碩士 / 國防醫學院 / 護理研究所 / 106 / Background
Gender is an independent predictor of patient’s quality of life and its related factor. The recovery from lung cancer and survival rate of women is better than men. Moreover, severity of post-operation symptoms differs in gender among lung cancer patients. Therefore, the research is focused on patient’s quality of life and its related factor after lung tumor resection on the basis of gender difference. To sum up, we are looking forward to providing more proper clinical nurse-caring from our research result.
Purpose
Based on gender difference, we realize the variation trend and situation of quality of life in terms of post-operation lung cancer patient’s physiologic index (which includes lung function and physical endurance), severity of symptom and caring needs. By observing them in three kinds of situations, before surgery, the day they’ve discharged and a month after surgery so as to understand the effect of related factors (physiologic index, severity of symptom, and caring needs) on quality of life.
Method
It is a descriptive and longitudinal study. The samples were taken from thoracic surgery ward and out-patient clinic in two medical centers which located on the north of Taiwan from December 18, 2017 to April 13, 2018. Also, the patients who are prepared for tumor resection are selected as our cases and we continuously follow their situation on the day they discharged and a month after surgery. Furthermore, we use structural questionnaires as our research tools which include Anderson Symptoms of Severe Symptoms Scale, Beck's Depression Scale, Supportive Care Needs Survey Profile, Quality of Life questionnaire, and the use of a pulmonary function machine to measure the patient's lung function and guiding patient to walk through the specific route which planned by researcher for six minutes. We compare and analyze all data by using Generalized Estimating Equation, GEE. The value p <0.05 is considered statistically significant.
Result
In physiologic index, the exercise endurance of women is worse than men before and after surgery (p=0.022 & p=0.044). After analyzed by GEE, the FVC of women are worse than men (p=0.020) on discharging day, the FEV1 of women are also worse than men on both discharging day and a month after surgery; however, the MVV of women are better than men (p=0.027) on a month after surgery.
In severity of symptom, the overall symptoms (p=0.010、p=0.006 & p<0.001) and and severity of daily life (p<0.001, p=0.034 & p < 0.001) and depression (p < 0.001, p < 0.001 & p = 0.009) are worse than men. After GEE polynomial regression analysis, the symptoms of women is worse than men after surgery.
In caring needs, the requirements of women’s overall needs (p<0.001, p<0.001 & p<0.001), physiologic and daily needs(p=0.002, p<0.001 & p<0.001), patient caring and supporting needs(p=0.005, p=0.020 & p=0.002), and psychological needs( p<0.001, p<0.001 & p<0.001) are higher than men. The pre-operative health system and information needs are lower than men's (p<0.001), and the health system and information needs are higher on the day of discharge and one month after surgery (p=0.002 & p=0.009). After GEE polynomial regression analysis, the overall care needs of women with lung cancer on discharge day and one month after surgery (p<0.001 & p<0.001), health system and information needs (p<0.001 & p<0.001) and physiology and daily life. The demand (p=0.002 & p<0.001) was higher in the men group and the psychological requirement is lower in the one month after surgery than in the men group (p=0.009).
In the quality of life, women's overall quality of life (p=0.003 & p=0.001), emotional functional facet (p<0.001 & p<0.001) and symptomatic facet (p<0.001 & p=0.034) are worse than men. Women functional dissection (p=0.022) and cognitive functional facet (p=0.009) were lower in men, and the functional facets are lower in men one month after surgery (p=0.034). After GEE polynomial regression analysis, the overall quality of life (p=0.005 & p<0.001) and cognitive functional facet (p=0.001 & p=0.008) in the women patients with lung cancer on the day of discharge and one month after surgery are worse than those in the men group. Emotional functional facets (p=0.001) and symptomatic facets (p<0.001) are worse on the discharge day than in the men group.
After controlling the time effect, women's exercise endurance, symptom severity, depression and overall care needs (p=0.036, p<0.001, p=0.024 & p=0.033) and other variables will affect the overall quality of life; men symptoms and severity of daily life and patient care and support needs (p < 0.001 & p < 0.001) will affect overall quality of life.
Conclusion
Lung cancer patient’s physiologic index (Before, After, and the discharged day), severity, caring needs and quality of life differ in gender. Thus, it can reduce patients risk of physiological dysfunction and severity after surgery by giving them guidance and caring personally. Knowing and solving caring needs of patient are significant. Also, we need to guide the patient who is received chemotherapy during treatment face to face, and encourage them to recognize and express their needs. If medical staffs offer proper care timely, it can improve patients physiologic function, reduce symptom and depression, satisfy caring needs in order to promote quality of life.
| Identifer | oai:union.ndltd.org:TW/106NDMC0563018 |
| Date | January 2018 |
| Creators | LEE, JHIH-CHEN, 李芷蓁 |
| Contributors | CHANG, NAI-WEN, 張乃文 |
| Source Sets | National Digital Library of Theses and Dissertations in Taiwan |
| Language | zh-TW |
| Detected Language | English |
| Type | 學位論文 ; thesis |
| Format | 247 |
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