中國醫藥大學機構典藏 China Medical University Repository, Taiwan:Item 310903500/604
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    題名: 測量攝護腺癌患者的生活品質：EORTC-C30及EORTC-PR25問卷之心理計量特質
    作者: 張玉君;Yu-Jun Chang
    貢獻者: 中國醫藥大學：環境醫學研究所
    關鍵詞: 攝護腺癌;傳統測量理論;項目反應理論;Rasch模式;歐洲癌症治療與研究組織生活品質核心問卷;歐洲癌症治療與研究組織攝護腺癌生活品質問卷;健康相關生活品質;Prostate cancer;Classical test theory;Item response theory;Rasch model;EORTC QLQ-C30;EORTC QLQ-PR25;Health-related quality of life
    日期: 2008-07-04
    上傳時間: 2009-08-11 16:56:16 (UTC+8)
    摘要: 目的：利用傳統測量與現代測量理論評估歐洲癌症治療與研究組織生活品質核心問卷（EORTC QLQ-C30）與攝護腺癌生活品質問卷（EORTC QLQ-PR25）兩份問卷應用在攝護腺癌（prostate cancer）患者的心理計量特質。
    材料與方法：本研究共計收案91名攝護腺癌（prostate cancer）患者，利用傳統測量與項目反應理論（item response theory, IRT）比較分析問卷各題目的特質，以適合度指標（infit statistic）檢驗各向度是否符合單一向度的假設，並檢驗每一題目的難度、門檻值範圍、適中性，以及問卷的信度；然後，再檢驗各題目在治療前後、不同疾病嚴重度或不同年齡族群中之心理計量特質是否相同。
    結果：問卷四向度內大多數的題目皆符合單一向度的假設，但題目難度分布的範圍除了性功能範疇稍難以外，其餘範疇題目對本研究之攝護腺癌患者而言均偏簡單而容易達成；問卷並不能有效區分不同疾病嚴重程度的患者，但發現有疼痛問題的患者，其整體生活品質較有影響。問卷詳列範疇平均分數與細項得分有助於提供更多臨床實證。接受根除性手術的患者手術後會產生排尿功能與治療相關的症狀，且身體功能、角色功能、社會功能等範疇等也連帶受影響；而放射治療組僅會發生排尿功能與治療相關的症狀，與治療相關的症狀在治療三個月後回復，而排尿功能則在治療六個月後也回復了；然手術組在這兩項直到治療後6個仍有區辨力。
    結論：兩問卷應用在攝護腺癌患者題目難度偏簡單且信度稍弱，與臨床指標的關連性較差，EORTC QLQ-PR25對臨床指標之區辨力較佳；症狀範疇的題目較能區辨反應性，以現代測量理論所估計的EORTC QLQ-C30及EORTC QLQ-PR25各題目難度與攝護腺癌患者健康相關生活品質的分佈情形，將可作為發展短式電腦適性測量的基礎，研究結果亦可提供臨床醫師用於診間診斷時瞭解究竟有哪些題目能夠用來預測攝護腺癌患者在功能及症狀相關之生活品質的改變情形。

    Objective: The aim of this study was to apply the classical test theory (CTT) and the modern test theory (MTT) to evaluate the psychometric characteristics of the European Organization for Research and Treatment of Cancer 30-item core quality of life questionnaire (EORTC QLQ C-30) and QLQ-prostate specific 25-item (EORTC QLQ-PR25) module in prostate cancer patients.
    Materials and Methods: There were 91 prostate cancer patients included in this study. We analyzed the characteristics of each item of the EORTC QLQ-C30 and EORTC QLQ-PR25 by CTT and IRT (item response theory). The infit statistics of Rasch model was used to examine the unidimensionality of each domain, and also evaluate the item difficulty, the range of item threshold, item targeting and the reliability of the two questionnaires. Furthermore, patients were measured before therapy and at 1, 3 and 6 months after the start of therapy and then compared each health-related quality of life (HRQoL) score of the post-therapy groups with the baseline scores. Finally, the item psychometric properties were examined for different groups stratified by age and disease severity.
    Results: Most of the items within each domain fitted the assumption of unidimensionality. The range of item thresholds for EORTC QLQ-C30 and EORTC QLQ-PR25 could not cover the range of the patients’ ability. The mean difficulties of functional domain of EORTC QLQ-PR25 were more difficult and the other domains were too simple for the prostate cancer patients. The HRQoL scores of EORTC QLQ-C30 and EORTC QLQ-PR25 could not discriminate patients from age and disease severity. The chronic pain in patients markedly reduced the global health-related quality of life. After radical prostatectomy for prostate cancer, prostate-specific antigen (PSA) of patients would return to the baseline but their HRQoL scores were rapidly reduced in most of the domains of EORTC QLQ-C30 and EORTC QLQ-PR25. Urinary and sexual functioning would not return to the baseline until 6 months after the therapy. While radiotherapy was used, patients were affected only in their sexual functioning domain and treatment-related symptom domain and it took just 3-6 months to return to baseline HRQoL.
    Conclusions: In general, both questionnaires showed a lower reliability in each domain and the mean difficulties were too simple for the prostate cancer patients. EORTC QLQ-PR25 has better discriminant ability on clinical indices than EORTC QLQ-C30. The symptom domain showed better discriminant validity. The distributions of item difficulty of EORTC QLQ-C30 and EORTC QLQ-PR25 and person ability can be used as the bases of developing short-form computer-adapted testing. The results can also be used by clinicians in daily clinical practice to determine items that can predict the impairment of quality of life related to function and symptom for prostate cancer patients.
    顯示於類別:[環境醫學研究所(已停用)] 博碩士論文

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