肝癌病患人格特質與疾病不確定感之探討

Abstract

肝癌對國人的威脅仍居高不下，目前是國人男性癌症死因之首位及女性癌症死因第二位，且肝癌易復發的特性，使病患在肝癌存活期間，始終伴隨著不確定感；然而，病患的人格特質可能影響其對不確定感之評價進而影響病患的生活品質。因此，本研究旨在瞭解肝癌病患之人格特質及不確定感現況及其相關性，並探討影響疾病不確定感之重要因素。本研究為橫斷式之相關性研究，採立意取樣於台北市某醫學中心肝膽腸胃內科及外科門診之肝癌存活者。研究工具以結構式問卷，包含個人基本屬性問卷、症狀困擾量表、Mishel疾病不確定感量表－社區版及D型人格量表進行資料收集，並以SPSS 18.0進行描述性及相關性分析及廣義概化推估方程式。收案時間自100年2月至5月，共收案163名。研究結果發現肝癌病患於存活期面臨輕度症狀困擾及中度之疾病不確定感，及輕度的負向情緒及社交壓抑。年齡愈輕、身體功能愈差、罹患C型肝炎、罹患C型肝炎時間愈長及接受治療次數愈少者，其負向情緒傾向愈高；社交壓抑傾向則與人口學變項及疾病特性間無相關。有19%的病患屬於D型人格，其感受症狀困擾也較非D型人格高，具有負向情緒及社交壓抑傾向的病患，其感受症狀困擾及疾病不確定感的程度也較高，同時年齡愈輕、身體功能狀態愈差、接受治療次數及復發次數愈多、距完成治療時間愈近、症狀困擾分數愈高者，其疾病不確定感程度愈高；且具備負向情緒傾向者（β = 0.283，p = 0.018）為疾病不確定感之最重要的影響因子。建議臨床護理人員，在照護年齡愈輕、身體功能狀態愈差、接受治療及復發次數較多、距治療時間愈近、症狀困擾較多及具備負向情緒及社交壓抑傾向之肝癌存活期患者時，需更深入了解其不確定感之來源，除身體症狀之照護外，也應評估心理層面及人格特質，並適當的給予衛教或支持、關心及協助，協助病患緩解其對疾病不確定感，以提升肝癌病患於存活期之生活品質。

The threat of Hepatocellular Carcinoma (HCC) remains high in Taiwan, and it is accounted for the top one of the cause of cancer death in male and the second in female. Due to its high recurrent rate, patients with HCC face the illness of uncertainty from diagnose stage to survival. In addition, personality affects how patients evaluate the uncertainty and thus affect their quality of life. However, there is no study to examine the relationships among symptom distress, personality, and uncertainty in survivors with HCC. The aims of this study were to (1) explore status and relationships among the symptom distress, personality and uncertainty in survivors with HCC, and (2) identify the significant factors for the illness of uncertainty. A cross-sectional correlated design was used and patients were recruited by purposive sampling from outpatient departments at a medical center in Taipei. A set of structured questionnaires were used to collect data including patients’ demographic data sheet, Symptom Distress Scale, Type D Scale-14 and Mishel Uncertainty in Illness Scale: Community Form. Data were analyzed by descriptive, correlations, and generalized estimating equation by SPSS 18.0 software. Totally, 163 patients were recruited. The results of this study found that: (1) the survivors of HCC experienced mild level of symptom distress and moderate level of uncertainty. (2) the patients who with younger age, poor performance status, fewer number of medical treatments, hepatitis C infection, and the longer period of hepatitis C infection had more tendency with negative affectivity; meanwhile, social inhibition was not correlated with any demographic or disease characteristics. (3)there were 19% of patients with type D personality. The patients with negative affectivity or social inhibition perceived higher level of symptom distress and uncertainty. Also, the patients with younger age, poor performance status, fewer number of medical treatments, more times of recurrence, time after completing treatment in years, and more symptom distress perceived higher level of uncertainty, and (4) negative affectivity(β= .283, p = .018)was the significant factor related to the uncertainty. Based on our study results, clinical nurses are suggested to pay more attention to those with higher risk factors of uncertainty in hepatocellular carcinoma survivors. Nurses should take care not only for the patients’ symptom distress, but also assessing their psychological problems and personality in order to understand the source of uncertainty, and provide them appropriate health education, mental support, and caring to help patients to reduce their uncertainty, and to have better quality of life.