世界衛生組織障礙評估手冊-認知量表之中文版測試於頭頸癌症病患

Abstract

頭頸癌治療，口腔癌早期以手術治療為首要，侵襲性口腔癌及鼻咽癌以放射線治療或化學同步放射治療為主，治療可能會造成中樞神經系統毒性，引起治療後認知功能缺損。臨床需要簡易、可信賴的評估工具，評估認知功能並可改善認知缺損對其生活品質的衝擊。本研究目的為測試中文版「世界衛生組織障礙評估手冊2.0-認知」（WHODAS 2.0-Cognition）之信度及效度。 本研究採量表測試研究設計，使用結構式問卷進行資料收集，研究工具包括：基本屬性問卷、癌症及治療相關特質、世界衛生組織障礙評估手冊-認知及、歐洲癌症治療與研究組織之癌症患者生命品質測定量表、醫院焦慮憂鬱量表及症狀嚴重度量表。 研究結果顯示：(1)本量表具有良好的內在一致性信度；(2)具有建構效度，萃取一個因素結構，解釋變異量為61.04%；(3)與生活品質、焦慮、疲倦及症狀嚴重度具有同時效度；(4)對接受不同治療方式病人的認知功能具有區辦效度。本研究結果顯示中文版「世界衛生組織障礙評估手冊2.0-認知」具有良好的信度及效度。本量表適用於台灣臨床頭頸癌病人認知功能評估。

Chemoradiotherapy (CCRT) is one of the major treatment modalities for advanced oral cavity cancer and for most nasopharyngeal carcinoma. However, both chemotherapy (CT) and radiation therapy (RT) might also cause the central nervous system toxicity and result in cognition impairment. Thus, an easily and reliable scale for clinical assessment is needed for assessing patients’ cognition function related these treatments. The purpose of the study was to examine the psychometric properties of the World Health Organization Disability Assessment Schedule 2.0-Cognition (WHODAS 2.0-Cognition). This is an instrument testing study. We used the World Health Organization Disability Assessment Schedule 2.0 –Cognition (WHODAS 2.0-Cognition), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLO-C30), Hospital Anxiety and Depression Scale (HADS), Symptom Severity Scale (SSS), and background information form to measure the psychometrics of WHODAS-cognition Chinese version. The results showed that: (1) the Chinese-version WHODAS 2.0-Cognition had good internal consistency reliability; (2) clear one factor structure with 61.04% of the variance examined by exploratory factor analysis; (3) had theoretically supported convergent validity between WHODAS 2.0-Cognition scale and quality of life, anxiety, fatigue, and symptom severity; (4) had theoretically supported discriminant validity which can identify the differences of the levels of cognition among various treatment modalities. The WHODAS 2.0-Cognition is a psychometrically satisfactory instrument. The scale is appropriate in measuring the cognition function of head and neck cancer patients in Taiwan.