肝癌病患不確定感之相關因素探討

Uncertainty and its Related Factors among Liver Cancer Patients

本研究目的在探討肝癌病患不確定感與症狀困擾。採橫斷式相關性研究設計，以立意取樣方式針對南部某醫學中心住院治療的70位肝癌病患進行收案，以許、黃(1996)所翻譯信效度良好的Mishel「疾病不確定感量表」及參考賴氏(1998)中文精簡修正版信效度良好的「症狀困擾量表」進行結構式問卷調查。研究結果顯示：肝癌病患在住院期間其不確定感屬於中等程度，其中以「我不知道下一步會發生什麼事」為其主要不確定原因，而疲倦為其症狀困擾之最，且發現症狀困擾與不確定感呈現顯著正相關，即自覺症狀困擾越高，不確定感程度也會增加。此外，信仰道教的肝癌患者比信仰基督教者有顯著較高的疾病不確定感，而症狀困擾、栓塞次數二個變項有意義的解釋25.4％不確定感的總變異量，其中症狀困擾為不確定感最重要的預測因子。因此建議未來研究可藉由護理介入措施，如加強疾病認知、疾病進展和症狀處置等相關治療衛教，降低肝癌病患的症狀困擾程度，以減少其不確定感。

The purpose of this study was to explore the factors associated with uncertainty and distress symptoms among liver cancer patients. This cross-sectional design was conducted with a purposive sampling of 70 liver cancer patients at a medical center in southern Taiwan. Structure questionnaires were designed by modifying the instruments of Hsu and Huang translated Chinese Mishel Uncertainty Scale, and Lai translated Chinese Symptom Distress Scale. Both scales have been shown to have good reliability and validity. Results showed that liver cancer patients’ uncertainty was in the moderate level. Uncertainty among liver cancer patients mainly related to changes in their lives. Additionally, fatigue is the major symptom distress for liver cancer patients. A positive significant relationship was found between uncertainty and symptoms distress, indicating that liver cancer patients who perceived more symptom distress also had higher uncertainty. Patients who practice Taoism had a higher degree of uncertainty than those who believed in Christianity. Furthermore, symptom distress and the frequency of thrombosis explained 25.4% of the variation in uncertainty. Among these predictors, symptoms distress was the most important predictor, explaining 20.1% of the variance of uncertainty. The investigators recommended that nursing intervention such as education which can strengthen disease cognition, disease progress, and symptom management may lessen symptom distress in order to decrease uncertainty for liver cancer patients.