接受腦瘤手術病人其主要照顧者照護需求及相關因素之探討

本研究目的旨在探討腦瘤手術病人主要照顧者照護需求及其相關因素。採前瞻性、描述性相關研究設計，以結構式問卷於台灣南部某醫學中心及其附設醫院，在病人手術前及出院後四週收集資料，採非隨機取樣選取80對腦瘤病人及其主要照顧者。資料分析方法包括描述性統計及推論性統計法，包括t-tests、one-way ANOVA、皮爾森積差相關與複迴歸統計法。資料收集時間為103年3月1日至104年3月31日。研究結果發現，整體照護需求術前得分為51.03 (SD = 16.96)，術後得分為 42.73 (SD = 15.13)；在其四個層面中，無論於術前或術後，均以訊息需求 (術前63.80分、術後 51.46分) 與健康照護服務需求 (術前56.44分、術後 45.72分) 此二層面的得分最高。當術前的照護需求未被滿足時，則術前及術後有較高的焦慮及憂鬱，病人術前身體功能狀況愈差時，較容易有術前憂鬱。此外，病人術後為診斷為惡性腫瘤、術後身體功能狀況愈差、有術後焦慮及憂鬱時，則術後照護需求也較高；當術前照護需求未滿足時其術後照護需求也愈高。術前照護需求的重要預測變項為術前焦慮，解釋力調整R2為12.8%；術後照護需求的重要預測變項為術後焦慮，解釋力調整R2為11.3%；當考慮術前照護需求相關變項為術後需求之影響因子而投入迴歸模式時，主要照顧者術前照護需求的重要預測變項則為術前照護需求及術後憂鬱，解釋力調整R2為19.5 %。本研究結果支持主要照顧者在手術前有高照護需求，術後的照護需求有顯著的改善。此外，當有明顯的焦慮及憂鬱，相對也會產生較高的照護需求，因此，臨床醫護人員在照護病人時，應主動評估主要照顧者的照護需求及焦慮與憂鬱狀況，提供適當且足夠的醫療資訊及健康照顧服務，減少其在照顧過程中因需求不滿足所導致或加重的焦慮及憂鬱。

關鍵字

腦瘤；主要照顧者；照護需求；焦慮；憂鬱

並列摘要

The purpose of this study was to explore the care needs and its related factors of the primary caregivers for patients undergoing brain tumor surgery. The study used a prospective and descriptive research design, which incorporated structured questionnaires to collect data from 80 pairs of patients and primary caregivers, before the brain tumor operation and 4 weeks after the discharge from a hospital at Southern Taiwan. Data analysis methods included descriptive statistics, inferential statistics consisting of t-tests, one-way ANOVA, Pearson Product-Moment Correlation, and multiple regression analysis. The data collection duration was from 1st March 2004 to 31st March 2004. The results show that the pre-operative score for care needs was 51.03 (SD=16.96), and the post-operative score was 42.73 (SD=15.13). Among the 4 aspects of care needs, information needs (pre-operative score 63.80, post-operative score 51.46) and health care service needs (pre-operative score 56.44, post-operative score 45.72) received the highest score both before and after the operation. Besides, the results also showed that the lesser the care needs met before the operation, the more the anxiety and depression experienced, and more post-operative care needs needed as well. The diagnosis of malignant tumor, poor post-operative performance status, experiencing of post-operative anxiety and depression would lead to higher level of healthcare needs. When pre-operative healthcare needs are not met, higher level of post-operative care needs would also be required. The only important predictor variable of pre-operative care needs was pre-operative anxiety, accounting for 12.8% of the variance. The only significant predictor variable of post-operative care needs is post-operative anxiety, explaining 11.3% of the variance. When entering the pre-operative care needs into the regression model, pre-operative healthcare needs and post-operative depression were selected as significant predictors of post-operative care needs. Together they accounted for 19.5% of the variance in post-operative care needs. This study supports that the primary caregivers had higher level of pre-operative care needs, and such level of care needs improved after the operation. Besides, prominent anxiety and depression will yield higher level of care needs. Therefore, healthcare providers should always evaluate the care needs and emotional states of primary caregivers, so that appropriate and adequate medical information and services could be provided on time, and in turn avoid any events that will cause or exacerbate the anxiety and depression state.