| 摘要: | 研究目的：本研究分為兩階段，首先為探討癌症患者憂鬱症狀、困擾風險程度兩者與其社會人口學、疾病相關變項的相關性，及其影響因子，最後，分析腫瘤護理領航師介入對癌症病人心理健康和醫療經驗之影響。
方法：研究第一階段採用橫斷面設計及方便抽樣方法，於2019年1月至2020年1月間，招募臺灣北部一所教學醫院癌症中心的191名癌症患者，統計分析採用逐步線性回歸及分層二元邏輯回歸，分別了解憂鬱症狀、困擾風險之決定因素。第二階段採用隨機對照試驗之方法，將第一階段納入之前128位癌症病人，隨機分配為領航護理組61人，常規護理組67人，並於前測以及介入三個月（後測）和六個月後（追蹤）完成困擾溫度計 (Distress Thermometer, DT)、問題清單 (Problem List, PL)、醫院焦慮憂鬱量表 (Hospital Anxiety and Depression Scale, HADS)、中文版失志量表 (Demoralization Scale_Mandarin Version, DS_MV)、自覺獲益量表 (Perceived Benefit Scale, PBS)，及病人醫療經驗量表 (Patient Assessment of Chronic Illness Care, PACIC) 自陳式問卷。
結果：研究第一階段發現憂鬱症狀、困擾和失志的盛行率分別為17.8%、36.1%和32.5%。吸煙習慣、生活自理能力、共病症、困擾、失志是憂鬱症狀的重要決定因素，且失志對憂鬱症狀影響最大 (β=0.408, t = 6.182, p < .001)。在校正其他變項後，失志每增加一分，憂鬱分數增加0.098分。在困擾風險程度上，情緒問題與其他層面的問題呈顯著相關，尤其是在情緒問題層面有擔心 (Worry) 因子的患者出現高困擾風險是無擔心者的3.08倍。第二階段呈現領航護理組相較常規護理組，在介入之後，後測之焦慮、失志、困擾程度有顯著降低，分別降低92%、75%，及58%，病人醫療經驗(OR = 1.418, p = .020) 亦有明顯的提升。
結論：本研究調查台灣癌症患者憂鬱症狀、困擾風險程度的相關因素，結果顯示心理因素比疾病因素影響更為顯著。而早期篩檢的領航護理措施有益於改善癌症患者的心理健康和醫療經驗。因此，建議可將領航護理師的角色和規劃擴展到醫療保健系統。
Purpose: The study consists of two phases. The first phase explores the correlation between depressive symptoms and distress risk levels in cancer patients with their sociodemographic and disease-related variables, as well as their influencing factors. The second phase analyzes the impact of oncology nurse navigators’ interventions on the mental health and patient medical experience.
Methods: In the first phase, a cross-sectional design with convenience sampling was used to recruit 191 cancer patients from a northern Taiwan cancer center between January 2019 and January 2020. Stepwise linear regression and hierarchical binary logistic regression identified determinants of depressive symptoms and distress risk. In the second phase, a randomized controlled trial enrolled 128 of these patients, randomly assigned to either the navigation care group (61 patients) or the usual care group (67 patients). Self-reported questionnaires, including the Distress Thermometer (DT), Problem List (PL), Hospital Anxiety and Depression Scale (HADS), Demoralization Scale_Mandarin Version (DS_MV), Perceived Benefit Scale (PBS), and Patient Assessment of Chronic Illness Care (PACIC), were completed at baseline, three months post-intervention, and six months post-intervention.
Results: The first phase revealed prevalence rates of 17.8% for depressive symptoms, 36.1% for distress, and 32.5% for demoralization. Key determinants of depressive symptoms included smoking habits, self-care ability, comorbidities, distress, and demoralization, with demoralization having the greatest impact (β = 0.408, p < .001). After adjusting for other variables, each one-point increase in demoralization score resulted in a 0.098-point increase in depressive symptoms score. Emotional problems were significantly associated with higher distress risk; patients with worry were 3.08 times more likely to have high distress risk. In the second phase, the navigation care group showed significant reductions in anxiety (92%), demoralization (75%), and distress (58%) levels post-intervention compared to the usual care group. Patient medical experience also significantly improved (OR = 1.418, p = .02).
Conclusion: The study highlights the greater impact of psychological over disease-related factors on depressive symptoms and distress risk in Taiwanese cancer patients. Early screening and intervention by nurse navigators can improve mental health and patient medical experience. Expanding the role and programs of nurse navigators across the healthcare system is recommended. |
