암환자의 우울, 피로 및 자원동원성의 관계

Abstract

ABSTRACT

Relationship among Depression, Fatigue and Resourcefulness of Cancer Patient

Kim, Hyo Soo Dept. of Hospice Nursing The Graduate School of Information in Clinical Nursing Hanyang University Direct by Prof. Kim, Jung A

The purpose of this study was to identify the level of depression, fatigue, and resourcefulness of cancer patient and to investigate the association among these three variables in cancer patient. This study was a cross-sectional, descriptive correlational study. The study included a total 103 cancer patient participants. The convenience-sampling method was used. The participants were recruited from three general hospitals in Seoul and Kyunggi Province. Three instruments were used in the collection of the data: (i) the depression subscale of the Korean version of the Profile of Mood States Brief Form (K-POMS-B); (ii) the fatigue subscale of K-POMS-B; (iii) the resourcefulness scale. The Profile of Mood States Brief Form (POMS-B) developed by McNair, Lorr and Droppleman (1992), which is widely used to measure six mood factors or affective states: tension, depression, anger, vigor, fatigue, and confusion. The six subscales are also combined to provide an overall total mood disturbance score, which denotes an overall assessment of emotional state. In this study, the Korean version of the POMS-B, which was translated into Korean by Yeun and Shin-Park(2006), was used. For the measurement of Resourcefulness, the instrument that was translated and modified by Suh(1996) from Self Control Schedule developed by Rosenbaum(1980) also was used in this study. The data collection survey was conducted from May to June in 2012. The software program, SAS Enterprise 4.0, was used for the data analysis.

The major research findings were as follows: 1. The mean age of participants was 57.7±14.4 years. Approximately 45.6% of the participants were male and 54.4% were female. Majority of the participants (72.8%) were married, and more than half (65.0%) were higher than high school graduate. More than half (61.0%) had a religion. 2. Approximately 23.3% of the participants were gastrointestinal cancer patient; 17.4% were colon cancer patients; 12.6% were breast cancer patient. About half of the participants (48.5%) had experienced some changes in their employment status after being diagnosed with cancer; 49.5% reported some activity restrictions from cancer or cancer treatments. More than half participants (64.1%) had suffered from tension; 62.1% had suffered from pain; 58.2% had suffered from dry mouth. 3. The mean score of depression was 7.22±2.89, while the mean score of fatigue was 4.86±5.07 and that of resourcefulness was 30.1±30.8. 4. There were no significant differences in depression, fatigue and resourcefulness by general characteristics of participants. 5. There were significant differences in depression according to pain (F=3.64, p=.016), tension (F=8.67, p<.001), nausea (F=5.75, p<.001), constipation (F=6.15, p<.001), hot flush (F=2.85, p.041), bowel incontinence (F=6.39, p<.001), urine incontinence (F=5.33, p=.002) and insomnia (F=5.21, p=.002). 6. There were significant differences in fatigue according to breathing difficulty (F=5.01, p=.003), pain (F=9.75, p<.001), tension (F=7.68, p<.001), nausea (F=4.41, p=.006), constipation (F=8.31, p<.001), hot flush (F=6.70, p<.001), bowel incontinence(F=7.65, p<.001), urine incontinence (F=9.28, p<.001), mouth dryness (F=4.71, p=.004), and insomnia (F=10.1, p<.001). 7. There was significant difference in resourcefulness according to hot flush (F=3.05, p<.032). 8. There was a significant positive correlation between depression and fatigue(r=0.738 p<.001), while the correlation between depression and resourcefulness(r=0.056, p=.572), and between fatigue and resourcefulness(r=0.090 p=.364) were not significant.

Depression and fatigue can affect a cancer patient’s likelihood of survival, treatment outcomes, and quality of life. In this study, depression and fatigue of cancer patient were positively correlated with each other and there were significant differences in depression and fatigue of cancer patients according to the physical symptoms that cancer patients experienced. Based on the results of this study, an exploration of strategies to prevent the physiological symptoms and to improve the symptoms will be necessary in order to decrease their rate of death and to improve the quality of life. Further research to investigate the relationship between emotional and physical status and resourcefulness in cancer patients will be required.

|국 문 요 약

암환자의 우울, 피로 및 자원동원성의 관계

본 연구는 암 환자의 우울, 피로, 자원동원성 및 이들 간의 상관관계를 확인하여, 향후 암 환자의 자원동원성을 증대시킬 수 있는 간호중재를 개발해 암 환자들의 우울, 피로 중재 프로그램의 기초자료를 마련하고자 시행된 연구이다. 연구대상자는 S시 K시, G시 소재 3개 종합병원에서 2012년 5월 19일부터 6월 14일까지 암 진단을 받고 수술, 항암화학요법, 방사선치료 등의 암 치료를 받고 있는 입원환자 및 외래환자 중 만 20세 이상의 암환자 103명을 대상으로 하였다. 우울 및 피로의 연구도구로 McNair, Lorr and Droppleman(1992)에 의해 개발된 기분상태 척도-단축형(POMS-SF) 도구를 Yeun과 Shin-Park(2006)이 한국어로 번역한 Korean Version of Profile of Mood State-Brief(K-POMS-B)중 우울 및 피로를 측정하는 문항 각각 5개의 문항을 사용하여 측정하였으며, 자원동원성은 Rosenbaum(1980)은 자기통제 측정 스케줄(self control schedule) 도구를 Suh(1996)가 한국어로 번역하여 신뢰도와 타당도 검사를 마친 도구를 사용하여 측정하였다. 수집된 자료는 SAS Enterprise 4.0 프로그램을 이용하여 통계분석을 시행하였다.

본 연구의 결과를 요약하면 다음과 같다.

1. 일반적 특성에서 평균연령은 57.7±14.4ª세였으며 남자가 47명(45.6%), 여자가 56명(54.4%)이고 결혼 상태는 기혼자가 75명(72.8%)으로 미혼이나, 이혼, 사별보다 월등히 많았으며, 동거인과 가족포함, 친구나 공동체에서 생활하는 이들이 90명(87.4%)을 차지하고 있었다. 교육정도는 고졸 이상이 67명(65%)이었으며, 68명(61%)가 종교가 있는 것으로 나타났다. 2. 대상자의 질병관련 특성에서는 위장관계 암 24명(23.3%), 대장암(18명) 17.4%, 유방암이 13명(12.6%)로 현재 통계적으로 상위를 차지하는 질병이 많은 부분을 차지하고 있었으며, 암 진단 후 직업변화는 50명(48.5%) 이상이 직업변화가 있었고, 본인의 수행 수준으로는 약간의 제한이 있다가 51명(49.5%)이었다. 자각 증상으로는 통증을 64명(62.1%)이 경험하고 있었으며 66명(64.1%)이 긴장감을 느끼고 있었다. 메스꺼움 53명(51.5%), 변비 59명(57.3%), 열감 52명(50.5%), 입이마름 60명(58.2%), 불면증 59명(57.3%)이 자각하고 있는 것으로 나타났다. 3. 대상자의 우울평균점수 7.22±2.89, 피로평균점수 4.86±5.07, 자원동원성 평균점수 30.1±30.8이었다 4. 대상자의 일반적 특성에 따른 우울, 피로 및 자원동원성에 유의한 차 이를 나타낸 항목은 없었다. 5. 대상자의 질병관련 특성에 따른 우울 정도의 차이를 분석한 결과, 자각증상 중 통증(F=3.64, p=.016), 긴장감(F=8.67, p<.001), 메스꺼움(F=5.75, p<.001), 변비(F=6.15, p<.001), 열감(F=2.85, p.041),대변실금(F=6.39, p<.001), 요실금(F=5.33, p=.002), 불면증(F=5.21, p=.002)에 따라 우울정도는 유의한 차이가 있는 것으로 나타났다. 6. 대상자의 질병관련 특성에 따른 피로의 차이를 분석한 결과 자각증상 중에서 호흡곤란(F=5.01, p=.003), 통증(F=9.75, p<.001), 긴장감(F=7.68, p<.001), 메스꺼움(F=4.41, p=.006), 변비(F=8.31, p<.001), 열감(F=6.70, p<.001),대변실금(F=7.65, p<.001), 요실금(F=9.28, p<.001), 입이마름(F=4.71, p=.004), 불면증(F=10.1, p<.001)에 따라 피로는 유의한 차이가 있는 것으로 나타났다. 7. 대상자의 질병관련 특성에 따른 자원동원성의 차이를 분석한 결과 자각증상 중 열감(F=3.05, p<.032)에 따라 자원동원성은 유의한 차이가 있는 것으로 나타났다. 8. 우울, 피로 및 자원동원성의 상관관계를 분석한 결과 암환자의 우울과 피로(r=0.738 p<.001) 간의 상관관계는 정의 상관관계가 있었으며, 우울과 자원동원성(r=0.056, p=.572) 간의 상관관계, 피로와 자원동원성(r=-0.090 p=.364) 간은 유의한 상관관계가 없는 것으로 나타났다.

우울과 피로는 상관관계가 있으나 자원동원성은 우울, 피로 등 부정적인 요인과는 상관관계가 없었다. 이에 암환자의 정신적 문제인 우울과 신체적 문제인 피로를 동시에 해결할 수 있는 통합적 간호중재가 필요하며 추후 자원동원성과 부정적인 요소인 우울, 피로와 관계에 대한 지속적인 연구 및 긍정적인 요소들과 암환자의 자원동원성에 대한 추가적인 연구가 필요하다. 특히 자원동원성은 타고나는 것이 아니라 학습되어지는 내적 자원이므로 암환자의 피로 및 우울을 중재할 수 있는 간호가 필요한 현실에서 이러한 간호중재의 한 방안으로 자원동원성을 높일 수 있는 간호프로그램을 개발하고 이러한 자원동원성의 증대를 통해 암환자의 우울 및 피로를 감소시킬 수 있는 방안을 모색해야 한다.

주요용어: 암환자, 우울, 피로, 자원동원성; 58.2% had suffered from dry mouth. 3. The mean score of depression was 7.22±2.89, while the mean score of fatigue was 4.86±5.07 and that of resourcefulness was 30.1±30.8. 4. There were no significant differences in depression, fatigue and resourcefulness by general characteristics of participants. 5. There were significant differences in depression according to pain (F=3.64, p=.016), tension (F=8.67, p<.001), nausea (F=5.75, p<.001), constipation (F=6.15, p<.001), hot flush (F=2.85, p.041), bowel incontinence (F=6.39, p<.001), urine incontinence (F=5.33, p=.002) and insomnia (F=5.21, p=.002). 6. There were significant differences in fatigue according to breathing difficulty (F=5.01, p=.003), pain (F=9.75, p<.001), tension (F=7.68, p<.001), nausea (F=4.41, p=.006), constipation (F=8.31, p<.001), hot flush (F=6.70, p<.001), bowel incontinence(F=7.65, p<.001), urine incontinence (F=9.28, p<.001), mouth dryness (F=4.71, p=.004), and insomnia (F=10.1, p<.001). 7. There was significant difference in resourcefulness according to hot flush (F=3.05, p<.032). 8. There was a significant positive correlation between depression and fatigue(r=0.738 p<.001), while the correlation between depression and resourcefulness(r=0.056, p=.572), and between fatigue and resourcefulness(r=0.090 p=.364) were not significant.

Depression and fatigue can affect a cancer patient’s likelihood of survival, treatment outcomes, and quality of life. In this study, depression and fatigue of cancer patient were positively correlated with each other and there were significant differences in depression and fatigue of cancer patients according to the physical symptoms that cancer patients experienced. Based on the results of this study, an exploration of strategies to prevent the physiological symptoms and to improve the symptoms will be necessary in order to decrease their rate of death and to improve the quality of life. Further research to investigate the relationship between emotional and physical status and resourcefulness in cancer patients will be required.