頭頸部癌症病患溝通表達與生活品質之探討
Communication and Quality of Life in Head and Neck Cancer Patients
中文摘要
頭頸部癌症中口腔癌死亡率佔5.28%，為所有癌症死亡原因第七位，喉癌死亡
率佔1.97%，佔男性癌症死亡原因第十五位，比女性（0.10%）多。頭頸部癌症 病患經手術治療後對於溝通的適應在術後期間是多變的，喪失溝通的聲音造成 情緒及社交的改變，進而導致頭頸部癌症病患的退縮、焦慮及降低生活品質。國 內對於頭頸部癌症病患溝通情形並未有更深入的探討。因此採橫斷性描述相關性 研究設計，探討頭頸部癌症病患的溝通表達及生活品質的變化。
本研究於94 年 11 月至 95 年 3 月期間，以立意取樣方式共收案 63 位個案，研究 對象為台北某醫學中心之頭頸部癌症病患。以結構式問卷訪談，問卷包括病患基 本資料、頭頸部癌症病患溝通能力評估問卷、頭頸部癌症病患溝通自我評估量表
華盛頓生活品質量表。資料以SPSS 統計軟體進行描述性統計（包括次數分配、
平均值、標準差、百分比）、皮爾森積差相關（Pearson’s correlation）、單因子變 異數分析（One-WAY ANOVA）。
研究結果發現，病患平均56.9 歲，以口腔癌最多。頭頸部癌症病患溝通的能力
及溝通經驗自我能力好。溝通的一般狀況子量表以您是一位主動、較外向、健談 的人，得分最高。以與周圍的人說話時會感到輕鬆自在，得分最低；溝通的環境 狀況子量表以在一大群人的環境及在吵鬧或喧嘩的地方說話最困難；溝通的態 度狀況子量表以因為說話方式常常及總是限制社交生活或個人生活。頭頸部癌症 病患生活品質量表以病患咀嚼問題影響生活品質最大。人口學特性及疾病治療特 質與溝通方式的能力評估狀況、溝通經驗自我評估狀況、生活品質量表之相關性 與年齡、職業、疾病分類、手術方式、腫瘤分期、溝通方式等有顯著相關，並且治 療方式、溝通方式、手術治療後時期均受生活品質的影響。
研究結果顯示，周圍環境及病患對於溝通的態度二項因素會影響溝通的學習。護 理人員及家屬應該更有耐心及愛心，提供安靜的環境及鼓勵病患繼續學習溝通 方式，以提高病患的生活品質，達到身、心、靈的和諧。
英文摘要
Oral cavity cancer and laryngeal cancer are two major head and neck cancers in Taiwan. The impacts of surgery and disease on head and neck areas may influence patients’ communication. However, there is little research to examine this issue in Taiwan. Therefore, the purposes of the cross-sectional description correlation study are to examine the level of communication and changes of quality of life in head and neck cancer patients receiving surgery.
A total of 63 subjects were recruited from a medical center in Taipei. We interviewed
patients to assess patients’ background information, level of communication ability, self-evaluation of experience after laryngeal/ oral cancers (SECEL), and quality of life (measured by University of Washington Quality of Life (UWQOL). The data was analyzed by descriptive statistics, Pearson’s correlation, Analysis of Variance (ANOVA).
The average age of the patients was 56.9 years. Majority of subjects were oral cavity cancer. In general, these patients perceived good ability and experience in
communication were good. However, the results showed that patients had relatively difficulties to communicate in crowded or noisy places. Disability of chewing is the most important factor to influence patients’ quality of life. Types of surgery, time since treatment, type of communication, level of communication ability and the self- evaluation of experience of communication were found to be significantly associated to patients’ quality of life. The results of this study showed that the environment and patients’ attitudes toward communication can affect learning of communication.
Nursing staff and family members should help patients to build a quieter environment, encourage patients to learning how to communicate well after surgery, and to enhance the ability of chewing or change of food preparation to improve their quality of life.
