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| 題名: | 以WHODAZ2.0探討台灣肝癌族群活動參與及生活品質之研究
The Exploration of Activity, Participation, and Quality of Life of Taiwanese Hepatocellular carcinoma Population with WHODAS 2.0 |
| 作者: | 洪郁惠
HUNG, YU-HUI |
| 貢獻者: | 護理學系碩士在職專班
賴甫誌 |
| 關鍵詞: | 身心障礙鑑定功能量表;肝癌;活動和參與;生活品質
Disability Eligibility Assessment Scale;Hepatocellular carcinoma;Functional of Activities and Participation;Quality of Life |
| 日期: | 2021-06-29 |
| 上傳時間: | 2022-04-17 19:41:21 (UTC+8) |
| 摘要: | 肝癌目前為國內十大死因第二位，大多數的病患必須藉由手術或非手術等治療方式，達到延長存活時間及減輕不適症狀，由於肝癌復發率高，經常需要反覆接受治療，相關合併症發生時容易造成病人活動量降低、影響日常生活活動參與及降低社交活動量，生活品質亦會受到不同程度之影響。活動參與功能是世界衛生組織於2001年提出的國際健康功能與身心障礙分類系統（International classification of functioning, disability and health；ICF）概念架構中重要的一部分，世界衛生組織身心障礙評估量表2.0(World Health Organization Disability Assessment Schedule 2.0;WHODAS 2.0)是依照ICF的概念架構制定而成，可做為個人活動參與通用的評估工具及功能障礙的測量，因目前肝癌著重於疾病治療及症狀減輕，鮮少人關注肝癌個案活動參與功能及對生活品質的影響，故本研究之目的在瞭解肝癌患者活動參與狀況與生活品質情形，並探討其間之相關性和生活品質之影響因素。
本研究為橫斷式的描述性研究，採立意取樣，以北部某醫學中心一般外科門診及病房之肝癌患者為研究對象，共收案140人，使用結構式問卷包括人口學特性問卷、EORTC QLQ-C30及EORTC QLQ-HCC18生活品質量表、身心障礙鑑定功能量表成人版(第8.0版)活動和參與(領域一至領域八)及病歷資料收集包括罹癌時間、肝功能分級（Child-Pugh分級）、有無合併症及共病症指數等進行資料收集，將所得資料以SPSS第25版中文套裝軟體進行描述及推論統計分析。
本研究結果顯示在活動參與相關性探討中發現，「性別」、「年齡」、「教育程度」、「工作狀況」及「物質使用狀況」分別在活動參與領域一到六方面皆達顯著水準、「相關症狀/合併症」在領域六社會參與方面達顯著相關、「治療方式」在領域四與他人相處方面達顯著相關。影響肝癌族群功能性生活品質的顯著預測因子為「年齡」、「罹癌時間」、「活動參與功能」，可解釋功能性生活品質76.2%的變異量；症狀性生活品質的顯著預測因子為「年齡」、「相關症狀與合併症」、「活動參與功能」，可解釋症狀性生活品質55.9%的變異量；整體健康狀態生活品質的顯著預測因子為「年齡」、「工作狀況」與「活動參與功能」，可解釋整體健康狀態生活品質36.1%的變異量；「相關症狀與合併症」、「活動參與功能」則為QLQ- HCC18生活品質之影響因素，可解釋QLQ- HCC18生活品質53.3%的變異量。
研究結果可提供臨床照護團隊了解肝癌患者活動參與限制及影響生活品質的因素，透過更多面向之評估，將後續復健治療、生活與工作重建作為提供肝癌患者臨床照護上的重點，期望能為肝癌患者之生活品質及日常活動參與狀況帶來實質性的裨益與提升。
Hepatocellular carcinoma is currently the second leading cause of death in Taiwan. Most patients receive surgical or non-surgical treatments to prolong survival time and relieve symptoms. Due to the high recurrence rate of Hepatocellular carcinoma, repeated treatments are often required, relevant complications, and recurrent symptoms often lead to the decrease of patient's activity level, affect the participation in daily life activities and reduce the amount of social activities, this consequently influence the quality of life at varying degrees. The function of participation in activities is an important part of the conceptual framework of the International Classification of Functioning, Disability and Health (ICF) proposed by the World Health Organization in 2001. The World Health Organization Disability Assessment Scale 2.0 (World Health Organization) Health Organization Disability Assessment Schedule 2.0; WHODAS 2.0) is formulated in accordance with the conceptual framework of ICF. It can be used as a general assessment tool for personal activities and participation in dysfunction measurement. Because liver cancer currently focuses on disease treatment and symptom reduction, few people Pay attention to the function of participation in activities of Hepatocellular carcinoma cases and its impact on the quality of life. Therefore, the purpose of this study is to understand the status of participation in activities and quality of life of patients with Hepatocellular carcinoma, and to explore the correlation between them and the influencing factors of quality of life.
This study is a cross-sectional and descriptive correlation study. It adopts intentional sampling and takes liver cancer patients in general surgery clinics and wards of a northern medical center as the research object. A total of 140 cases were enrolled. Structured questionnaires including demographic characteristics questionnaire and EORTC QLQ-C30 and EORTC QLQ-HCC18 Quality of Life Scale, Adult Version of the Functioning Disability Evaluation Scale (version 8.0), activities and participation (domain 1 to domain 8) were used and medical record data collection including time to cancer, liver function classification (Child -Pugh classification), the presence or absence of comorbidities and comorbidity index, etc. to collect data, and use SPSS 25th edition Chinese software package for description and inference statistical analysis.
The results of this study show that in the discussion on the relevance of activity participation, it is found that "gender", "age", "education level", "work status" and "substance use status" have reached significant levels in activity participation areas one to six respectively. "Related symptoms/comorbidities" are significantly related to social participation in domain six, and "therapeutic methods" are significantly related to getting along with others in domain four. The significant predictors that affect the functional quality of life of the liver cancer population are "age", "time to cancer", and "activity participation function", which can explain 76.2% of the variation in functional quality of life; The significant predictors of symptomatic quality of life are "age", "related symptoms and comorbidities", and "activity participation function", which can explain 55.9% of the variation in symptomatic quality of life; overall; The significant predictors of the quality of life in a healthy state are "age", "work status" and "activity participation function", which can explain 36.1% of the variance in the overall quality of life in a healthy state; "related symptoms" "Complications and comorbidities" and "activity participation function" are the influencing factors of QLQ-HCC18 quality of life, which can explain 53.3% of the variance of QLQ-HCC18 quality of life.
Study results can be taken as references for clinical care teams to understand the factors that limit the participation and quality of live of patients with Hepatocellular carcinoma. Through more focused assessments, follow-up rehabilitation treatment and reconstruction of life and work will be the focus of providing clinical care for patients with Hepatocellular carcinoma to increase the quality of life and participation in daily activities that will be substantial benefits for this population. |
| 描述: | 碩士
指導教授：賴甫誌
委員：劉燦宏
委員：張君照 |
| 資料類型: | thesis |
| 顯示於類別: | [護理學系] 博碩士論文
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