分化型甲狀腺癌患者接受甲狀腺切除手術後之照護需求及其相關因素探討

Abstract

甲狀腺癌是最常見的內分泌腺癌，以分化型甲狀腺癌為主，目前主要的治療方式為腫瘤切除手術，然而病人術後卻可能受手術及內分泌相關之症狀所困擾，術後的身體心像改變、擔心腫瘤復發等想法亦可能造成病人之問題，目前相當有限之研究探討該群病人之照護需求，故本研究目的於探討分化型甲狀腺癌病人手術後症狀、身體心像改變及擔心癌症復發嚴重度與照護需求現況，及其與照護需求之相關性。 本研究為橫斷式設計，採連續取樣，收案對象為三年內完成甲狀腺切除手術並確診分化良好型甲狀腺癌患者，於臺灣北部某醫學中心一般外科及內分泌科門診進行收案，並透過一次性的結構式問卷訪談術後之分化型甲狀腺癌病人，問卷內容包含：症狀嚴重度量表、身體心像量表、擔心癌症復發量表，支持性照護需求量表增訂版，以描述性統計、曼恩-惠尼U檢定、克瓦二氏單因子變異數分析、斯皮爾曼等級相關係數及邏輯斯迴歸分析照護需求現況及其相關和預測因素。 本研究共收錄150位個案，研究結果發現：(1) 病人呈現輕度症狀嚴重度；(2)病人身體心像改變輕微；(3) 99.3%病人有不同程度之擔心復發的問題；(4)支持性照護需求程度前三項，由高至低依序為：健康系統資訊層面需求、營養及症狀層面需求及心理層面照護需求；(5)整體照護需求與「性別」及「癌症分期」有關，與「症狀嚴重度」、「身體心像改變」及「擔心復發嚴重度」呈現正相關，「症狀嚴重度」及「擔心復發嚴重度」為整體照護需求的預測因子。 整體而言，雖然分化型甲狀腺癌病人術後之症狀嚴重度及身體心像問題屬輕度，但多數病人仍有擔心復發之考量，以及照護需求未滿足的問題，本研究可提供分化型甲狀腺癌病人照護需求資訊，作為日後照護之參考，經由適當評估，提供適當照護，協助病人降低照護需求，提升生活品質。

The purposes of this study were to (1) explore the level of symptom severity, body image changes, fear cancer recurrence (FCR), and supportive care need; and (2) the relationship between care needs and disease/ treatments and above mentioned factors in Differentiated Thyroid Cancer (DTC) patients within three year post surgery. A cross-sectional design with consecutive sampling was conducted to recruit DTC patients in one medical center in Northern Taiwan. Two research nurses assessed for patients’ Symptom Severity, Body Image, Fear of Cancer Recurrence, (4) Supportive Care Needs. The descriptive statistics, Mann-Whitney U Test, Kruskal–Wallis H test, Spearman's rank correlation, and logistic regression were applied for data analysis. A total of 150 participants were recruited. The results showed that (1) in general, DTC patients experienced mild symptom severity; (2) having mild body image change and majority of patients had mild levels of FCR; (3) patients care needs as its descending order are system and information needs, nutritional and symptom requirement needs and psychological needs; (4) overall care needs were associated to gender, stage of cancer, higher symptom severity, higher body image score, and higher FCR. Symptoms severity and FCR are the two most robust factors to predict the overall care needs based on the logistic regression. Providing appropriate care through needs assessments are strongly suggested to decrease the unmet care needs in DTC patients.