住院癌症病人之情緒篩檢

Screening for Emotional Distress Among Inpatients With Cancer

10.6550/ACP.201912_13(1_2).0003

王興豪(Sing-Hao Wang)；洪宜翔(Yi-Hsiang Hung)；范聖育(Sheng-Yu Fan)

簡式健康量表 ； 癌症 ； 困擾溫度計 ； 情緒困擾 ； 篩檢 ； Brief Symptom Rating Scale-5 ； cancer ； Distress Thermometer ； emotional distress ； screening

臨床心理學刊

13卷1/2期（2019 / 12 / 01）

25 - 38

繁體中文

目的：癌症病人會因為疾病或是治療而有情緒困擾。本研究欲探索：（1）困擾溫度計（Distress Thermometer, DT）的切分點；（2）住院癌症病人情緒困擾的比例；以及（3）情緒困擾的相關風險因子。方法：橫斷式研究，使用回溯性資料庫進行資料收集，共納入1,716位癌症病人。包括DT、簡式健康量表（Brief Symptom Rating Scale-5, BSRS-5）、人口學與疾病特性變項。以BSRS-5中度以上作為切分點，使用接收者操作特徵（receiver operating characteristic, ROC）曲線分析DT的最佳切分點；並使用邏輯式迴歸探索顯著的風險因子。結果：DT的最佳切分點為6分。DT與BSRS-5達情緒困擾的比例為29.89%與30.53%。有9.03%病人有自殺意念。顯著的風險因子有女性、自殺意念；頭頸部癌症與大腸直腸癌的風險較其他癌症低，與診斷無分期的病人風險較第四期低。結論：約三成的住院癌症病人有情緒困擾，需要進一步轉介與接受心理照護。

Objective: Patients with cancer have emotional distress because of cancer or cancer treatments. The aims of this study were to explore: (1) the cutoff point of Distress Thermometer (DT); (2) the prevalence of emotional distress among inpatients with cancer; and (3) the risk factors of emotional distress. Methods: A retrospective cross-sectional study was conducted (n = 1,716), and data collection from chart review included DT, Brief Symptom Rating Scale-5 (BSRS-5), and demographic and disease characteristics. The moderate and severe emotional distress was taken as the golden standard, and receiver operating characteristic (ROC) curve was used to identify the best cutoff point of DT. Logistic regression was used to identify the significant risk factors. Results: The cutoff of DT was 6. The prevalence of emotional distress were 29.89% and 30.53% in DT and BSRS-5 respectively, and 9.03% had suicidal ideation. The significant risk factors included female and suicidal ideation. In addition, patients with head and neck cancer and colorectal cancer had lower risk than those with other cancer, and patients with non-stage cancer had lower risk than those in stage IV. Conclusion: Around 30% of inpatients with cancer had emotional distress and they needed further referral and psychological care.

1. 王裕庭,楊延光,陳高欽,葉宗烈,陸汝斌(2008)。五題簡式精神症狀量表在綜合醫院住院病人的效度。台灣精神醫學，22(4)，316-321。
   連結：
2. Blázquez, M. H.,Cruzado, J. A.(2016).A longitudinal study on anxiety, depressive and adjustment disorder, suicide ideation and symptoms of emotional distress in patients with cancer undergoing radiotherapy.Journal of Psychosomatic Research,87,14-21.
3. Bujang, M. A.,Adnan, T. H.(2016).Requirements for minimum sample size for sensitivity and specificity analysis.Journal of Clinical and Diagnostic Research,10(10),1-6.
4. Bulli, F.,Miccinesi, G.,Maruelli, A.,Katz, M.,Paci, E.(2009).The measure of psychological distress in cancer patients: The use of distress thermometer in the oncological rehabilitation center of Florence.Supportive Care in Cancer,17,771.
5. Campbell, A.,Steginga, S. K.,Ferguson, M.,Beeden, A.,Walls, M.,Cairns, W.,Dunn, J.(2009).Measuring distress in cancer patients: The distress thermometer in an Australian sample.Progress in Palliative Care,17(2),61-68.
6. Carlson, L. E.,Angen, M.,Cullum, J.,Goodey, E.,Koopmans, J.,Lamont, L.,MacRae, J. H.,Martin, M.,Pelletier, G.,Robinson, J.,Simpson, J. S. A.,Speca, M.,Tillotson, L.,Bultz, B.D.(2004).High levels of untreated distress and fatigue in cancer patients.British Journal of Cancer,90,2297-2304.
7. Carlson, L. E.,Groff, S. L.,Maciejewski, O.,Bultz, B. D.(2010).Screening for distress in lung and breast cancer outpatients: A randomized controlled trial.Journal of Clinical Oncology,28,4884-4891.
8. Carlson, L. E.,Zelinski, E. L.,Toivonen, K. I.,Sundstrom, L.,Jobin, C. T.,Damaskos, P.,Zebrack, B.(2019).Prevalence of psychosocial distress in cancer patients across 55 North American cancer centers.Journal of Psychosocial Oncology,37,5-21.
9. Chen, W. J.,Chen, C. C.,Ho, C. K.,Lee, M. B.,Chung, Y. T.,Wang, Y. C.,Lin, G. G.,Lu, R. Y.,Sun, F. C.,Chou, F. H.(2009).The suitability of the BSRS-5 for assessing elderly who have attempted suicide and need to be referred for professional mental health consultation in a metropolitan city, Taiwan.International Journal of Geriatric Psychiatry,24,1151-1157.
10. Chiou, Y. J.,Chiu, N. M.,Wang, L. J.,Li, S. H.,Lee, C. Y.,Wu, M. K.,Chen, C. C.,Wu, Y. S.,Lee, Y.(2016).Prevalence and related factors of psychological distress among cancer inpatients using routine distress thermometer and Chinese health questionnaire screening.Neuropsychiatric Disease and Treatment,12,2765-2773.
11. Chiou, Y. J.,Lee, C. Y.,Li, S. H.,Chong, M. Y.,Lee, Y.,Wang, L. J.(2017).Screening for psychologic distress in Taiwanese cancer inpatients using the national comprehensive cancer network distress thermometer: The effects of patients’ sex and chemotherapy experience.Psychosomatics,58,496-505.
12. Fang, C. K.,Chang, M. C.,Chen, P. J.,Lin, C. C.,Chen, G. S.,Lin, J.,Hsieh, R. K.,Chang, Y. F.,Chen, H. W.,Wu, C. L.,Lin, K. C.,Chiu, Y. J.,Li, Y. C.(2014).A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer.Supportive Care in Cancer,22,3165-3174.
13. Grassi, L.,Johansen, C.,Annunziata, M. A.,Capovilla, E.,Costantini, A.,Gritti, P.,Torta, R.,Bellani, M.(2013).Screening for distress in cancer patients: A multicenter, nationwide study in Italy.Cancer,119,1714-1721.
14. Grassi, L.,Nanni, M. G.,Caruso, R.(2010).Emotional distress in cancer: Screening policy, clinical limitations and educational needs.Journal of Medicine and the Person,8,51-59.
15. Guan, B.,Wang, K.,Shao, Y.,Cheng, X.,Hao, J.,Tian, C.,Chen, L.,Ji, K.,Liu, W.(2019).The use of distress thermometer in advanced cancer inpatients with pain.Psycho-Oncology,28,1004-1010.
16. Hawkes, A. L.,Hughes, K. L.,Hutchison, S. D.,Chambers, S. K.(2010).Feasibility of brief psychological distress screening by a community-based telephone helpline for cancer patients and carers.BMC Cancer,10,14.
17. Holland, J. C.,Bultz, B. D.(2007).The NCCN guideline for distress management: A case for making distress the sixth vital sign.Journal of the National Comprehensive Cancer Network,5,3-7.
18. Lee, M. B.,Liao, S. C.,Lee, Y. J.,Wu, C. H.,Tseng, M. C.,Gau, S. F.,Rau, C. L.(2003).Development and verification of validity and reliability of a short screening instrument to identify psychiatric morbidity.Journal of the Formosan Medical Association,102,687-694.
19. Riba, M. B.,Donovan, K. A.,Andersen, B.,Braun, I.,Breitbart, W. S.,Brewer, B. W.,Buchmann, L. O.,Clark, M. M.,Collins, M.,Corbett, C.,Fleishman, S.,Garcia, S.,Greenberg, D. B.,Handzo, R. G. F.,Hoofring, L.,Huang, C. H.,Lally, R.,Martin, S.,McGuffey, L.,Darlow, S. D.(2019).Distress management, version NCCN clinical practice guidelines in oncology.Journal of the National Comprehensive Cancer Network,17,1229-1249.
20. Sharp, L.,Carsin, A. E.,Timmons, A.(2013).Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer.Psycho-Oncology,22,745-755.
21. Sun, H.,Thapa, S.,Wang, B.,Fu, X.,Yu, S.(2020).A systematic review and meta-analysis of the distress thermometer for screening distress in Asian patients with cancer.Journal of Clinical Psychology in Medical Settings
22. Teunissen, S. C. C. M.,Wesker, W.,Kruitwagen, C.,de Haes, H. C. J. M.,Voest, E. E.,de Graeff, A.(2007).Symptom prevalence in patients with incurable cancer: A systematic review.Journal of Pain and Symptom Management,34,94-104.
23. Wang, G. L.,Cheng, C. T.,Feng, A. C.,Hsu, S. H.,Hou, Y. C.,Chiu, C. Y.(2017).Prevalence, risk factors, and the desire for help of distressed newly diagnosed cancer patients: A large-sample study.Palliative & Supportive Care,15,295-304.
24. Wang, G. L.,Hsu, S. H.,Feng, A. C.,Chiu, C. Y.,Shen, J. F.,Lin, Y. J.,Cheng, C. C.(2011).The HADS and the DT for screening psychosocial distress of cancer patients in Taiwan.Psycho-Oncology,20,639-646.
25. Wang, Y.,Zou, L.,Jiang, M.,Wei, Y.,Jiang, Y.(2013).Measurement of distress in Chinese inpatients with lymphoma.Psycho-Oncology,22,1581-1586.
26. Watts, S.,Leydon, G.,Birch, B.,Prescott, P.,Lai, L.,Eardley, S.,Lewith, G.(2014).Depression and anxiety in prostate cancer: A systematic review and meta-analysis of prevalence rates.BMJ Open,4(3)
27. Watts, S.,Prescott, P.,Mason, J.,McLeod, N.,Lewith, G.(2015).Depression and anxiety in ovarian cancer: A systematic review and meta-analysis of prevalence rates.BMJ Open,5(11)
28. Youden, W. J.(1950).Index for rating diagnostic tests.Cancer,3,32-35.
29. Zabora, J.,BrintzenhofeSzoc, K.,Curbow, B.,Hooker, C.,Piantadosi, S.(2001).The prevalence of psychological distress by cancer site.Psycho-Oncology,10,19-28.
30. Zainal, N. Z.,Nik-Jaafar, N. R.,Baharudin, A.,Sabki, Z. A.,Ng, C. G.(2013).Prevalence of depression in breast cancer survivors: A systematic review of observational studies.Asian Pacific Journal of Cancer Prevention,14,2649-2656.
31. 台灣心理腫瘤醫學學會（2019 年 12 月 27日）。癌症心理照護指引。TPOS 台灣心理腫瘤醫學學會的部落格。https://bit.ly/3khLOBe
32. 衛生福利部國民健康署（2020年6月30日）。癌症醫療品質。衛生福利部國民健康署網站。https://www.hpa.gov.tw/Pages/List.aspx?nodeid=208

1. 鍾文珍(Wen-Jean Chung);張捷芸(Jie-Yun Jang);鄒榮慧(Rung-Huei Tzou);陳孟君(Meng-Chun Chen)(2024)。癌症病人於門診化療時之情緒困擾的改善專案。高雄護理雜誌。41(2)。23-33。 
2. 朱品嘉(Pin-Jia Zhu);陳佩君(Pei-Jyun Chen)(2024)。照顧一位有自殺意念口腔癌復發個案之居家護理經驗。彰化護理。31(3)。129-139。