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系統識別號 U0026-0408201716264300
論文名稱(中文) 婦癌婦女接受化學治療期間症狀群群集與生活品質之關係
論文名稱(英文) Symptom Cluster and Quality of Life among Gynecological Cancer Patients during Receiving Chemotherapy
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 105
學期 2
出版年 106
研究生(中文) 哈雅妮
研究生(英文) Haryani
學號 TA8027013
學位類別 博士
語文別 英文
論文頁數 128頁
口試委員 指導教授-許玉雲
口試委員-胡文郁
口試委員-鄭雅敏
口試委員-孫秀卿
口試委員-王新台
中文關鍵字 none 
英文關鍵字 Symptom Cluster  Gynecological Cancer  Quality of Life  Chemotherapy 
學科別分類
中文摘要 none
英文摘要 Background: Gynecological cancer is the most common cancer after breast cancer in women. In Indonesia, the incidence of gynecological cancer was 2nd among women’s cancers in 2012, and this figure is expected to increase by around 20% by 2020. Dramatic advances in cancer diagnosis and treatment have improved the prognosis; however, multiple concurrent symptoms are experienced by cancer patients undergoing chemotherapy. The research on symptom management has changed from exploring single symptoms to symptom clusters. However, there have been limited symptom cluster studies on patients with gynecological cancer and its impact on their quality of life.
Purpose: to explore the structure of symptom clusters and their impact on the QOL at different time points during chemotherapy treatment among gynecological cancer patients.
Methods: A longitudinal design was used to explore the patterns of symptom clusters across four time periods from pre-chemotherapy (T0), 1-3 weeks after cycle 1 treatment (T1), cycle 2 treatment (T2) to cycle 3 (T3) in Dr. Sardjito General Hospital, Indonesia. The subjects were women diagnosed with gynecological cancer. Inclusion criteria for the subjects were planning to undergo chemotherapy, older than 18 years old, and able to read Bahasa. Exclusion criteria were cancer recurrence, cognitive impairment, central nervous system metastasis, and co-morbidity with other cancers. Three instruments were used including the Demographic and Clinical Characteristics, the Memorial Symptom Assessment Scale (MSAS), and the Short Form-36 (SF-36) questionnaires.
Data Analysis: Descriptive statistics were used to analyze the demographic and clinical characteristics as well as symptom occurrence and severity. Exploratory factor analysis (EFA) was used to identify the structures of symptom clusters at each time point. A panel regression was used to analyze the influence of demographic and clinical characteristics on symptom clusters across time and the influence of the symptom cluster on QOL across time.
Results: Overall, 120 patients with gynecological cancer provided baseline data, and 82 participants retained at T3. Before chemotherapy, the pain-related, nutrition, emotion, and treatment-related symptom clusters were determined as the four symptom clusters. However, after first cycle of chemotherapy, the symptom clusters were floating and changing across time points. The nutrition, fatigue-treatment, emotion, and pain-related symptom clusters presented after first cycle of chemotherapy (T1). After third cycle of chemotherapy (T3), the nutrition, emotion, body-image and pain-treatment symptom clusters presented. Cancer metastasis, types of gynecological cancer, stages, disease comorbidity and the level of education influence symptom clusters across time. Emotion and pain-related symptom clusters influence the QOL index.
Conclusions: Four symptom clusters were identified across time points with slightly different structures. The patterns of symptom clusters changed across time points, which indicated the complexity of symptom clusters and the dynamic relationships among symptoms. Assessing symptom clusters is important to gynecological cancer patients undergoing chemotherapy.
論文目次 TABLE OF CONTENTS
ABSTRACT I
ACKNOWLEDGEMENTS III
TABLE OF CONTENTS V
LIST OF TABLES VIII
LIST OF FIGURE IX
CHAPTER ONE INTRODUCTION 1
1.1 Background 1
1.2 Significance 3
1.3 Research purpose 4
1.4 The research questions 5
CHAPTER TWO LITERATURE REVIEW 6
2.1 Gynecological cancer 6
2.2 Symptom Cluster in Cancer 12
2.3 Symptom clusters in gynecological cancer patients 21
2.4 Factors associated with symptom clusters among cancer patients 27
2.5 Symptom Cluster and Quality of Life in Cancer Patients 33
CHAPTER THREE METHODS 41
3.1 Research Design 41
3.2 Research Framework 41
3.3 Definition of terms 43
3.4 Subjects 45
3.5 Sample size 45
3.6 Setting 45
3.7 Instruments 45
3.8 Study Procedure 50
3.9 Data analysis 51
3.10 Ethical Consideration 54
CHAPTER FOUR RESULTS 55
4.1 Characteristics of Participants 56
4.2 Occurrence and Symptom Score at Each Time Point 59
4.3 Symptom Clusters Each Time Point and their Pattern Over Time 62
4.4 The Influence of Demographic and Clinical Characteristic on Symptom Cluster Structure Across Time 72
4.5 The Influence Of The Symptom Cluster Across Time On Quality Of Life 78
CHAPTER FIVE DISCUSSION 79
5.1 Symptom severity at each time point 79
5.2 Symptom clusters and their patterns over time 81
5.3 The Influence of Demographic and Clinical Characteristics on the Symptom Cluster Across Time 86
5.4 The Influence of Symptom Clusters Across Time on the QOL 87
CHAPTER SIX CONCLUSION 89
6.1 Conclusions 89
6.2 Strengths and limitations of this research 90
6.3 Recommendations for future research 91
6.4 Clinical implications 91
REFERENCES 94
APPENDICES 114
Appendix A: Questionnaire 114
Appendix B : Approval for using questionnaire 122
Appendix C : Ethical approval 125
Appendix D : Permission approval 128



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