口腔癌、喉癌病人術前與術後主要照顧者的照顧負荷及相關因素

Family Caregiver Burden in Pre-Operative and Post-Operative Oral and Laryngeal Cancer Patients

張筱姃(Hsiao-Cheng Chang)

指導教授 ： 陳靜敏

共同指導教授 ： 賴裕和 ； 朱本元(Pen-Yuan Chu)

臺北醫學大學/護理學院/護理學研究所/碩士(2008年)

https://doi.org/10.6831/TMU.2008.00022

摘要

病人診斷癌症時，其所受之衝擊不單單影響病人，家庭主要成員均也同時感到困擾，當癌症照顧者為滿足病人所需照護之一切，而產生過多之照顧負荷，終究未能有效擔當照顧工作，使得照顧工作成效較差。本研究採縱貫性相關性研究，探討口腔癌和喉癌病人主要照顧者術前一週、術後一個月負荷及其相關因素。
共收集58位病人及其主要照顧者，收集資料包含病人人口學、疾病治療特質、症狀嚴重度、主要照顧者人口學、社會支持，同時使用照顧者反應評估量表測量照顧者之照顧負荷。資料分析方式包含描述性統計、t檢定、GEE模式分析，本研究發現：（1）病人術後，其主要照顧者負荷嚴重程度依序為，時間安排、健康負荷、經濟負荷及家庭支持缺乏負荷，術後照顧者感受各照顧負荷，均較術前各照顧負荷嚴重。（2）影響主要照顧者時間安排負荷主要相關因素為照顧者年齡較年輕者、照顧者就業中者、照顧時間較長、照顧無輪替者、照顧者為獨立者、社會支持度較低者、病人症狀嚴重度較高者，其主要照顧者有較高之時間安排負荷。（3）影響主要照顧者健康負荷主要相關因素為，主要照顧者有慢性病者、照顧時間較長者、照顧者為獨立者、社會支持度較低者、病人疾病診斷為口腔癌者，其主要照顧者有較高之健康負荷。（4）影響主要照顧者經濟負荷主要相關因素為，照顧時間較長者、病人有接受先前治療者，其主要照顧者之經濟負荷感受較高。（5）影響主要照顧者家庭支持負荷主要相關因素為，主要照顧者有慢性病者、照顧時間較長者、照顧者為獨立者、病人疾病分期第四期者，其主要照顧者之家庭支持負荷感受較高。
當口腔癌和喉癌病人症狀嚴重度較為嚴重、照顧者花費照顧時間較長者、照顧型態為獨立照顧者、照顧者本身有慢性疾病者、照顧者為就業中、照顧者社會支持度較低者，有較高之時間安排負荷、健康負荷、經濟負荷、家庭支持負荷。本研究結果發現主要照顧者在照顧口腔癌、喉癌術後病人時會有不同層面的照顧負荷，建議臨床專業人員提供相關協助，進而減輕因罹患口腔癌、喉癌所帶給病人本身及家庭層面之衝擊程度。

關鍵字

口腔癌 ； 喉癌 ； 術後病人 ； 照顧者負荷

並列摘要

Family caregivers provide an important part of the care needed in post- operative oral cancer and laryngeal cancer patients.However, there are heavy burdens associated with providing care to cancer patient. The longitudinal study was designed to understand the family caregiver care burden and related factors in pre-operative and post-operative oral and laryngeal cancer patients of one teaching hospital in Northern Taipei.
58 dyads of patients and families participated in the study.The data includes of patient’s and family’s demographics, disease-related information, patient’s symptom severity (measured with Symptom Severity Scale), care pattern, social support (measured with Medical Outcome study Social Support), and the caregiver’s burden (measured with the Caregiver Reaction Assessment).
The methods of analysis included descriptive statistics, Pair-t-test and Generalized Estimating Equation model. (1). The results revealed that the primary caregiver experienced higher burden after patient received surgery.
(2). The severity of care burden on the primary caregiver was in the order: disrupted schedual, health problems, financial problems, and lack of family support. (3).The main predictors of disrupted schedual were the caregiver’s age, caregiver’s employment, caregiver’s health status, time arrangement, type of care, caregiver’s social support, patient’s pre-operative treatment option, and patient’s symptom severity. (4). The main predictors of caregiver’s health problems were caregiver’s employment, caregiver’s health status, time arrangement, caregiver’s social support, patient’s disease diagnosis, and patient’s pre-operative treatment option. (5). The main predictors of financial problems included caregiver’s employment, time arrangement, patient’s age, and patient’s pre-operative treatment option. (6). The main predictors of lack of family support included caregiver’s health status, caregiver’s time arrangement, type of care, and patient’s disease stage.
The most related factor affecting the caregiver burden were caregiver’s time arrangement, type of care, caregiver’s health status, caregiver’s employment, caregiver’s social support, and patient’s symptom severity.
These related factors can be served as important reference for clinical healthy care provider to pay more attention about the caregiver burden issue. The recommendation is that clinical healthy care provider can offer mental support, transition care type information, and supplied the assistance to reduce the caregiver burden to help the caregiver keep continue to provide better care services of oral cancer and laryngeal cancer patients.

並列關鍵字

oral cancer ； laryngeal cancer ； symptom severity ； caregiver ； social support ； caregiver burden

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