本研究目的為使用個人化生活品質評量表直接權重版(SEIQoL-DW)，評估國內血液透析患者的個人化生活品質，探討對其特別重要的生活品質向度與相關影響因素，此外，並以Locke(1969, 1976)(引自Wu & Yao,2006b)的「情感間距假設」、Calman(1984)的期望理論與Wu(2009)提出的移轉傾向指標為基礎，探討SEIQoL-DW重要性評估程序的應用價值與潛在臨床應用指標。研究對象以立意取樣，自台北市松山區某私人洗腎中心募集57名血液透析患者、以及台北市文山區一般社區成人60名，研究工具包含SEIQoL-DW、生活滿意度量表、焦慮與憂鬱評量表、自編人口背景/疾病變項問卷，統計方法含描述性統計、卡方檢定、相關分析、平均數差異檢定與迴歸分析。研究結果發現，血液透析患者最常列舉的重要生活向度為健康(77%)，其次依序為家庭(72%)、經濟(65%)、人際關係(53%)、休閒活動(49%)、因應/正向態度(23%)、工作/學業(21%)、心理健康(16%)、生活條件(16%)、靈性/信仰(9%)、角色功能(9%)、其他(9%)，血液透析患者在各向度提名百分比與一般成人組未有顯著差異，但血液透析患者對健康向度的現況評比顯著較低，對健康的現況-期望落差也顯著較高，共病數與血液透析患者個人化生活品質指標有顯著負相關；而SEIQoL-DW項目重要性對項目現況分數與整體滿意度之間的關係不具調節效果，SEIQoL-DW的權重程序未能提升對整體滿意度的解釋力，此外，自項目重要性與現況-想望落差所得移轉傾向指標，和整體生活滿意度、SEIQoL-DW現況平均數亦未有一致的相關性或獨特解釋力。儘管本研究不支持SEIQoL-DW權重程序或衍生指標的助益，但若從個人脈絡來看，向度重要性仍可協助探索個案生活目標重要順序，有其臨床醫療應用價值；最後，SEIQoL-DW個人現況-想望落差分數、現況平均數、以及整體生活滿意度、負向情緒彼此有顯著關聯性與解釋力，在個案生活滿意度、負向情緒評估或介入方案中，具有成為臨床應用指標的潛力。 / The primary purpose of this thesis was using the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) to explore hemodialysis patients’ Individual Quality of Life and relative determinants. And further using affect-range hypothesis (Locke, 1969, 1976), expection theory (Calman,1984) and shifting tendency Index(Wu, 2009) as framework to evaluate SEIQoL-DW weighting procedure’s efficiency and potential clinical application variables. 57 hemodialysis patients and 60 counterparts was recruited from Taipei city, IQoL was assessed by SEIQoL-DW, the general life satisfaction and anxiety /depression statement was chosen as criterian variables. In the analysis, twelve quality of life domains were identified. Health(77%), family(72%), finance(65%), relations(53%) and leisure time(49%) were the most prominent quality of life domains of hemodialysis patients, although the domains nominated percentage and importance rating didn’t differ between groups, hemodialysis patients’ health domain status and have-want discrepancy were worse than the counterparts. Among the investgated variables, only the comorbidity had negative correlation with hemodialysis patients’ IQoL. The result didn’t support the SEIQoL-DW’s weighting procedure and shifting tendency Index had significant efficiency, but the weighing information could still be useful in personal profile context. Finally, the personal have-want discrepancy, satus average, general life satisfaction and anxiety/depression statement have significant relations with each other, thus could be the potential clinical application variables in negative emotion or life satisfaction intervention programs.

健康相關生活品質越來越重視病人主觀的感受，然而將這個部分納入測量之後，許多研究結果卻出現殘疾悖論(disability paradox)的現象，也就是重度疾病病人的自評生活品質並不比程度輕微或甚至健康的人差。反應轉移理論認為，造成這個現象的原因在於個人的自評生活品質會受到個體對於生活品質定義的改變（重新構念）、內在測量尺度標準的改變（重新校準）、以及價值的改變（重新權重）的影響，到目前為止，反應轉移尚未發展出合適的測量工具。 SEIQoL-DW (Schedule for the Evaluation of Individual Quality of Life- direct weighting)做為一個生活品質測量個人化的代表，其評估分成三個步驟，分別是提名重要的生活領域、評估提名領域的滿意程度、以及評估提名領域的相對權重，許多研究者嘗試用SEIQoL-DW在兩點間的領域變化做為重新構念，權重變化做為重新權重，重新校準則需要搭配then test來測量，then test是在第二個測量點時邀請受試重新對第一個時間點的提名領域進行評估，然而這三個成分指標的操作型定義不一，then test也有使用上的不便，同時過去這些指標對生活品質的效用檢驗也都未達顯著。本研究分認為，若能解決上述的問題，將有助於解釋殘疾悖論，同時可以區辨不同類別病人的反應轉移模式，並運用在臨床來幫助病人進行調適。 本研究以立意取樣招募3期以上之慢性腎臟病患者、以及血液透析、腹膜透析未滿一年以上之三組病患共85名，除了背景和臨床資料外，在間隔三個月的兩點分別填寫SEIQoL-DW、ideal scale（評估期待）、生活滿意問卷、正負向情緒問卷，並在後測時填寫then test。研究結果顯示，三組病人的生活品質符合殘疾悖論，並無顯著差別。重新構念、重新校準、和重新權重當中，僅重新校準有助於生活品質的提升，並能夠顯著解釋生活品質的改變。 對腎臟病患者來說，期待越高，生活品質提升得越多，進一步的分析顯示，受試會捨棄相對權重較低的領域，新提名領域的滿意程度、期待、和相對權重都顯著高於捨棄的舊領域，這可以作為臨床上協助病人調適的策略。雖然then test的結果顯著，但實證結果和理論卻相當混亂，尚待未來研究釐清。 / Health-related quality of life (HRQoL) is increasingly recognized as being subjective, which emphasized patient-reported outcomes. Many HRQoL studies reported that people with serious illness perceived no less quality of life (QoL) than those without such illness. This phenomenon is labeled as disability paradox. Response shift theory provides an explanation for it and refers to a change in the meaning of one’s self-evaluation of QoL as a result of changes in internal standards (recalibration), values (reprioritization), and reconceptualization of QoL. It is these changes that will influenced perceived QoL. Current methods to detect Response Shift are still evolving. SEIQoL-DW (Schedule for the Evaluation of Individual Quality of Life- direct weighting) is one of individualized QoL instruments and measures three elements of QoL, including five important aspects of life, current satisfaction with each aspect, and relative importance of each aspect. Many researchers tried to use SEIQoL-DW to detect response shift. Changes in the content of aspects of life between two time points reflect reconceptualization. Changes in the relative weighting between two time points reflect reprioritization. Recalibration is measured by then test, which is a method by asking respondents at time two to provide a renewed rating of their aspects of life given at time one. However, there are no consensus operational definition of indices of reconceptualization , reprioritization, and recalibration. The examination between indices and improvements in QoL was not significant, either. Besides, then test with SEIQoL-DW has a disadvantage when aspects nominated between time one and two are different. This study tried to resolve issues above. If these issues are resolved, disability paradox will be explained. Response Shift will possibly differentiate patients of various disease, and provide ideas to help patients adjust to illness. 85 patients were recruited, including those with renal disease stage 3-5, and those undergoing hemodialysis or peritoneal dialysis within one year. All patients completed SEIQoL-DW, ideal scale, Satisfaction with Life Scale, the Positive And Negative Affect Scale at time one and three months after , except questionnaire on personal background and biological information (at time one) and then test (at time two). Results indicated that the QoLs of these three groups of patients showed no different, which confirmed disability paradox. Only recalibration showed helpful. Regression analyses also showed that recalibration indices were better predictors in QoLs. For End-stage Renal Disease patients, higher expectation suggested higher QoL improvement. Further analysis showed that patients would abandon lower-weighted aspect of life. Compared to the abandoned aspects, higher satisfaction, expectation and weighting were seen in new-nominated aspect. This finding could be useful in helping patients adjust. Although then test also reached significance, evidences was contradicted to its prediction. More research is needed in the future.