암 환자의 발생률이 지속적으로 증가함에 따라 암 환자의 수술인원과 건수도 증가하고 있다. 어떤 목적의 수술이든지 치료를 선택하는 암 환자들은 수술 후 다양한 증상과 문제들을 동반한 항암치료에 대한 의사결정갈등 정도가 높을 수밖에 없으므로 이에 대한 영향요인을 파악하는 것이 필요하겠다.
본 연구는 수술전 암 환자의 치료에 대한 태도, 공유의사결정, 불안이 항암치료 의사결정갈등 정도에 미치는 영향을 규명하기 위한 서술적 조사연구이다. 연구의 대상자는 B광역시 소재 K대학병원에서 수술 예정인 암 환자 110명이었다. 자료수집기간은 2016년 7월 1일부터 동년 8월 31일까지이었다. 자료수집방법은 IRB 및 간호부의 승인을 얻은 후 대상자에게 연구목적과 방법을 설명하고 연구에 참여하기로 동의한 수술예정인 암 환자를 대상으로 설문지를 배부한 뒤 자가 보고 방식으로 작성하게 하여 자료를 수집하였다.
연구도구로 항암치료 의사결정갈등 측정도구는 O’connor(1995)가 개발한 환자의 갈등척도를 바탕으로 Yun 등(2011)이 번안한 도구로 측정한 점수를 말하며, 치료에 대한 태도 측정도구는 Stiggelbout(1996)이 개발한 치료에 대한 태도 설문지를 김보경(2013)이 번안한 도구를, 공유의사결정 측정도구는 Kriston등(2010)이 개발한 공유의사결정 설문지를 윤영신(2013)이 수정,보완한 도구를, 불안 측정도구는 Spielberger(1976)가 개발한 상태불안 척도를 김정택과 신동균(1978)이 번안하여 표준화한 도구를 사용하였다.
수집된 자료는 SPSS/PC 18.0 프로그램을 이용하여 실수와 백분율, 평균, 표준편차, 평균평점, t-test, ANOVA와 Scheff’e test 및 Pearson’s Correlation Coefficients, Multiple regression으로 분석하였다.

본 연구의 결과는 다음과 같다.

1.대상자의치료에대한태도정도는하위영역으로생명연장 선호의 치료에 대한 태도 평균이 14.06±3.51점, 평균평점 3.52±0.88점이었으며, 삶의 질 선호의 치료에 대한 태도 평균이 12.35±2.39점, 평균평점 3.09±0.60점으로나타났다.대상자의공유의사결정정도는평균이 30.47±7.19점, 평균평점 3.39±0.80점으로 나타났다. 대상자의 불안 정도는 평균이 46.88±9.70점, 평균평점 2.34±0.49점으로 나타났다. 대상자의 항암치료의사결정갈등 정도는 평균이 17.98±8.70점, 평균평점 1.12±0.54점으로 나타났다.

2. 대상자의 일반적 특성에 따른 항암치료의사결정갈등 정도는 치료과정 중 지지체계(F=5.01, p=.008)에 따라 유의한 차이가 있었다. 이를 사후 검증한 결과 지지체계가 없는 군이 의료인이나 종교를 가진 지지체계군보다 항암치료 의사결정갈등 정도가 높은 것으로 나타났다.

3. 대상자의 치료에 대한 태도와 항암치료 의사결정갈등 정도의 관계는 하위영역으로 생명연장 선호의 치료에 대한 태도에서는 항암치료 의사결정갈등과 유의한 관계가 없는 것으로 나타났다. 그러나 삶의 질 선호의 치료에 대한 태도에서는 통계적으로 유의한 역 상관관계(r=-.28, p=.003)가 있는 것으로 나타났다. 대상자의 공유의사결정과 항암치료 의사결정갈등 정도의 관계는 통계적으로 유의한 역 상관관계(r=-.42, p<.001)가 있는 것으로 나타났다. 대상자의 불안과 항암치료 의사결정갈등 정도의 관계는 통계적으로 유의한 순 상관관계(r=.28, p=.003)가 있는 것으로 나타났다.

4. 대상자의 항암치료의사결정갈등에 가장 큰 영향을 미치는 요인은 의사와 환자간의 공유의사결정(β=-.31)이었고, 그 다음으로 치료에 대한 태도의 하위영역인 삶의 질 선호의 치료에 대한 태도(β=-.22)로 나타났다. 수술전 암 환자의 공유의사결정, 삶의 질 선호의 치료에 대한 태도의 항암치료 의사결정갈등에 대한 전체 설명력은 21.0%이었다.

결론적으로 수술전 암 환자의 항암치료 의사결정갈등 정도는 중간보다 낮게 나타났으며, 의사와의 공유의사결정과 치료에 대한 태도의 하위영역인 삶의 질 선호의 치료에 대한 태도가 수술전 암 환자의 항암치료 의사결정갈등에 영향을 미치는 요인으로 나타났다. 따라서 수술전 암 환자의 항암치료 의사결정갈등을 낮추기 위해서는 이들 변수를 고려한 항암치료 의사결정갈등조절 중재개발이 필요하다고 사료된다.

주요용어: 수술전 암 환자, 항암치료 의사결정갈등

As the incidence rate of cancer continues to grow, the number of surgery patients and the number of surgeries of cancer patients are also on the rise. The cancer patients who choose treatment regardless of the purpose of surgery cannot help but have a high level of decision-making conflicts about the cancer treatment with various symptoms and problems after surgery. Therefore, this study attempted to grasp the factors affecting the decision-making conflicts of preoperative cancer patients.
This study is a descriptive study to identify the impact of the attitude on treatment, shared decision-making and anxiety on the level of decision-making conflicts in preoperative cancer patients. The subjects of this study were 110 cancer patients scheduled to undergo surgeries at K university hospital in B metropolitan city. The data collection period was from July 1, 2016 to August 31 of the same year. After getting the approvals from the IRB and the nursing department, data were collected by explaining the study purpose and methods to the subjects, distributing the questionnaires to the cancer patients who were scheduled to undergo surgeries and agreed to participate in this study and making them fill in the questionnaires in self-report style.
As for research tools, the tool adapted by Yun et al.(2011) based on the conflicts scale developed by O''connor (1995) was used as the measurement tool for decision-making conflicts, the tool adapted by Kim, Bo-Gyeong (2013) based on the attitude survey developed by Stiggelbout (1996) was used as the measurement tool for the attitude toward treatment, the tool reconfigured by this author to be suitable for the purpose of this research based on the tool amended and adapted by Yoon, Yeong-Shin (2013) based on the shared decision-making measurement tool developed by Kriston et al.(2010) was used as the measurement tool for shared decision-making and the tool amended and adapted by Kim, Jeong-Taek and Shin, Dong-Kyun (1978) based on the anxiety state scale developed by Spielberger (1976) was used as the measurement tool for anxiety.
The collected data were analyzed by real number and percentage, mean, standard deviation, mean rating, t-test, ANOVA and Scheff''e test, Pearson''s correlation coefficients and Multiple regression using SPSS/PC 18.0 program.

The results of this study are as follows:

1. For the subjects'' attitudes toward treatment, it turned out that the mean of life extension as a subdomain was 14.06±3.51 points(at least 4 point, at most 20 points) and mean rating was 3.52±0.88 points(scale range 1-5), and for the quality of life, it turned out that the mean was 12.35±2.39(at least 7 and at most 19) and the mean rating was 3.09±0.60(scale range 1-5). For the level of subjects’ shared decision-making, it was found that the mean was 30.47±7.19(at least 6, at most 45), and the mean rating was 3.39±0.80(scale range 0 to 5). For the level of subjects'' anxiety, it turned out that mean was 46.88±9.70 points(at least 27 points, at most 79 points) and mean rating was 2.34±0.49 points(scale range 1-4). For the level of decision-making conflicts of the subjects, it was found that the mean was 17.98±8.70 points(at least 0 point, at most 47 points) and mean rating was 1.12±0.54 points(scale range 0-4).

2. As for the level of decision-making conflicts of anticancer treatment according to the overall characteristics of subjects, there was a significant difference according to the support system (F=5.01, p=.008) among treatment procedures. As a result of the post hoc test, it was found that the group with no support system showed higher level of decision-making conflicts than the group with the support from medical staff or religion.

3. The relationships among decision-making conflicts over cancer treatment, attitude toward treatment, shared decision-making and anxiety level were as follows. The relationship between the subjects’ attitudes toward treatment and the level of decision-making conflicts over cancer treatment was shown to have no significant relation with the decision-making conflicts in life extension, which is a subdomain. However, the quality of life was shown to have a statistically significant inverse correlation(r=-.28, p<.003). It was found that there was a statistically significant inverse correlation(r=-.42,p<.001) between the subjects'' shared decision-making and the level of decision-making conflicts over cancer therapy. It was shown that there was a statistically significant positive correlation(r=.28, p<.003) between the subjects'' anxiety and the level of decision-making conflicts over cancer therapy.

4. The most important factor affecting the subjects’ decision-making conflicts over cancer treatment was the shared decision-making between physicians and patients(β=-.31) followed by the quality of life(β=-.22), which is a subdomain of the attitude toward treatment. The overall explanatory power of these measurement variables over the decision-making conflicts over cancer therapy was 21.0%.

In conclusion, the level of decision-making conflicts over cancer treatment of preoperative cancer patients turned out to be slightly lower than the median, and shared decision-making with physicians and the attitudes toward treatment were found to be the factors affecting the decision-making conflicts over cancer treatment of the preoperative cancer patients. Therefore, in order to lower the decision-making conflicts over cancer therapy of preoperative cancer patients, it is deemed to be necessary to develop the mediation of decision-making conflicts over cancer treatment in consideration of these variables.

Key words : Preoperative cancer patient,
Decision-making conflicts over cancer treatment