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系統識別號 U0026-2308201321183100
論文名稱(中文) 肺癌病人生活品質及其相關因素
論文名稱(英文) Factors Associated with Quality of Life among Patients with Lung Cancer
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 101
學期 2
出版年 102
研究生(中文) 吳易霖
研究生(英文) Yi-Lin Wu
電子信箱 n029091@mail.hosp.ncku.edu.tw
學號 t26994012
學位類別 碩士
語文別 中文
論文頁數 66頁
口試委員 指導教授-柯乃熒
口試委員-王榮德
口試委員-蘇五洲
中文關鍵字 肺癌  生活品質  相關因素 
英文關鍵字 Lung cancer  Quality of life  Factors 
學科別分類
中文摘要 背 景:醫療科技進展使得癌症病人存活時間延長,追求好的生活品質將成為癌症病人新的照護課題。
研究目的:本研究目的為分析肺癌病人生活品質長期變化趨勢,並了解影響肺癌病人生活品質之相關因素。
研究方法:本研究採次級資料庫分析法,包含醫院癌症登記資料庫、肺癌診療資料庫及成大醫院生活品質資料庫收集資料。以2005-2012年成大醫院診斷且完成世界衛生組織生活品質量表台灣簡明版填答之肺癌病人為研究對象,排除條件為沒有病理學診斷者。本研究以描述性統計分析病人基本資料及疾病治療特性,再把肺癌診斷後各時間點之平均生活品質分數連成曲線,進而描繪成大醫院肺癌病人生活品質長期變化趨勢,並使用SAS 9.3版軟體以混和模式 (Mixed Model)進一步分析個案特性、健康特性、疾病特性、醫療特性隨著不同時間點對生活品質趨勢的影響。
研究結果:肺癌病人的生理、心理、環境生活品質會隨著診斷後的時間改善。工作狀態的有無會影響生活品質整體得分狀況,有工作者生活品質隨時間的改善都較多;男性肺癌病人較女性在生理、心理與社會生活品質隨著時間改善較多;年輕的病人可在生理與社會生活品質變化較好;初診斷無腦轉移較有轉移的病人隨時間增加生理與心理生活品質得分。具有慢性腎臟疾病和單身的病人會影響社會生活品質隨時間下降,經濟狀態、初診斷身體活動功能(ECOG)則對環境生活品質長期變化有另外的影響;治療方式只有曾做過放射線治療對生理生活品質有隨時間顯著的降低影響。
結 論:本研究發現在生理、心理與環境範疇,本院肺癌病人的生活品質有隨時間逐漸變好,顯示在本院的照顧同時亦兼具提升並維持病患診斷之後的生活品質。我們應更加注意無工作者、女性、年老患者的生活品質變化,給予更多的關心;而針對單身、經濟狀況較差的病人加強評估社會與環境生活品質狀況,適時提供相關資源轉介。在治療方面,可對放射線治療患者生理生活品質隨時間下降的進一步探討分析,以規劃預防生活品質下降的照護方案。
英文摘要 Background: Factors associated with quality of life have become the issues of focus and need to be elucidated as the improvements of medical science prolong the survival of patients with lung cancer.
Study Purpose: The purpose of this study was to describe the long-term trend on the quality of life of patients with lung cancer, and to understand the related factors.
Study Design: The study design was to analyze secondary databases. The study samples were lung cancer (primary diagnosis ICD-9 = 162.0-162.9) patients who were diagnosed from 2005 to 2011 at National Cheng Kung University Hospital and joined WHOQOL interview. Those diagnosed without tissue proof were excluded. The databases included the cancer registration database, the diagnosis and treatment database for lung cancer, and the NCKUH quality of life database. Using SAS 9.3 software, the mixed-models were constructed to explore related factors and the time trend of quality of life.
Result: The quality of life in the physical, psychological, environment domains and global QOL among lung cancer patients was improved over time. Status of employment influenced the global quality of Life. Male patients improved more than female over time in the domains of physical, psychological and social quality of life. Younger patients improved more over time in the physical domain. Non brain metastasis improved over time in the domains of physical and psychological quality of life. There were subtractive effects in the social domain of quality of life if the patients had chronic kidney disease or were single. Low income and poorly ECOG had negative impact on the long-term trend in the environmental quality of life. Among the therapeutic options, only radiotherapy had significant effect on the physical Quality of Life over time.
Conclusion: The quality of life in the physical, psychological, environment domains among NCKUH lung cancer patients improved as time went by, which showed the promising quality of care and treatment in NCKUH. More resources are to be explored for those who are single or have lower income, and special attention should be paid to those who are unemployed, female, elder, or to undergo radiotherapy to improve their quality of life.
論文目次 摘 要 1
ABSTRACT 3
誌 謝 5
第一章 緒 論 10
第一節 研究背景 10
第二節 研究動機與重要性 11
第三節 研究目的 12
第二章 文獻查證 12
第一節 肺癌 12
第二節 肺癌病人的生活品質 14
第三節 肺癌生活品質變化之相關因素 22
第三章 研究方法 31
第一節 研究設計 31
第二節 研究場域與對象 31
第三節 研究資料庫 31
第四節 研究架構 34
第五節 資料收集 41
第六節 資料分析 41
第七節 倫理考量 42
第四章 結果 43
第一節 肺癌病人屬性分析 45
第二節 肺癌病人生活品質狀態 49
第三節 肺癌病人生活品質變化 51
第四節 肺癌病人生活品質相關因素分析 52
第五章 討論 56
第六章 研究限制 59
第七章 結論與建議 60
參考文獻 62
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