害怕疾病惡化簡明量表中文版之信效度測試與現況探討 -以頭頸癌病人為例

背景及目的：在臺灣，自1981年開始癌症就高居十大死因之首，害怕疾病惡化是癌症病人最嚴重且備受關注的心理困擾。本研究目的為：(1) 翻譯害怕疾病惡化簡明量表之中文版，評估其表面效度及內容效度，(2) 進行信效度評估，(3) 運用害怕疾病惡化簡明量表進行臺灣完成治療門診追蹤以及住院正在治療的頭頸癌病人現狀探討。研究方法：本研究主要以橫斷式研究設計以及連續取樣，以頭頸癌病人為研究對象，於臺灣北區某醫學中心分成兩階段進行研究。第一階段：進行量表之翻譯以及進行表面效度、內容效度以及可行性評估。第二階段：運用量表進行完成治療於門診追蹤(121人)及住院治療中(62人)兩組病人的收案，並進行效度分析，評估建構效度以及區別效度，最後由門診病人隨機取樣45人，在兩週後進行量表再測信度測試。收集之資料以描述性統計、斯皮爾曼相關係數檢定、無母數統計進行分析。研究結果： (1) 害怕疾病惡化簡明版中文量表具良好的內在一致信度 (Cronbach’s alpha=0.91) 及穩定的兩週後再測信度 (ICC=0.78)，(2)經由以下理論概念支持假設的相關性驗證，具有良好建構效度：害怕疾病惡化量表與生活品質概念 (r = -0.63)、身體功能狀態 (r = -0.50)呈現中度負相關；與整體生理症狀嚴重度 (r = 0.50)、焦慮程度 (r = 0.57)、憂鬱程度 (r = 0.49) 成中度正相關。完成治療門診追蹤的病人與住院正在治療的病人相比，兩族群間具有區別效度。經探索性因素分析，檢測具有兩項因素結構。(3) 害怕疾病惡化的程度在有無工作、有無復發或轉移及不同治療方式的病人間具顯著差異，其他人口學特質與疾病特質與害怕疾病惡化的程度不具顯著差異或相關性。結論與實務運用：本研究結果建立具有信效度之害怕疾病惡化簡明量表施測工具，可提供臨床工作者能夠利用此量表評估臨床病人害怕疾病惡化的程度，更深入害怕疾病惡化之盛行率，有利於提供介入措施，提升癌症病人心理社會層面的照護品質。

關鍵字

害怕疾病惡化；頭頸癌；心理測量；信效度

並列摘要

Background: Fear of progression (FoP) is one of the most distressful psychological concerns for cancer patients. However, relatively limited information has provided in Chinese speaking society due to a lack of psychometrically validated tools in Chinese. The purposes of this study are to: (1) translate and evaluate the face and content validity of the ‘Fear of Progression Questionnaire Short Form (FoP-Q-SF)’. (2) Examine the Psychometrics of the FoP-Q-SF which include internal reliability, test-retest reliability and construct validity, and (3) explore the current status of FoP in Head and Neck Cancer Patients (HNC). Methods: This is a cross-sectional study using consecutive sampling to recruit HNC patients in both OPD and Inpatient ward at a medical center in northern Taiwan. In phase I, there were 30 eligible subjects were explored for face validity. Content validity was examined by 5 experts in this field. For phase II, 186 subjects are recruited (OPD: 121, inpatient ward: 62). Construct validity was measured using theoretically supported correlations between the FoP-Q-SF and related constructs. Discriminant validity would also be assessed between. A 2-week test-retest reliability of FoP-Q-SF will be examined and randomly selected from OPD subjects in phase II (n=45). Results: The Chinese version of the Fear of Progression Questionnaire Short Form (FoP-Q-SF) explored two-dimensional structure and had satisfactory internal and test-retest reliability. Validation was also demonstrated through convergent and discriminant validity. FoP-Q-SF scores correlated positively with the degree with physical symptom anxiety, and depression, but correlated negatively with the level of quality of life, and performance status. Conclusions: FoP-Q-SF is a valid instrument for the examination of the fear of progression in HNC. Clinicians can assess the clinical level of fear of progression, and better understand the relevance of illness-related and personal or social factors for dysfunctional fear of progression, to provide more intervention and improve the quality of psychosocial care to cancer patients.