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DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 賴裕和 | |
dc.contributor.author | Yu-Chien Liao | en |
dc.contributor.author | 廖幼媫 | zh_TW |
dc.date.accessioned | 2021-06-08T05:04:28Z | - |
dc.date.copyright | 2011-03-03 | |
dc.date.issued | 2011 | |
dc.date.submitted | 2011-01-31 | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/23596 | - |
dc.description.abstract | 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。 | zh_TW |
dc.description.abstract | 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. | en |
dc.description.provenance | Made available in DSpace on 2021-06-08T05:04:28Z (GMT). No. of bitstreams: 1 ntu-100-D95426004-1.pdf: 1492795 bytes, checksum: c24d83ccca86d3fb3b548f3618dfa401 (MD5) Previous issue date: 2011 | en |
dc.description.tableofcontents | 論文口試委員審定書................................. i
誌謝............................................... ii 中文摘要........................................... iii 英文摘要........................................... v 目錄............................................... vii 圖目錄............................................. ix 表目錄............................................. x 第一章 緒論....................................... 1 第一節 研究背景及重要性....................... 2 第二節 研究問題及研究目的..................... 6 第二章 文獻查證................................... 8 第一節 理論背景................................. 8 第二節 生活品質............................... 12 第三節 肺癌及肺癌治療......................... 15 第四節 肺癌病患的生活品質及影響因素........... 17 第五節 研究架構............................... 25 第六節 研究假設............................... 28 第三章 研究方法................................... 29 第一節 研究設計............................... 29 第二節 研究工具............................... 32 第三節 資料分析............................... 37 第四章 研究結果................................... 41 第一節 研究對象基本屬性及疾病相關特質......... 41 第二節 生活品質及症狀的程度及變化............. 48 第三節 自我效能、不確定感及憂鬱的程度及變化... 58 第四節 生活品質變化之影響因素................. 62 第五章 討論....................................... 77 第一節 研究結果討論........................... 77 第二節 結論與建議............................. 94 參考資料........................................... 100 圖目錄 圖1 肺癌病患生活品質之研究架構.................... 27 圖2 三個測量時間點的收案數、拒絕與流失原因........ 44 圖3 各層面生活品質於三個測量時間點之變化.......... 49 圖4 T1 - T3嚴重度逐漸增加的症狀................... 52 圖5 T1 - T3嚴重度逐漸減輕的症狀................... 53 圖6 T1 - T2不變 ─ T2 - T3增加的症狀.............. 54 圖7 T1 - T2增加 ─ T2 - T3減輕的症狀.............. 55 圖8 T1 - T3無顯著變化的症狀....................... 56 圖9 各層面癌症因應自我效能於三個測量點的變化...... 60 圖10 疲憊與整體生活品質關係之GAM平滑函數圖........ 74 圖11 疼痛與整體生活品質關係之GAM平滑函數圖........ 75 圖12 癌症因應自我效能與整體生活品質關係之GAM平滑函數圖 76 表目錄 表1 測量項目及時間表.............................. 31 表2 研究對象的基本人口學資料...................... 45 表3 研究對象的疾病相關特質........................ 46 表4 研究對象的生活品質、功能與症狀於三個測量時間點的程度及變化.................................. 57 表5 研究對象自我效能、不確定感及憂鬱於三個測量時間點的程度及變化................................ 61 表6 研究對象於基準點之人口學特質及疾病相關特質與研究變項之關係.................................. 65 表7 研究變項間的相關性............................ 66 表8 症狀與各層面生活品質間的相關性................ 67 表9 各層面生活品質變化的顯著影響因素.............. 72 | |
dc.language.iso | zh-TW | |
dc.title | 新診斷肺癌病患治療期間的生活品質與相關因素探討 | zh_TW |
dc.title | Changes and Related Factors of Quality of Life in Newly Diagnosed Lung Cancer Patients Receiving Treatment | en |
dc.type | Thesis | |
dc.date.schoolyear | 99-1 | |
dc.description.degree | 博士 | |
dc.contributor.oralexamcommittee | 余忠仁,蕭妃秀,孫秀卿,林寬佳 | |
dc.subject.keyword | 肺癌,生活品質,症狀,自我效能,不確定感,憂鬱, | zh_TW |
dc.subject.keyword | lung cancer,quality of life,symptom,self-efficacy,uncertainty,depression, | en |
dc.relation.page | 118 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2011-01-31 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 護理學研究所 | zh_TW |
顯示於系所單位: | 護理學系所 |
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