장루보유자의 불확실성과 삶의 질

Abstract

[한글]

본 연구는 장루보유자의 불확실성 정도와 불확실성 평가, 삶의 질의 정도를 확인하여 장루보유자의 불확실성에 대한 간호 중재를 통해 환자들의 삶의 질을 증진시키기 위한 간호 중재 프로그램 개발을 위한 기초자료를 제공하기 위한 목적으로 시행된 서술적 상관관계 연구이다.

연구 대상자는 대장직장암 수술 후 장루형성술을 시행 받은 장루보유자로서 2008년 4월 28일부터 6월 11일까지 서울에 소재해있는 3차 의료기관인 S병원에서 치료를 받기 위해 입원한 대상자와 치료 종결 후 추후 관리를 위해 대장암 전문 클리닉 및 외래를 방문한 장루보유자 55명이었다. 연구도구로 구조화된 설문지를 사용하였다. 불확실성 정도를 측정하기 위해 MUIS (Mishel's Uncertainty in illness Scale), 불확실성 평가양상을 측정하기 위해 불확실성 평가도구인 위험평가도구(danger appraisal scale)와 기회평가도구(opportunity appraisal scale), 삶의 질을 측정하기 위해 European Organization for Research and Treatment of Cancer-Quality of Life Core30(EORTC-QOL-C30)과 Colorectal Cancer-specific Core Questionnaire(EORTC-QOL-CR38)을 이용하였다.

수집된 자료는 SPSS 12.0프로그램을 이용하여 서술적 통계, t-test, ANOVA, Pearson's correlation Coefficient 로 분석하였다.

연구결과는 다음과 같다.

1. 장루보유자의 불확실성 정도는 165점 만점에 평균 95.18점(평균평점 2.88점)으로 불확실성 정도는 보통이었다.

장루보유자의 불확실성의 4가지 하위영역별 불확실성정도는 ‘애매모호성’은 42.35점(평균평점 3.26점), ‘불일치성’은 18.27점(평균평점 2.61점), ‘복잡성’은 17.51점(평균평점 2.50점), ‘불예측성’은 14.40점(평균평점 2.88점)순으로 ‘애매모호성’에 대한 불확실성이 가장 높게 나타났다.

장루보유자의 불확실성에 대한 평가의 경우 위험평가는 40점 만점에 평균 18.49점(평균평점 2.31점), 기회 평가는 35점 만점에 평균 14.09점(평균평점 2.01점)으로 위험평가가 기회평가보다 더 높게 나타났다.

2. 장루보유자의 전반적 삶의 질 점수는 100점 만점에 평균 45.0점으로 보통보다 낮았고, 점수가 높을수록 좋은 기능상태를 나타내는 기능영역은 100점 만점에 평균 55.31점으로 보통보다 약간 높았고, 점수가 높을수록 불편감 정도가 심해지는 증상영역은 평균 29.19점으로 보통보다는 낮아, 장루보유자의 삶의 질은 낮았다.

3. 장루보유자의 전체적인 불확실성이 높고 애매모호성과 불일치성이 높을수록 위험평가가 높아지고, 기회평가가 낮아짐을 알 수 있었다. 장루보유자의 불확실성 정도가 높을수록 전반적 삶의 질은 낮았다. 또한 애매모호성, 불일치성, 불예측성의 정도가 높을수록 전반적 삶의 질이 낮았다.

4. 남자 장루보유자보다 여자 장루보유자가 불일치성에 대한 불확실성이 높았다(t=5.010, p<.05). 종교가 있는 장루보유자가 종교가 없는 장루보유자보다 불예측성이 낮았다(t=4.991, p<.05). 대장암인 장루보유자가 직장암인 장루보유자보다 기회평가가 높았다(t=5.018, p<.05).

5. 장루보유자의 인구사회학적 특성 및 질병관련 특성과 전반적인 삶의 질, 기능영역, 증상영역과는 통계적으로 유의한 차이를 나타내지 않았다.

결론적으로 장루보유자의 불확실성 정도는 보통이었지만, 불확실성이 높을수록 불확실성에 대해 위험평가가 높았고 기회 평가는 낮았다. 장루보유자의 불확실성이 높을수록 전반적인 삶의 질은 낮았으며 또한, 불확실성에 대해 위험으로 평가할수록 전반적 삶의 질은 낮고, 불확실성에 대해 기회로 평가할수록 전반적 삶의 질은 높아지는 것을 알 수 있었다.

따라서, 장루보유자의 불확실성을 줄이기 위한 간호 중재 프로그램을 개발하되 불확실성에 대한 위험평가를 줄이고 기회평가를 높이는 프로그램을 개발하여 실무에 적용하는 것이 필요하다.

[영문]

This study examines the relationship between uncertainty, appraisal and quality of life in ostomates with colorectal cancer. This study employed a descriptive correlation and cross-sectional survey design research with the aim of providing basic material for developing a nursing mediation program to improve patients' quality of life by means of nursing mediation to alleviate uncertainty of ostomates based on measuring the degree and appraisal of uncertainty and quality of life.

The study subjects are ostomates who had stoma formation after colorectal cancer surgery. The subjects were a total of 55 ostomates with colorectal cancer who were recruited from one university hospitalized at a tertiary medical center, "S" hospital in Seoul during the period of April 28 ~ June 11, 2008, in addition to ostomates who were outpatients at a specialized colorectal cancer clinic and "S" hospital receiving follow-up care after finishing cancer treatments. Informed consent was obtained from each participant. A structured questionnaire was used. For uncertainty measuring, MUIS (Mishel's Uncertainty in Illness Scale) was used. We also made use of a danger appraisal scale and opportunity appraisal scale, which are uncertainty measuring tools, for measuring uncertainty estimation phase. The European Organization for Research and Treatment of Cancer-Quality of Life Core 30 (EORTC-QOL-C30) and the Colorectal Cancer-specific Core Questionnaire (EORTC-QOL-CR38) were used to measure quality of life. The collected materials were analyzed by descriptive statistics, t-test, ANOVA, and Pearson's Correlation Coefficient using an SPSS12.0 program.

The results of this study are summarized as follows :

1. The degree of uncertainty of ostomates averaged 95.18 points (average point :2.88) out of a total of 165 points, which was normal.

Regarding the degree of uncertainty of the 4 subordinate fields of ostomates?? uncertainty, scores were higher in order of "Ambiguity" 42.35 points (average point 3.26), "Inconsistency" 18.27 points (average point 2.61), "Complexity" 17.51 points (average point 2.50), "Unpredictability" 14.40 points (average point 2.88), placing "Ambiguity" as having the highest level of uncertainty.

In the case of estimating ostomates' uncertainty, danger appraisal averaged 18.49 points (average point 2.31) out of a total of 40 points, and opportunity appraisal averaged 14.09 points (average point 2.01) out of 35, indicating that danger appraisal was higher than opportunity appraisal.

2. With regard to the scores for QOL in "Global quality of life" for ostomates, the average was 45.0 points out of 100, which was lower than normal, and in the functional category, where higher scores are better, the average was 55.31 points out of 100, which was slightly higher than normal. In the symptoms category, where a higher score indicates a higher degree of discomfort, the average was 29.19 points, which was lower than normal, meaning the quality of life for ostomates was low.

3. We found that as the overall uncertainty, ambiguity and inconsistency for ostomates increased, danger appraisal increased as well, while opportunity appraisal become lower. The higher ostomates' uncertainty, the lower was the global quality of life. In addition, as degrees of ambiguity, inconsistency and unpredictability became higher, global quality of life became lower.

4. Compared with male ostomates, female ostomates showed a higher level of uncertainty on inconsistency (t=5.010, p<.05). Ostomates having religion expressed lower unpredictability than those who didn't have religion (t=4.991, p<.05). Ostomates with colon cancer obtained higher scores of opportunity appraisal as compared to ostomates with rectal cancer (t=5.018, p<.05).

5. The demographic-sociologic feature and the disease-related feature of ostomates didn't show any statistical difference between global quality of life, the functional field and the symptoms field.

Consequently, the uncertainty of ostomates was normal. The higher uncertainty was, however, the higher danger appraisal became, while opportunity appraisal became lower. As ostomates' uncertainty became higher, global quality of life became lower. In addition, if we estimated uncertainty as danger, global quality of life declined, while if estimated as opportunity, global quality of life improved.

Therefore, we need to develop a nursing mediation program in order to decrease ostomates' uncertainty which is able to decrease danger appraisal on uncertainty and increase opportunity appraisal so that they can be actually applied to field practices.