影響癌友生活品質因素的研究：檢視增權條件的調節效果

An examination of the direct and mediating effects of empowerment factors on the quality of life among cancer survivors

目標：在存活率提升的趨勢下，癌症逐漸成為一種慢性疾病，也延長了患者與癌症共存的時間，癌友的中長期生活品質成為全人醫療照顧的工作焦點之一。本研究旨在探討癌友生活品質的影響因素，以及因素間的交互作用，以期找尋有效介入的工作取向。方法：本研究利用結構式問卷，探討罹癌一年以上、結束急性治療之癌友的生活品質。運用台灣簡明版世界衛生組織生活品質量表來蒐集生活品質資訊，用中文化增權量表、社會支持多面向量表來測量癌友生活品質的增權條件。最後，採用階層式複迴歸和組間差異調節檢驗模型來檢視影響生活品質的各個因素，以及因素之間的交互作用。結果：研究發現經濟狀況與增權條件是影響癌友生活品質的主要因素，其中增權條件對於癌友的生活品質具有直接的正向作用，也可調節經濟狀況對於環境範疇生活品質的影響力。結論：既然增權為促進癌友生活品質的重要因素，而增權條件的效果又立基於癌友的經濟安全基礎上，未來癌友的中長期生活品質之維護，除了增權的方法外，也應同時考量癌友的經濟風險對於增權策略的影響。

Objectives: In recent years the cancer survival rate has followed a steady upward curve. Indeed, a cancer diagnosis is no longer a death sentence. Rather, cancer is a chronic disease for which patients are in need of long-term care. With respect to whole person care, the quality of life amongst cancer survivors has become one of the major intervention targets to promote well-being. The current study determined how empowerment dynamics impact cancer survivor quality of life. Methods: A structured questionnaire was used to determine the relationship between empowerment and quality of life amongst cancer survivors. Three scales (the Chinese version of the WHOQOL-BREF, empowerment scale, and MSPSS) were used to measure the main variables. Cancer survivors at least 1 year post-treatment were invited to participate in the interview. Block regression and simultaneous regions of significance methods were used to test the specification model and mediating effect on the variable relationship. Results: The economic status of cancer survivors and empowerment were shown to be two main predictors of the quality of life among the other variables. The level of survivor empowerment has a positive and direct effect on promoting the quality of life in all domains. Moreover, the level of survivor empowerment can moderate the economic effect on the quality of life within the environment domain. Conclusions: These results suggest that empowerment is a key factor for better quality of life amongst cancer survivors. The empowerment effect had a greater impact on patients who had a better economic status. Therefore, a powerful total cancer care strategy should be based on the empowerment plan, while taking long-term economic risks of cancer survivors and social disparities into consideration. Not only should empowerment-oriented services be offered, but additional financial care should be arranged for the vulnerable population.