共得有效樣本201 人。研究工具包括中文版Mishel 疾病不確定感量表、中文版赫氏希望量表和中文版癌症治療功能性評估表-骨髓移植第四版及McGill 生活品質量表-台灣版。以SPSS 17.0Window 版建立資料與統計分析。 本研究重要結果描述如下:1.病人平均年齡46.4 歲,以白血病居多(66.3%),移植後平均存活為5.6±4.7 年,近半數(46.2%)自覺個人健康狀況好及很好。2.呈現中度不確定感 (55.32±14.92 分),希望感偏高(36.32±5.37 分)。FACT-BMT(100.03±22.09分)及MQOL 整體生活品質(7.57±2.42)總平均分數值偏高,表示血液腫瘤病人接受造血幹細胞移植後長期的生活品質在中上等程度以上。3.以逐步迴歸分析,找出FACT-BMT 生活品質的重要預測因子為「不確定感受、希望程度、自覺健康狀況很好、婚姻以及移植後存活5-10 年」,總解釋量(R2)為59.5%;MQOL 生活品質的重要預測因子為不確定感受、希望程度、自覺個人健康差、有無合併症、家庭年收入50 萬以上,總解釋量(R2)為49.5%,均達統計上顯著意義。 結論:本研究結果找出血液腫瘤病人接受造血幹細胞移植之重要預測因子,其中尤以不確定感為護理人員護理教育重點與方向,以加強臨床護理人員的角色功能,提升臨床護理照護能力,協助降低接受造血幹細胞移植病人的不確定感,進而提升生活品質介入措施之參考。

並列摘要


This study aims to explore the relationship among quality of life, uncertainty and levels of hope in patients with Hematological malignancy undergoing hematopoietic stem cell transplantation. A descriptive and cross-sectional correlation design with purposive sampling from two bone marrow transplantation center in northern Taiwan medical hospital. The data were collected by mail and interviewing out-patients with hematological malignancy undergoing hematopoietic stem cell transplantation after discharge as the research object. The valid samples are 201 objects from March 2011 to June 2011.The structure questionnaires were including:(1)demographic questionnaire, (2)the Chinese version of MUIS-Adult Form,(3)the Chinese version of Herth Hope Index,(4)the traditional Chinese version of FACT-BMT,(5) the McGill Quality of Life Scale-Taiwan version).The data were analyzed by SPSS 17.0 Window and descriptive statistics, t test, ANOVA, pearson correlation and multiple regression analysis. The major finding of this study were as below: 1.The patients’ mean age was 46.4 years, the majority of patients diagnosed with leukemia (66.3%), the mean time since transplantation was 5.6±4.7 years, the personal health status was very good and great (46.2%). 2.Levels of uncertainty(55.32 ± 14.92 points) were medium, levels of hope (36.32 ± 5.37 points) were high. An average of FACT-BMT QOL total score (100.03 ± 22.09) and overall MQOL (7.57 ± 2.42) were high. Long-term quality of life in patients with Hematological malignancy undergoing hematopoietic stem cell transplantation was in the middle and upper level. 3.With stepwise regression analysis to identify the important predictors of FACT-BMT QOL were " levels of uncertainty, levels of hope, good personal health status, marital and post-transplant survival of 5-10 years",explained the total amount of (R2) to 59.5%, the important predictors of MQOL were " levels of uncertainty, levels of hope, poor personal health status, complications, annual household income, explained the total amount of (R2) to 49.5%., and were statistically significant. The conclusion: the results of this study indicated levels of uncertainty, levels of hope, personal health status were the most important factors of quality of life in patients undergoing trasplantation, FACT-BMT and MQOL questionnaires are a reliable and valid assessment for measuring the QOL of patients undergoing hematopoietic stem cell transplantation. It would strengthen the clinical nursing staffs' role function., We hope that nursing staff will provide a continous and comprehensive nursing care to reduce uncertainty of patients and enhance levels of hope and quality of life for patients.

參考文獻


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被引用紀錄


鄭芸閑(2015)。癌末安寧療護病患症狀嚴重程度、身體活動功能、靈性安適感與生活品質之關係〔碩士論文,臺北醫學大學〕。華藝線上圖書館。https://doi.org/10.6831%2fTMU.2015.00042
黃盈芷(2014)。白血病病人接受異體造血幹細胞移植後之身體心像 與生活品質之相關因素探討〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2014.00489

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