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系統識別號 U0026-1402201812545400
論文名稱(中文) 運用網路科技提供乳癌存活婦女個別存活照護計畫之成效
論文名稱(英文) Effect of Using eHealth Technology to Establish a Tailored Survivorship Care Plan for Breast Cancer Survivors
校院名稱 成功大學
系所名稱(中) 護理學系
系所名稱(英) Department of Nursing
學年度 106
學期 1
出版年 107
研究生(中文) 王育琳
研究生(英文) Yu-Lin Wang
學號 t26031042
學位類別 碩士
語文別 中文
論文頁數 157頁
口試委員 指導教授-方素瓔
召集委員-盧文祥
口試委員-邱靜如
中文關鍵字 網路健康科技  乳癌  存活照護計畫 
英文關鍵字 e-Heatlh technology  breast cancer  survivorship care 
學科別分類
中文摘要 研究背景:乳癌存活日增,乳癌婦女即使在接受完治癒性治療後仍有許多未滿足之照護需求,包含害怕癌症復發、焦慮憂鬱、生理症狀如手臂淋巴水腫及其他生理和心理困擾。然而在有限的醫療照護人力與資源下,提供符合婦女期待與所需之存活照護為一大挑戰。運用網路科技做為癌症存活照護介入的方式可針對不同乳癌存活婦女的需求提供個別化資訊與照護支持。
研究目的:1.探討由網路科技提供存活照護計畫對婦女害怕癌症復發、癌症症狀困擾、焦慮憂鬱、未滿足照護需求和生活品質的成效;2.了解婦女使用由網路科技設計的存活照護計畫滿意程度與害怕癌症復發、癌症症狀困擾、焦慮憂鬱、未滿足照護需求和生活品質變化之相關。
研究方法:藉由認知-社會行為健康模式架構與參考存活照護指引建立“擁抱新生活”網站與手機應用程式,採塊狀分派隨機控制實驗研究設計,針對治療結束後至五年內乳癌存活婦女進行收案。實驗組個案予網頁和手機應用程式個別化存活照護衛教指導,控制組僅獲得存活照護追蹤建議表,兩組皆定期常規門診追蹤。研究於介入前給予前測,並於第五週、第三個月進行追蹤後測資料收集。
研究結果:共納入165位(實驗組/控制組:83/82位),納入收案時至結束治療時平均為29.55(2~59)月、平均年齡為48.99(24~75)的乳癌存活婦女。兩組個案於人口學屬性沒有顯著組間差異。疾病屬性方面,僅實驗組個案接受化學治療的比例顯著高於控制組。結果顯示運用「科技網路為設計的乳癌存活照護計畫指導」無法顯著降低乳癌存活婦女的害怕癌症復發、癌症症狀困擾、焦慮、憂鬱、需求強度和總需求數,亦無法顯著提昇婦女的生活品質總分、整體評價生活品質、生理範疇、心理範疇、社會範疇與環境範疇生活品質,然而可以顯著減少未滿足需求數、資訊未滿足需求數、心理與疾病症狀處理未滿足需求數,並顯著提升對生活品質之整體健康滿意度。且使用手機應用程式的滿意程度越高,症狀困擾總分、症狀發生總數與未滿足需求數降低越多。
結論與臨床建議:根據本研究結果,建議未來研究可長期的介入成效探討並擴充發展網頁內容與網頁的功能。可將藉網路科技設計不同癌症的存活照護應用程式與網頁,並實際推廣至臨床標準化的存活照護流程中。
英文摘要 The study aimed to examine the effect of using e-Heath technology as survivorship care plan on fear of recurrence, cancer symptom distress, anxiety, depression, unmet care needs and quality of life. Randomized control-group with pretest-posttest design study and block randomization was used for women with breast cancer after active treatment but less than 5 years. The intervention group was given tailored survivorship care by using APP and website, the control group was only provided a paper based-survivorship care recommendation. All the two groups were under regular clinics follow-up. Data were collected on baseline before the intervention, and then followed on the 5th week & 3rd month. Total 165 (intervention/ control: 83/82) breast cancer survivors participated in this study. The results showed that using e-Health technology as survivorship care did not have effect on fear of recurrence, anxiety, depression, strength of need, total needs and quality of life. However, the intervention could decrease the total unmet needs, including information, psychology and disease management and increasing the satisfaction of health related quality of life. We also found that the higher satisfaction of using survivorship APP women perceived, the greater changes of total symptom distress, number of symptoms and unmet needs they reported.
Key words: e-Health technology, breast cancer, survivorship care
論文目次 目錄
中文摘要 I
英文摘要 III
誌謝VI
目錄VIII
表目錄X
圖目錄XI
附件目錄 XII
第壹章 緒論1
第一節 研究背景與重要性1
第二節 研究目的6
第三節 研究問題6
第四節 研究假設7
第貳章 文獻查證8
第一節 乳癌之治療後長期與晚期延遲之副作用及對婦女的衝擊8
第二節 乳癌存活者照護需求19
第三節 網頁化設計之癌症存活照護27
第參章 研究方法39
第一節 研究架構39
第二節 名詞解釋與操作型定義40
第三節 研究設計46
第四節 研究對象與場所47
第五節 實驗介入措施49
第六節 研究工具58
第七節 研究計畫執行流程與資料收集64
第八節 資料處理與分析66
第九節 研究倫理考量67
第肆章 研究結果68
第一節 人口學屬性與疾病相關資料70
第二節 運用科技網路為設計之個別化存活照護計畫對乳癌存活婦女其害怕癌症復發、癌症症狀困擾、焦慮憂鬱、癌症未滿足照護需求與生活品質之成效74
第三節 存活照護應用程式的滿意程度與乳癌存活婦女的照護需求、害怕癌症復發、癌症症狀困擾、焦慮憂鬱和生活品質之相關94
第伍章 討論98
第一節 研究個案基本屬性與疾病特性98
第二節 科技網路為設計之乳癌存活照護計畫對婦女害怕癌症復發、症狀困擾、焦慮憂鬱、未滿足照護需求與生活品質之影響100
第三節 科技網路為設計之乳癌存活照護應用程式和網頁使用滿意程度與婦女自述成效之相關111
第陸章 結論、研究限制與建議114
第一節 結論114
第二節 研究限制115
第三節 研究結果之建議116
參考文獻 119
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