頭頸癌病人之家屬照顧者害怕癌症復發--中文版量表測試、現況及相關因素之探討

Abstract

研究背景與目的：頭頸癌是台灣男性前五大癌症致死疾病，害怕癌症復發是病人及其家屬照顧者最關注及擔憂的心理困擾。本研究目的為：(1)建立與檢測家屬照顧者害怕癌症復發中文量表之信效度，及(2)探討頭頸癌病人之家屬照顧者害怕癌症復發的現況及相關影響因素。研究方法：橫斷式研究設計，採立意取樣，於北部某醫學中心放射腫瘤科門診收案，以頭頸癌病人與其家屬照顧者為研究對象，共215對病人及其家屬照顧者。統計分析：第一部份採用驗證性因素分析與皮爾斯相關，進行量表信效度的檢測。第二部份採用t檢定、變異數分析、皮爾斯相關及階層多元迴歸進行資料分析。研究結果：(1)照顧者害怕癌症復發中文版量表具有可接受的內在一致信度及再測信度。驗證性因素分析顯示量表由7個子量表所組成。總量表與焦慮及憂鬱具有同時效度，與生理層面生活品質具有分歧效度。(2)最常觸發照顧者害怕癌症復發的情境是病人感到身體不適或生病的時候。影響照顧者害怕癌症復發之嚴重度最大的是，不相信病人的癌症已治癒且不再復發。當照顧者害怕病人癌症復發時，最常採取的再確認及因應策略，分別是陪病人去醫院或診所做檢查，及說服自己正向思考。(3)病人年齡、慢性疾病、收入、曾癌症復發/轉移，及完成治療距今時間；照顧者教育程度、收入，及宗教信仰與照顧者害怕癌症復發總量表或7個子量表有顯著相關。照顧者害怕癌症復發與病人癌症相關疼痛、疲倦及干擾呈顯著正相關；與病人生理安適及頭頸癌關注健康相關生活品質呈顯著負相關。照顧者害怕癌症復發與其社交抑制及負向情感之D型人格特質呈顯著正相關；與其實質性、情緒/訊息性及整體性社會支持呈顯著負相關。(4)病人的平均疲倦強度及照顧者的負向情感人格特質，對照顧者害怕癌症復發之觸發具有顯著影響力；病人的癌症曾復發/轉移、平均疲倦強度及家屬照顧者的負向情感人格特質，對照顧者害怕癌症復發之嚴重度具有顯著影響力。結論與實務運用：本研究結果建立具有信效度之照顧者害怕癌症復發施測工具，可提供臨床評估照顧者害怕癌症復發。未來可針對照顧者害怕家人癌症復發之長期變化進行評估，設計有助於減緩照顧者害怕癌症復發困擾有效因應資源之處置。

Research background and aims: Head and neck cancer (HNC) is one of the top five fatal diseases among men in Taiwan. Fear of cancer recurrence (FCR) is identified as the most concern and psychological distress for patients and their family caregivers (FCs). The purposes of the study were: (1) to examine psychometric properties of the Chinese version of Fear of Cancer Recurrence Inventory-Caregiver version (FCRI-c); (2) to identify current status and factors associated with fear of cancer recurrence in family caregivers of patients with HNC. Research Design: A cross-sectional study with purposive sampling was conducted. Patient-family caregiver dyads were recruited from the outpatient radiation department of a medical center in northern Taiwan. A total of 215 patient-family caregiver dyads were recruited in this study. Statistical analysis: In the first part, confirmatory factor analysis (CFA) and Pearson correlation were used to analyze the reliability and validity. In second part, the data analysis was conducted with t-test, Pearson correlation, ANOVA, and hierarical multiple regression. Results: (1) The FCRI-c had acceptable internal consistency and test-retest. The FCRI-c had construct validity, supported by seven factors. The FCRI-c had concurrent validity, supported by the FCs’ anxiety and depression. The FCRI-c had divergent validity, supported by the FCs’ physical quality of life; (2) The trigger of FCR is the most concerned part in caregivers, in particular, while patients had some physical distress or got sick. FCs’ FCR is also reflected in the severity of worry about metastasis and recurrence. FC cope with FCR by accompanying with patient going to the hospital or clinic for examinations and convincing themselves positively; (3) The factors significantly correlated with the FCRI-c or its seven subscales were: patient’ age, chronic disease, income, cancer recurrence or metastasis before, and time since completion of treatment; FCs’ education, income, and religion. Negative associations were found between FCs’ fear of recurrence, patients’ cancer-related pain, fatigue, and related distress; a significant negative association was also found between FCs’ fear of recurrence, patients’ physical wellbeing, and head & neck concern. Positive associations were found between FCs’ fear of recurrence and FCs’ social inhibition and negative affective of D-type personality; a significant negative association was also found between FCs’ fear of recurrence and FCs’ tangible, emotional/information, and overall social support; and (4) Factors significantly related to FCs’ triggers of FCR were patients’ average fatigue, and FCs’ negative affect of D-type personality trait; Factors significantly related to FCs’ severity of FCR were patients’ cancer recurrence or metastasis before, patients’ average fatigue, and FCs’ negative affective of D-type personality trait. Conclusion and clinical practice: The FCRI-c is a valid instrument to provide healthcare providers to assess FCs’ fear of cancer recurrence. Future research should use Longutidinal follow up and and additional interventions related to effective coping resources are needed.