肝癌患者不確定感、生活品質及其相關因素之探討

Exploring Uncertainty, Quality of Life and Related Factors in Patients with Liver Cancer

肝癌是國內男女性癌症死因之第一、二名，由於肝癌復發率高，易使病患出現不確定感，嚴重影響其生活品質。本研究目的在探討肝癌患者之人口學特性、疾病特性、不確定感與生活品質間之關係，以及生活品質之預測因素。採橫斷式的描述相關性研究法，在高雄某一醫學中心及一區域教學醫院進行，以立意取樣方式選擇近六個月內曾接受治療之門診肝癌患者110位為研究對象，以個人基本屬性問卷、中文版Mishel疾病不確定感量表、中文版生活品質量表（Functional Assessment of Cancer Therapy-Hepatobiliary Cancer, FACT-Hep）等進行資料收集。研究結果發現：肝癌患者的生活品質的平均值為125.36，不確定感的平均值為61.69，不確定感與生活品呈顯著負相關（r = -.51, p < .01）。男性、大於65歲以上、罹患肝癌三年以上、Child’A級、無合併症及無疼痛者，其生活品質較好。不確定感、Child-Pugh分級、疼痛及性別為生活品質之重要預測因子（F = 22.05, p < .001），可解釋總變異量的44%。本研究建議臨床人員評估病患的不確定感程度，並加強對病患的關懷與溝通，以改善肝癌患者的不確定感及生活品質。

Liver cancer is the leading cause of cancer death for both males and females in Taiwan. Because of its high rate of reccurrence, liver cancer patients experience uncertainty that seriously affects their quality of life. The purpose of this study was to explore the relationships between demographic and disease characteristics, uncertainty and quality of life (QOL), and to find the predictors of QOL in liver cancer patients. The study used a cross-sectional descriptive correlational design with the purposive sampling method to select 110 liver cancer patients who had received treatment within the previous six months at a medical center and a regional teaching hospital in Kaohsiung. The questionnaires used in the study included questions on personal and disease characteristics, the Chinese version of the Mishel Uncertainty in Illness Scale, and Chinese versions of QOL scales (FACT-Hep). The results were: The mean of QOL was 125.36 and the mean of uncertainty was 61.69 in liver cancer patients. Uncertainty was negatively associated with QOL (r = -.51, p < .01). Patients, who were male, aged over 65, had been diagnosed more than three years previously, had liver function in class of Child’s A, had no complications or pain, had better QOL. The predictors of QOL were uncertainty, Child-Pugh classification, pain, and gender, and it accounted for 44% of the variance in QOL. The study suggests that clinicians need to assess the degree of patients’ uncertainty and strengthen communication skills to improve uncertainty and QOL in liver cancer patients.