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巴金森氏症病人症狀及緩和治療相關因素之研究

Symptoms and Palliative Care-Related Factors in Patients with Parkinson's Disease

摘要


目的:巴金森氏症是一種漸進性的中樞神經退化疾病,然而因病程時間長,且病人長期受功能減退與各項症狀困擾,顯著影響其生活品質,但其緩和醫療利用率卻僅0.6%。本研究目的在探討巴金森氏症病人症狀與緩和治療的相關因素,期能提供病人更好的照護。方法:本研究採用橫斷式相關性研究設計,以立意取樣法,共收集64位符合收案條件者:一、診斷為原發性巴金森氏症病人;二、神智清楚、無精神疾病、失智症等疾病;三、經解釋研究目的後,同意參與研究者。量表包括:緩和療護巴金森氏症症狀量表(Palliative Outcome Scale-Parkinson Disease, POS_PD)及緩和療護結果量表(Palliative Outcome Scale, POS)。以SPSS 19.0版進行資料分析,統計方法包括獨立樣本t檢定、單因子變異數分析及迴歸分析。結果:由看護照顧者、H&Y侯葉分級較高、有去過急診者,有顯著較高的緩和療護需求,亦代表生活品質較差;巴金森氏症症狀與緩和療護結果間呈中度正相關(r=0.65, p<0.001),顯示症狀越嚴重則生活品質越差,越需要緩和療護之介入;利用逐步複迴歸進行巴金森氏症病人接受緩和療護的預測因素為症狀嚴重度,可顯著預測接受緩和療護結果41.9%的變異量。結論:當巴金森氏症病人症狀嚴重度增加將提升病人接受緩和療護的需求,醫護人員應提早傳達緩和療護相關觀念以提供病人照護選擇。

關鍵字

巴金森氏症 緩和療護 症狀

並列摘要


Purposes: Parkinson's disease (PD) is a progressive degenerative disease of the central nervous system. It significantly affects patients' quality of life due to the long disease course, long-term dysfunction, and various symptoms. In addition, the palliative care utilization rate is only 0.6%. The purpose of this study was to explore the factors related to the symptoms and palliative treatment of patients with PD, so as to provide better care for patients. Methods: This study employed a cross-sectional correlational study design, and purposive sampling was used to enroll 64 participants. The inclusion criteria for patients were: (1) diagnosis with primary PD disease; (2) clear mental state, free from psychiatric diseases and dementia; and (3) provision of informed consent after the aim of the study was explained to him/her. A set of validated instruments, including the Palliative Outcome Scale-Parkinson Disease (POS-PD) and Palliative Outcome Scale (POS), were used for data collection. SPSS 19.0 software was used for data analysis. The statistical methods included an independent sample t-test, one-way analysis of variance, and regression analysis. Results: Subjects with caregivers, higher Hoehn and Yahr stage or those who visited the emergency department had a significantly higher need for palliative care, which also represents a poor quality of life. PD symptoms showed moderate positive correlation with palliative care outcomes (r=0.65, p<0.001), showing that the quality of life was poorer when symptoms were more severe and required more palliative intervention. Stepwise regression analysis results showed that symptom severity was a predictor of palliative treatment in PD patients and could explain 41.9% of palliative care outcome variance. Conclusions: When the severity of symptoms of PD patients increases and there is an increased need for palliative care, healthcare providers should communicate palliative care concepts early to provide patient care options to improve outcomes.

並列關鍵字

Parkinson's disease Palliative care Symptoms

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