消化道末期癌症病患居家主要照顧者之照顧負荷與其相關性因素探討

Caregiving Burden and Associated Factors among Caregivers of Terminally Ill Gastrointestinal Cancer Patients

王俐絜(Li-Chieh Wang)

指導教授 ： 王瑞霞

高雄醫學大學/護理學院/護理學系研究所/碩士(2010年)

https://doi.org/10.6832/KMU.2010.00110

摘要

本研究在於探討消化道末期癌症病患主要照顧者的照顧負荷相關因
素。本研究目的為（1）探討病患和主要照顧者之人口學屬性、疾病特性與照顧負荷的關係；（2）探討主要照顧者的社會支持、死亡恐懼、照顧自我效能、自覺病患症狀困擾與照顧負荷之相關性；（3）探討主要照顧者照顧負荷之重要解釋因子。
本研究採橫斷式、描述性相關性研究設計，以消化道末期癌症病患之主要照顧者為研究對象，採結構式問卷調查和方便取樣，收集嘉南地區4家醫療機構的末期消化道癌症病患（口腔癌、食道癌、胃癌、結腸直腸癌、肝癌、胰臟癌）之居家主要照顧者共收案178 位。問卷內容包括：人口學之基本資料表、巴氏量表、社會支持、死亡恐懼、照顧自我效能、自覺症狀困擾與照顧負荷等量表。量表經信度和效度檢定，包括內在一致性、再測信度、專家效度與表面效度。研究資料以百分比、平均值、標準差、獨立樣本t 檢定、單因子變異數分析、皮爾森積差相關分析與逐步複迴歸分析。
本研究結果發現：（1）主要照顧者之總照顧負荷標準化得分為50.72分，呈中等程度；（2）收案場所、病患年齡、診斷、病患身體活動功能與總照顧負荷呈顯著差異；（3）主要照顧者之照顧關係、自覺健康狀況、宗教信仰與總照顧負荷呈顯著差異；（4）主要照顧者之社會支持標準化得分為52.63 分，呈中等程度，主要照顧者之社會支持越差，總照顧負荷越嚴重（r = -.610, p < .01）；（5）主要照顧者之照顧自我效能標準化得分為74.40分，呈中上程度，主要照顧者之照顧自我效能越佳，總照顧負荷越低（r =
-.436, p < .01）；（6）主要照顧者之自覺病患症狀困擾標準化得分為37.40分，呈中低程度，照顧者感受到病患症狀困擾越嚴重，總照顧負荷越嚴重（r = .555, p < .01）；（7）主要照顧者的死亡恐懼標準化得分為64.39 分，呈中上程度，主要照顧者之死亡恐懼越嚴重，總照顧負荷越嚴重（r = .460, p < .01）；（8）社會支持、自覺病患症狀困擾、自覺健康狀況、收案場所、死亡恐懼、照顧關係為總照顧負荷的重要解釋因子，可解釋63.8%之總變異數。

關鍵字

照顧負荷 ； 社會支持 ； 自覺症狀困擾 ； 死亡恐懼 ； 照顧自我效能

並列摘要

The study aimed to investigate the factors associated with caregiving burden among main caregivers of terminally ill patients with gastrointestinal cancer. The purposes of this study were (1) to explore the relationship of
demographic and disease characteristics of both patients and caregivers to caregiving burden; (2) to explore the relationship of social support, fear of death,
self-care efficacy, self-perceived symptom distress to caregiving burden; (3) to explore the important explanatory factors for caregiving burden.
The study adopted a cross-sectional, descriptive and correlational research design with a convenience sampling and structured questionnaires. We recruited 178 family caregivers of terminally ill patients with gastrointestinal cancer (oral, esophageal, stomach, colorectal, liver, or pancreatic cancer) from four medical
care institutions in Tainan and Chiayi areas. Structured questionnaires including demographic characteristics, Barthel Index, social support scale, fear of death
scale, self-care efficacy scale, self-perceived symptom distress scale, and caregiving burden scale were used to collect data. Internal consistency, test-retest reliability, content validity, and surface validity were used to examine the reliability and validity of all scales. Data were analyzed using percentage, mean, standard deviation, independent samples t-test, One-way ANOVA, Pearson product-moment correlation, and stepwise regression analysis.
Results showed that (1) the standardized score in total caregiving burden was 50.72, indicating a medium level of burden; (2) location of study subject recruitment, age, disease diagnosis, and physical activity function of patients existed significant differences with total caregiving burden; (3) the relationship with patient, self-perceived health status, and religion of caregivers showed
significant differences with total caregiving burden; (4) the standardized score in social support of caregivers was 52.63, indicating a medium level of burden; the less social support the caregivers had, the more total caregiving burden they had (r = -.610, p < .01); (5) the standardized score in self-care efficacy of caregivers
was 74.40, indicating a medium high level of burden; the better self-care efficacy the caregivers had, the less total caregiving burden they had (r = -.436, p < .01); (6) the standardized score in self-perceived symptom distress of caregivers was 37.40, indicating a medium low level of burden; the more severe symptom distress in patient the caregivers perceived, the more total caregiving
burden they had (r = .555, p < .01); (7) the standardized score in fear of death of caregivers was 64.39, indicating a medium high level of burden ; the more fear of death the caregivers had, the more total caregiving burden they had (r = .460, p < .01); (8) social support, self-perceived symptom distress in patient, self-perceived health status, location of study subject recruitment, fear of death,
and relationship with patient were the most important explanatory factors for total caregiving burden, which explained 63.8% of the variation.

並列關鍵字

caregiving burden ； social support ； self-perceived symptom distress ； fear of death ； self-care efficacy

參考文獻

邱啟潤、許淑敏、吳淑如（2003）。居家照護病患之主要照顧者綜合性需求調查。醫護科技學刊，5（1），12-25。

邱啟潤、許淑敏、吳瓊滿（2002）。主要照顧者負荷、壓力與因應之國內研究文獻回顧。醫護科技學刊，4（4），273-290。

王士華、戎瑾如、陳喬琪、魏秀靜、林寬佳（2007）。青少年精神分裂症病患主要照顧者相關壓力、習得智謀與照顧負荷之研究。護理雜誌，54（5），37-47。

蔣立琦、郭雅雯、林綽娟（2004）。自我效能之概念分析。護理雜誌，51（2），67-72。

馬先芝（2003）。照顧者負荷之概念分析。護理雜誌，50（2），82-86。