接受免疫治療肺癌病人希望感及其相關因素之探討

Abstract

晚期肺癌為威脅生命的疾病,近年來免疫治療治療有相對突破性的成效,提升肺癌病人治療預後的希望,然病患治療間,相關的經驗較少被探討。本研究目的為:(1)探討接受免疫治療 肺癌患者症狀嚴重度、不確定感與希望感之程度;(2)探討希望感的重要相關因素。本研究為橫段式設計,以連續性收案方式針對台灣北部醫院接受免疫治療的肺 癌患者為研究對象,結構式問卷進行資料收集,包括症狀嚴重度評估量表、Mishel 疾病不確定感量表社區版量表、中文版赫氏希望指標與基本資料表。針對本研究目的(1)採描述性統計分析;針對目的(2)則採兩階段統計分析,階段一以皮爾森相關、獨立樣本 t 檢定、單因子變異數分析,逐一探討各變項(人口學特質、疾病 與治療特性、症狀嚴重度、不確定感)與希望感之關係,階段二將第一階段統計分 析中具顯著性變項整體放入線性回歸模型中,採逐步回歸分析方式找出更強有而力能預測希望感之預測因子。 本研究共收案 130 位接受免疫治療的肺癌病人,研究結果為:(1)患者其症狀嚴重度為輕度,前五大症狀為疲倦、無力、外觀改變、皮膚搔癢、呼吸喘;(2)病人有中至高度的不確定感及感受中度希望程度;(3)初步推論性統計研究得知,當患者經濟狀態愈好、罹病時間越長、接受免疫治療持續時間愈久、最近一次電腦斷層報告顯疾病愈穩定、Karnofsky 氏身體功能愈佳、症狀嚴重度愈輕、不確定感程度愈低,具有顯著較高的希望程度;(4)進一步將上述具顯著相關變項放入逐步回歸分析,發現希望感最相關因子為:不確定感中不明確程度愈低、身體功能愈佳、不確定感中的複雜性程度愈低與罹病時間越長,可解釋希望感 64.8%的變異量。 本研究為國內外第一篇針對免疫治療病患其希望感之探討,有助於臨床醫護人員進而相關的護理與資訊,以提升病人之希望感。

The purposes of this study were to: (1) examine the levels of symptom severity,uncertainty and hope; and (2) identify robust factors related to level of hope in advanced lung cancer patients receiving immunotherapy. A cross-sectional study with consecutive sampling was conducted in two hospitals in Northern Taiwan. Three major instruments, including Symptom Severity Scale, Mishel Uncertainty in Illness Scale for community, and Herth's Hope Index, were used for assessment. For research purpose 2, two levels of analysis was applied. First, we used the bivariate correlation or t-test. ANOVA to identify those significant factors. Second, the above significant variables were further analyzed by a stepwise regression to identify the most robust factors related to level of hope. A total of 130 patients were recruited. The results showed that (1) patients experienced mild symptom severity. The top five severe symptoms are fatigue, weakness, appearance change, itchy skin, and shortness of breath; (2) patient had a moderate to high level of uncertainty and moderate level of hope; (3) the bivariate analysis showed that higher hope level is related to better economic status, longer time since diagnosed with cancer and longer time receiving immunotherapy , stable condition reported from Computer tomography, better performance status, lower levels of symptom severity and uncertainty; (4) The regression analysis showed that having lower level of ambiguity (in uncertainty scale), better performance status, having lower level of complexity (in uncertainty scale), and the longer time since cancer diagnosed were the four robust factors related to hope which explained 64.8% of variance. Findings from the study suggest that nursing interventions to reduce uncertainty, symptoms and enhance performance status should be applied to increase patients’ hope.