台灣版癌症末期病患善終品質工具之信效度檢定

Validation of the Quality of Dying and Death Instrument-Taiwan Form

陳燕華(Yen-Hwa Chen)

指導教授 ： 林佳靜

臺北醫學大學/護理學院/護理學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00119

摘要

促進末期病人照護品質乃是全世界臨床研究者們關注的議題。善終品質的評估能使醫療照顧者瞭解、評值末期照護的品質以及發展具體的改善措施。然而，目前國內仍缺乏一個敏感、有效、可供具體測量且以病人為中心的善終評估工具。
本研究目的為發展「台灣版善終品質量表」(Quality of Dying and Death Instrument-Taiwan Form, QODD-T)。檢測量表之內在一致性、建構效度以及效標效度。並比較臨終病人及家屬其得分之差異。更進一步探討影響台灣末期病人善終品質之相關因子。
研究採橫斷式敘述相關性研究，利用結構式問卷訪談共收案53位末期病患及55位喪親家屬。以人口學基本資料表、安德森症狀量表(M. D. Anderson Symptom Inventory-Taiwan -Form, MADSI-T)、善終想望量表(Preferences about Dying and Death, PADD)、台灣版善終品質量表QODD-T及品質照護指標，作為資料收集工具。
結果顯示善終量表總分界於27.93至98.91分，平均70.93分，量表整體的內在一致性，Cronbach’s α值為.93；專家效度總CVI值為.83；與安德森症狀量表之症狀嚴重程度相關係數r為-.36(p<.01)、與症狀干擾日常生活嚴重程度相關係數r為-.51(p<.01)達顯著負相關；與品質照護指標之整體照護品質（r=.39, p<.01）、醫師照護品質（r=.36, p<.01）、生命最後七天之生活品質（r=.54, p<.01）及死亡當下的品質（r=.50, p<.01）呈顯著正相關，顯示台灣版善終量表具良好效標效度。末期病患之善終想望滿意度與症狀干擾日常生活嚴重程度於統計學上呈顯著負相關（r=-.30, p<.05）。死亡地點、症狀干擾日常生活之嚴重度、生命最後七天之生活品質及死亡當下的品質是善終品質的預測因子。
研究結果顯示29題之台灣版善終品質量表，有適當的信度及效度，研究結果可以提供臨床用以實際測量病人以及家屬的善終經驗，協助有效反映生命末期照護品質。

關鍵字

癌末病患 ； 善終品質 ； 信效度

並列摘要

Background：Improving the quality of health care for patients at the end of their lives has become a major national clinical and research objective. Outcome measures that accurately assess these features of care at the end of life will allow us to identify, evaluate, and disseminate interventions that improve care at the end of life. However, there has been a lack of sensitive measures of the outcomes that patients and families define as important.
Objectives：The purposes of this study were to develop and validate the Taiwanese version of the Quality of Dying and Death among advanced cancer patients and their caregivers at the end of life. To compare the QODD-T scores obtained from the patient and their primary family caregiver and investigate clinical factors related to the quality of dying and death.
Methods：This is a cross-sectional designed study, the structured-
questionnaire was administered to 53 advanced cancer patients and 55 beraved families. The interview included questions assessing symptom, patient preferences,quality of dying and death , and quality indicators .
Results：QODD-T questionnaire with content validity index .83,A total QODD-T scores ranged from 27.93 to 98.91,with a mean of 70.93 .The internal consistency Cronbach’s α was .93. Construct validity examined by correlating with MDASI-T, revealed significantly associated with symptom severity（r=-.36, p<.01）, and interference with daily life（r=-.51, p<.01）. Concurrent validity significantly associated with quality of care from all providers（r=.39, p<.05）、quality of care from physician（r=.36, p<.05）、quality of life during last days（r=.54, p<.01）and quality of moment of death（r=.50, p<.01）. Satisfaction of patients’ preferences about dying and death was negtively correlated with symptom interference (r=-.30, p<.05).Death at home、lower symptom interfere、experiences of the moment of death and quality of life during last days were predictors of QODD-T.
Conclusion：The 29-item QODD-T questionnaire is a reliable and valid tool for measure the quality of dying experiences ,which would help the health care team improve care for terminally ill patients.

並列關鍵字

advanced cancer patients ； quality of dying and death ； validation

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