初次接受化學治療之癌症病患憂鬱、連續性照護與生活品質相關因素之探討

背景：癌症連續多年為臺灣十大死因之首，根據2023年衛生福利部國民健康署統計，癌症死亡人數達51,927人，占總死亡人數的24.9%。接受化學治療的癌症病患，常因治療程長與藥物副作用，常面臨生理不適與心理壓力，尤其是初次接受化療患者，因缺乏治療經驗與對療程預後的不確定性，容易產生憂鬱症狀，進而影響其生活品質。憂鬱症狀會降低患者的心理適應能力，亦可能降低治療依從性，增加疾病惡化與死亡風險，對患者整體預後影響重大。連續性照護是透過跨專業團隊協作與資訊整合的照護模式，能有效提升患者心理支持與生活品質。然而，針對初次接受化療患者憂鬱與連續性照護的相關性研究仍屬有限。因此，本研究旨在探討初次接受化療患者的憂鬱程度、連續性照護與生活品質之間的相關性，期能提供臨床實務參考，進一步優化癌症病患的照護策略。目的： 探討初次接受化學治療癌症病患的社會人口學特徵、疾病特性、憂鬱與連續性照護對生活品質的相關性，並分析影響生活品質的重要預測因子。方法： 本研究採橫斷式相關性研究設計，透過便利取樣法，於中部某醫學中心及區域教學醫院之腫瘤科病房，收集年滿20歲且初次接受化學治療之癌症病患資料，共納入180位有效樣本。研究工具包含社會人口學特徵與疾病特性問卷、短版CES-D憂鬱量表、連續性照護量表及WHOQOL-BREF生活品質量表。資料以SPSS 25.0進行描述性統計、皮爾森積差相關分析與多元逐步回歸模型，探討憂鬱、連續性照護對生活品質的影響及關鍵預測因子。。預期結果：多元逐步迴歸分析結果顯示，憂鬱總分、連續性照護總分、ADL總分、IADL總分、工作狀況、BMI、教育程度及住院天數為影響生活品質的重要預測因子。憂鬱總分具有最大的解釋力，可解釋 44.1% 的變異量，其次為連續性照護總分（12%）、IADL總分（9%）、ADL總分（9%）、工作狀況（4%）、BMI（4%）、教育程度（2%）及住院天數（1.3%）。這些變項對生活品質的整體解釋力達 53.4%（F = 46.315，p < 0.001）。此外，憂鬱與生活品質呈顯著負相關（r = -0.61，p < 0.001），連續性照護與生活品質則呈顯著正相關（r = 0.35，p < 0.001），顯示心理健康與持續性照護在提升病患生活品質方面的重要性。結論/實務應用： 本研究確認憂鬱症狀、連續性照護品質、BMI、教育程度、工作狀況與住院天數等多項因素為影響初次接受化學治療癌症病患生活品質的重要預測因子，憂鬱程度與生活品質呈顯著負相關，連續性照護與生活品質呈顯著正相關，顯示心理健康與連續性照護在提升病患生活品質中的重要性。建議臨床護理人員定期使用標準化工具（如短版CES-D量表）進行憂鬱篩檢，為高風險病患提供個別化心理支持與早期介入，包含心理諮詢、行為治療與必要的藥物干預。同時，透過多專業團隊協作優化連續性照護模式，加強醫療資訊傳遞與病患溝通。此外，針對BMI偏低與教育程度較低者，提供營養支持與適宜的衛教資料，以改善病患整體生活品質。

Background: Cancer remains the leading cause of death in Taiwan, with 51,927 deaths reported in 2023, accounting for 24.9% of total mortality. Chemotherapy, particularly for first-time patients, often results in significant physical discomfort and psychological stress due to the lack of prior experience and uncertainty about treatment outcomes. These factors increase the risk of depression, which adversely affects quality of life (QoL) and may reduce treatment adherence, exacerbating disease progression and worsening prognosis.Continuity of care (CoC), involving multidisciplinary collaboration and integrated information management, has been shown to improve psychological well-being and QoL. However, limited research has examined the relationship between depression, CoC, and QoL in first-time chemotherapy patients. This study aims to investigate these associations and provide evidence-based guidance to enhance clinical care strategies..Objective: This study aims to explore the relationships between sociodemographic characteristics, disease factors, depression, and continuity of care (CoC) in relation to quality of life (QoL) among first-time chemotherapy cancer patients. It also seeks to identify key predictors of QoL to support better clinical care and improve patient outcomes..Methods: This cross-sectional study recruited 180 cancer patients aged 20 or older receiving initial chemotherapy. Participants were selected by convenience sampling from oncology wards of a medical center and a regional teaching hospital in central Taiwan. Data were gathered through structured questionnaires on sociodemographic and disease characteristics, depression (CES-D short version), continuity of care (CoC), and quality of life (WHOQOL-BREF). SPSS 25.0 was used for analysis, applying descriptive statistics, Pearson correlation, and multiple stepwise regression to identify key factors influencing QoL..Expected results: Multiple stepwise regression analysis is expected to identify depression, continuity of care (CoC), ADL, IADL, employment status, BMI, education level, and hospital stay as key predictors of quality of life (QoL) in first-time chemotherapy patients. Among these, depression is likely to have the strongest influence, explaining 44.1% of the variance, followed by CoC (12%), IADL (9%), ADL (9%), employment status (4%), BMI (4%), education (2%), and hospital stay (1.3%). Collectively, these predictors are expected to account for 53.4% of the variance in QoL (F = 46.315, p < 0.001). Depression is expected to have a significant negative correlation with QoL (r = -0.61, p < 0.001), while CoC is expected to show a positive correlation (r = 0.35, p < 0.001), underscoring the importance of mental health support and consistent care in improving QoL..Conclusion/Practical applications: This study found that depression, continuity of care (CoC), BMI, education level, employment status, and hospital stay were key factors influencing the quality of life (QoL) in first-time chemotherapy patients. Depression had the greatest negative impact on QoL, while CoC contributed positively, highlighting the need to address mental health and maintain consistent care. Regular depression screening using validated tools, such as the CES-D short version, is recommended, along with personalized psychological support through counseling, behavioral therapy, and medication when needed. Strengthening CoC by promoting teamwork among healthcare providers, improving communication, and ensuring proper information sharing is essential. For patients with low BMI or lower education levels, providing nutritional support and clear, practical health education can help enhance their QoL.