惡性腦瘤病患之健康生活品質及其相關因素探討

Abstract

腦瘤是國內十大常見的腫瘤之一，其發生率有逐年增加的情形。本研究的主要目的在了解惡性腦瘤(Malignant Brain tumor)患者健康相關生活品質的狀況，並探討影響之相關因素。研究採描述性橫斷式調查法，以立意取樣方式，選取台北某醫學中心神經外科病房與門診之惡性腦瘤患者(ICD-9-CM為191.9)，並且意識清楚能與他人溝通的病患為研究對象。於民國95年3月1日至95年6月30日進行資料的收集，共有53位收案對象，研究工具包括「個人基本資料表」、「癌症病患生活品質問卷表EORTC QLQ-C30」、「腦瘤病患特殊生活品質問卷表EORTC QLQ-BN20」、「社會支持量表」等四部份量表。所得資料以SPSS13.0進行分析。 研究結果發現，惡性腦瘤病患自覺整體生活品質題組之平均得分為54.08分±20.06分。各層面得分方面，於生活品質核心問卷(EORTC QLQ-C30)中，在功能性題組方面以「情緒功能」平均分數最高，而「社會功能」最低；在症狀題組或單獨題中以「疼痛」平均分數最高，而「腹瀉」分數最低。於特殊疾病生活品質(EORTC QLQ-BN20)問卷中，以「未來不確定感」平均分數最高，而「嗜睡」問題次之，「皮膚搔癢」的問題最不嚴重。於「社會支持量表」中，在受訪病患中有58.5%獲得低等程度的社會支持；整體社會支持以配偶及家人為最主要的支持來源(49.36±19.09)，各次量表單題得分總平均以評價支持(3.36分)最高，其次為情緒性支持(2.54分)，最低為訊息性支持(2.14分)。 影響惡性腦瘤病患健康相關生活品質之因素探討，以「年齡」、「發病年齡」、「全家收入」、「婚姻狀況」、「功能狀態」、「症狀困擾」與「社會支持」等變項為預測「整體生活品質」之重要變項。其表示當年齡與發病年齡較輕者、全家收入大於5萬元者、已婚者且功能狀況評分高與症狀評分低者，其整體的生活品質較好。而社會支持各項評分會影響病患之功能狀態與症狀困擾，也表示當社會支持評分高的，與功能狀態之評分成正相關，與症狀困擾評分成負相關。 研究結果可以提供臨床護理人員關於惡性腦瘤病患之疾病照護與諮詢服務的相關訊息，使其能更了解病患在患病過程中所面臨的問題與困擾，並當作照護惡性腦瘤病患時的重要指標，以提升照護品質與增加病患對生活品質感受的滿意度。

Brain tumor is one of the 10 most common tumors in Taiwan, its incidence rate has been increasing with years. The purpose of this study was trying to survey the health-related quality of life in malignant brain tumor patients, and the related factors. This research used descriptive cross-sectional survey method. With purposive sampling, we include 53 malignant brain tumor patients (ICD-9-CM: 191.9), who are conscious and communicable. All of them were neurosurgical inpatients and outpatients in a Taipei medical center. The instruments included “Personal Data Questionnaire”, “EORTC QLQ-C30”, “EORTC QLQ-BN20” and “Social support scale”. Data was collected from Mar 1st to Jun 30th of 2006, and analyzed with SPSS13.0. As for the results, the average score of overall QoL in malignant brain tumor patients was 54.08±20.06. The data collected from the Core Questionnaire of Living Quality (EORTC QLQ-C30) indicated that the patients had the highest score in Emotional Function and the lowest score in Social Function in relation to Function Group. In Symptom Group, pain gets the highest score while diarrhea the lowest. The Questionnaire of Living Quality Related with Special Disease (EORTC QLQ-BN20) indicated that patients were troubled most by uncertainty of the future, followed by drowsy. Skin itching caused the least trouble. Social support scale showed that 58.5% of the subjects gain low-level social support. The majority of the subject received general social support (49.36±19.09) from their spouses and family members. The highest score of single item of each questionnaire went to As for single item score, Comment support scores highest (3.36), followed by Emotional Support (2.54), while informational support (2.14) scores lowest. This study indicates that “Age”, “ Disease Outbreak Age”, “Family Income”, “Marital Status”, “Functional Status”, “Symptom Distress” and “Social Support” were important influential factors to General Quality of Life, which meant married and younger subjects with family income over 50,000 and who got higher scores in functional status but low scores in symptom status would enjoy a better quality of life. The research also demonstrates that social support had positively correlated with functional status and negatively correlated with symptom distress. The results of this research not only provided information for clinical nurses of malignant brain tumor patients to make them understand better the problems patients have to face during treatment, but also could be taken as the important nursing indicators of malignant brain tumor patients. The utilization of the study can greatly improve the nursing quality and satisfaction in patients with malignant brain tumor.