住院腸胃道癌症病人主要照顧者的負荷及相關因素

Family Caregiver Burden and Its Correlates in Hospitalized GastroIntestinal Cancer Patients

李英芬(In-Fun Li)

指導教授 ： 蔡佩珊 ； 賴裕和

臺北醫學大學/護理學院/護理學研究所/碩士(2006年)

摘要

當病人被診斷為癌症時，病人和家屬都會受到衝擊，若主要照顧者產生照顧負荷，會影響照顧者之角色功能，進而使病人照顧成效變差，因此照顧者負荷已是家屬照顧的一個重要議題。本研究以橫斷式研究法，探討台北某醫學中心之腸胃道癌症病人之主要照顧者之照顧負荷。共收集78位病人及其主要照顧者，資料包括病人人口學資料、病人之症狀嚴重度、病人焦慮及憂鬱情形及照顧者之人口學資料、照顧照顧型態與社會支持，再以照顧者反應評估量表（CRA）測量家屬之照顧負荷程度。資料分析以描述性統計、t檢定、單因子變異數分析、皮爾森積差相關檢測與逐步迴歸分析。結果發現：(1)主要照顧者負荷的嚴重程度依序為時間安排、健康負荷、經濟負荷及家人支持。（2）病人的性別與主要照顧者之健康負荷有關，病人的年齡與主要照顧者時的經濟影響呈負相關，病人的身體功能狀態與主要照顧者時的時間安排有關，罹病時間長短與時間安排呈負相關，病人的整體症狀困擾、焦慮狀態與憂鬱狀態與主要照顧者的身體健康、時間安排均呈正相關。而憂鬱狀態對主要照顧者的家人支持負荷亦呈正相關。（3）照顧者的性別、年齡、教育程度、病人關係及有無慢性疾病和健康影響有關，照顧後職業狀況時間安排、家人支持有關，照顧類型與時間安排及家人支持有關，而照顧者的社會支持與時間安排、經濟影響、家人支持均為負相關。（4）時間安排的重要預測因子為病人的憂鬱程度、獨立且需全天照顧的照顧類形及病人身體功能狀態為KPS評分70分者，其解釋時間安排總變異量為39.7%（p<.000）。健康影響的主要預測因為有無慢性疾病、病人焦慮程度及女性主要照顧者，其解釋之總變異量為32.8%（p<.000）。經濟影響之重要的預測因子為社會支持與照顧者為子女，其解釋總變異量為29.3%（p<.000）。家人支持的重要預測因子為社會支持與照顧類形為輪班照顧者，其解釋家人支持總變異量為55.6%（p<.000）。照顧者的社會支持與主要照顧者自尊感受有關。本研究結果可見照顧者受到不同層面負荷，建議提供照顧者支持措施，以緩解其照顧負荷，增進對癌症病人及其家屬之照顧品質。

關鍵字

腸胃道癌症病人 ； 主要照顧者 ； 照顧負荷

並列摘要

Both patient and family suffered a great impact when be diagnosed for the cancer. If the care burden is over the caregiver’s tolerance, it might change the caregiver’s role function and decrease the quality of patient care. For this reason, the care burden for a cancer patient’s family is an important issue today. The cross-sectional study was designed to understand the care burden on the primary caregiver of cancer patients when hospitalization. 78 dyads of patients and families participated in the study. Data collection included patient and family’s demographics, disease-related information, patient’s performance status (measured with Karnofsky Performance Status, KPS), patient’s psychological distress (measured with The Hospital Anxiety and Depression, HADS), care pattern, social support (measured with Medical Outcome study Social Support), and the caregiver’s burden (measured with the Caregiver Reaction Assessment, CRA). Data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, Pearson’s correlation, and multiple stepwise regressions. The results revealed that 1). The severity of care burden on the primary caregiver was in the order: Time arrangement, health status, economics situation, and other family’s support. 2). Patient’s sex was related with primary caregiver’s health status, patient’s age was negatively related with primary caregiver’s economics situation, patient’s performance was related with primary caregiver’s time arrangement, the length of illness was negatively related with caregiver’s time arrangement, patient’s symptom distress, anxiety and depression status were positively related with caregiver’s health status, time arrangement, patient’s depression status was related with other family’s support. 3). The primary caregiver’s sex, age, education, relationship with patient were related with the health status; caregiver’s employment, time arrangement, and care pattern were related with other family’s support; there was a negative relations in caregiver’s social support, time arrangement, economic situation, and other family’s support. 4). The main predictors of time arrangement were patient’s depression status, dependent, and that patient’s performance level was 70; the main predictors of caregiver’s health status were with/without chronic disease, patient’s depression status, and female; the main predictors of other family’s support were social support and the shared care pattern; caregiver’s social support was related with caregiver’s feeling of self esteem. The results suggest that the caregivers should be concerned and be supported to release their burden, and then, to increase the quality of cancer patients care.

並列關鍵字

gastrointestinal cancer patient, Primary caregiver, Caregiving burden

參考文獻

張青蕙(2003)．住院癌症病患疲憊問提及其相關因素之探討．未發表的碩士論文．台北:台北醫學大學護理學研究所。 張淑琦、林淑鈴 (2002)．已故癌症病人之主要照顧家屬如何面對死亡？．安寧療護雜誌，7(2)，109-127。

楊嘉玲、孫惠玲 (2003)．照顧者負荷概念分析．馬偕學報，3，15-27。

邱啟潤、許淑敏、吳瓊滿 (2002)．主要照顧者的負荷、壓力與因應行為之國內文獻研究文獻回顧．醫護科技學刊，4(4)，273-290。

林玲華、林佳蓉、陳美伶 (2004) ．癌症與非癌症手術後住院病患照顧者的負荷及其相關因素之初探．長庚護理，15(2)，141-155。

高淑芳、盧孳豔、葉淑惠、劉雪娥 (1999)．探討家庭功能、社會支持與社區殘病老人照顧者負荷之關係．護理研究，7(2)，172-181。