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  • 學位論文

新診斷肺癌病患治療期間的生活品質與相關因素探討

Changes and Related Factors of Quality of Life in Newly Diagnosed Lung Cancer Patients Receiving Treatment

指導教授 : 賴裕和
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摘要


新診斷肺癌之病患於接受治療的前三個月期間受許多身心衝擊,若此時期適應不良將影響長期的生活品質,目前尚無縱貫性研究探討第III - IV 期肺癌病患生活品質的變化及影響因素,因此本研究主要的目的為探討肺癌病患從新診斷至接受治療三個月之 (一) 症狀及各層面健康相關生活品質之程度及其變化型態;(二) 癌症因應自我效能、症狀處置自我效能、不確定感,以及憂鬱之程度及其變化型態;(三) 病患基本特質及疾病因素 (包括疾病分期、功能狀態、治療方式、症狀)、認知因素 (癌症因應自我效能、症狀處置自我效能、不確定感)、及憂鬱對整體生活品質及五個功能層面 (生理、角色、心理、認知、社會) 相關生活品質變化之影響。本研究採前瞻性縱貫性研究法,於北部某醫學中心進行收案,測量74位非小細胞癌第 III - IV 期之新診斷且接受治療之病患於新診斷治療前、治療一個月及治療三個月的症狀、生活品質、不確定感、自我效能及憂鬱的程度。以六個概化估計模式分析縱貫性資料的變化及六層面生活品質的預測因子。研究結果顯示病患的整體生活品質程度為中等,在三個月期間沒有顯著的改變。社會功能及角色功能在追蹤期間有相對較低的得分,生理功能、認知功能及角色功能有顯著的衰退,情緒及社會功能的變化未達顯著性。平均而言症狀屬輕至中等嚴重度,咳嗽及咳血等肺癌特定症狀於治療三個月內顯著的改善,然而其它治療相關症狀及癌症一般性症狀程度則隨著時間增加或是未顯著改變。自我效能的總分於追蹤期間屬中度,且未有顯著的變化。不確定感屬中等程度以上,於初診斷期時最高隨著治療開始逐漸的降低;憂鬱程度逐漸增加且於治療三個月時最高,且有31.3%的病患達到臨床憂鬱個案的程度。癌症因應自我效能、疲憊、疼痛及治療方式是影響整體生活品質的主要預測因子,而病患基本特質、疾病特質、症狀、癌症因應自我效能、不確定感及憂鬱,亦顯著的影響不同層面的生活品質相關功能層面。本研究的結論為新診斷肺癌的病患在其接受治療的前三個月期間,生活品質的變化受多種因素共同影響,為促進肺癌病患的生活品質,臨床人員應提供跨專業整合性的介入課程,內容應涵蓋症狀、生活品質及相關因素的完整評估、個別化症狀處置及訓練、自我效能提升及不確定感處置,並建議未來的研究應朝向測試提升肺癌病患生活品質介入課程之可行性及成效。

關鍵字

肺癌 生活品質 症狀 自我效能 不確定感 憂鬱

並列摘要


Newly diagnosed lung cancer patients experience severe physical and psychological impacts during their first three-month treatment. Ineffective adaptation during this period will negatively affect their long-term quality of life (QOL). Little was known about the factors related to the change of QOL of patients with stage III - IV lung cancer in this critical period. Therefore, the purposes of this study were to examine the levels and change of QOL, symptoms, self-efficacy on cancer coping behavior and symptom management, uncertainty and depression in newly diagnosed lung cancer patients undergoing first three-month treatment, and to determine the related factors of the change of QOL in six dimensions (global QOL, physical function, role function, psychological function, cognitive function and social function). The prospective longitudinal study of 74 newly diagnosed lung cancer patients at a medical center in northern Taiwan assessed their symptoms, QOL, self-efficacy on cancer coping behavior, symptom management self-efficacy, uncertainty and depression at pretreatment and one-month and three-month after treatment initiated. Six Generalized Estimating Equations (GEE) models were applied to analyze the longitudinal data and to identify the significantly related factors of change of QOL in six dimensions. The results showed that the participants had a moderate level of global QOL which did not change statistically in the period of study. Relatively low scores in role function and social function were reported. Physical, cognitive and role functions significantly reduced over time while emotional and social functions had no significant change. In general, levels of symptoms were mild-to-moderate; cough and hemoptysis significantly diminished after treatment while the other symptoms increased or remained unchanged. Stable self-efficacy and reduced uncertainty were observed over time while depression increased with 31.3 % of the participants developing clinical depression after the three-month treatment. The GEE models identified that self-efficacy on coping behavior, fatigue, pain and treatment significantly contributed to the change of global QOL. Demographic and disease characteristics, symptoms, self-efficacy on coping behavior, uncertainty and depression significantly affected the change of different dimensions of QOL-related functioning. In conclusion, the QOL of newly diagnosed lung cancer patients was affected by multiple factors. A comprehensive multi-faceted intervention delivered by a multi-disciplinary team consisting of systematic assessment of QOL and the related factors, tailored symptom management and training of symptom management skills, self-efficacy enhancement, and uncertainty reduction is suggested to improve patients’ QOL. Further research to test the feasibility and effectiveness of the QOL enhancement intervention is recommended.

參考文獻


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被引用紀錄


林晏汝(2017)。早期肺癌術後患者之疾病衝擊及照護需求探討〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU201703023
韓幼軒(2014)。婦癌病人睡眠障礙及相關因素探討〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2014.03004
許晏寧(2012)。早期肺癌術後患者睡眠品質與相關因素探討〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2012.02110

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