2011-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/648208摘要：由於肝癌早期沒有症狀，診斷常僅能接受非手術治療方式；在台灣約有40%病患於首次診斷後，接受肝動脈栓塞、酒精注射、或放射頻消融術。但由於接受非手術治療之住院期間約 3-4天，臨床醫護人員多僅針對身體症狀困擾之處理，而忽視返家後自我照顧之需要以及後續照護。因此，此三年期計畫之研究目的： (1) 瞭解肝癌病患接受肝動脈栓塞、酒精注射、或放射頻消融術治療後返家自我照顧之需求改變；(2) 根據 (1)結果發展電話追蹤諮詢計畫，及評估其於肝癌病患接受非手術治療後之症狀控制自我效能、焦慮、憂鬱以及生活品質之成效。第一年採量性合併質性之縱貫式研究設計，於治療後二個月內共三次(出院前、出院後第四週、第八週)訪談，以了解肝癌病患於治療後需求改變。量性使用困擾處理評估表、醫院焦慮與憂鬱量表及Short form-12生活品質量表評估病患之困擾處理需求、焦慮及憂鬱以及生活品質程度。使用描述性統計、Pearson’s 相關性分析、逐步回歸分析，以了解照護需求與焦慮、憂鬱、生活品質之相關性，並分析生活品質之重要預測因子。質性部分，採半結構問卷之深度質性訪談及錄音，全程錄音逐字抄錄後，以內容分析進行資料整理。預估第一年訪談質性訪談15位及量性問卷填寫100位。第二、三年採隨機臨床試驗，於台北市某一醫學中心內科及腫瘤科病房，選取符合之研究對象，隨機分配至對照組或實驗組。對照組接受病房常規照護，而實驗組則進行七次(出院前、出院後第1、2、3、4、6、8週)之電話追蹤諮詢。將以症狀困擾量表、1疲倦症狀量表、醫院焦慮與憂鬱量表、癌症行為量表及Short form-12評估病患之症狀嚴重度、疲倦、焦慮及憂鬱、自我效能以及生活品質；問卷於出院前、出院後第8、12週進行施測以了解立即效果及維持效果。資料將以獨立t檢定、單因子變異數、以及廣義估計模式 (generalized estimating equations; GEE)進行分析。第二、三年實驗組與對照組各 48人，考量流失率30%，預計共訪談126位病患。預期結果:預期本研究結果可了解肝癌病患接受非手術治療返家後之需求以及電話追蹤諮詢於後續照護之成效，以作為未來臨床照護之參考。<br> Abstract: Taiwan, around 40% of those newly diagnosed liver cancer patients receive non-surgical treatment including transcathether hepatic chemoembolization (TACE), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA). However, during the average of 3 to 4 days’ hospitalization for receiving treatments, the health care providers mainly focus on control of physical distress and not on the needs for self care and aftercare following discharge. Therefore, the aims of this three-year study are to (1) explore the needs for home care after receiving TACE, PEI, and RFA, and (2) develop a telephone follow-up and consultation program and examine its effect on self-efficacy, anxiety, depression and quality of life in liver cancer patients receiving non-surgical treatment.In the first year, a longitudinal mixed method with quantitative and qualitative method will be used. In order to explore the change in needs in the patients, interviews will be conducted three times (the day before discharge, and during the fourth and eighth weeks after discharge).The Distress Management Tool, the Hospital Anxiety and Depression Scale, and the Short Form-12 quality of life will be used to assess patients’ care needs, anxiety, depression, and quality of life in the quantitative method. Data will be analyzed by descriptive, Pearson’s Correlation, and Stepwise Regression for each time point. Tape-recorded and in-depth interviews withsemi-structured interview guidelines will be used in qualitative method to interview the cancer patients who are scheduled to be discharged after treatment. Content analysis will be used to analyze the interview content. At least 115 subjects including 100 subjects in quantitative method and 15 subjects in qualitative method will be interviewed in the first year.In the second and third year, randomized control trial will be used to recruit eligible subjects from inpatients in oncology wards in one medical center in Taipei. The eligible subjects will be randomized into a control or experimental group. The patients in the control group will receive usual care and those in the experimental group will receive seven instances of telephone follow-up or face-to–face education (the day before discharge and during the first, second, third, fourth, sixth, and eighth weeks after discharge). The Symptom Distress Scale, the Fatigue Symptom Inventory, the Hospital Anxiety and Depression Scale, the Cancer Behavior Inventory, and the Short form -12 quality of life will be used to assess symptom distress, fatigue, anxiety, depression, self-efficacy, and quality of life on the day before discharge and during eighth, and twelfth weeks after discharge for examining immediate effect and maintaining effect of intervention. Data will be analyzed by independent t-test, one-way analysis of variance, and generalized estimating equations. Forty-eight subjects will be recruited in each group. Totally, 126 subjects will be approached interms of including a 30% dropout rate in the second and third years.We expect this study to explore the change in home care needs and the effect of a telephone follow-up program on aftercare in liver cancer patients after treatment. The results may provide information for clinicians to tailor interventions in clinical settings.肝癌需求電話追蹤非手術治療Liver CancerNeedsTelephone Follow-upNon-surgical treatment