氣切病人接受語言治療現況之初探

The Status of Tracheostomy Patients Receiving Speech Therapy: A Pilot Study

盧采臻(Cai-Jhen Lu) ； 王雅慧(Ya-Hui Wang)

《台灣復健醫學雜誌》 42卷2期 (2014/06) Pp. 99-110

https://doi.org/10.6315/2014.42(2)04

摘要

目的：許多氣切病人在溝通及吞嚥方面有程度不等的困難，生活品質因而受影響，不論家屬或病人都有極高的治療需求，然而病人在接受相關治療的比率卻不高，而且各科別醫護人員對於相關治療的認知程度不一，國內對於氣切病人在溝通及吞嚥方面的需求以及相關處置的研究甚少著墨。因此，本研究旨在了解氣切病人接受語言治療（包括溝通與吞嚥治療）的現況。方法：本研究採取問卷調查的方式，訪查台北市某醫學中心50位住院氣切病人及80位醫護人員。結果：有超過九成的病人都覺得因為氣切套管的使用，而在吞嚥及溝通方面造成了影響，並且有70%以上的病人希望能接受語言治療服務，但實際上只有16%的氣切病人曾接受過相關的治療。進一步分析發現，醫護人員均了解氣切套管對溝通及吞嚥的影響，但僅有33.8%的醫護人員曾轉介氣切病人接受語言治療，未轉介的原因有七成與醫護人員決策相關，大多是不了解轉介的流程與方法。綜合上述，目前氣切病人在溝通及吞嚥方面所受到的鉅大影響，對照實際接受過相關治療經驗的落差，有待語言治療師進一步提供病人及氣切醫療團隊人員相關資訊與知識，以期能滿足更多氣切病人在溝通及吞嚥上的需求，及提升病人與照顧者的生活品質。

關鍵字

醫護人員 ； 轉介 ； 溝通 ； 吞嚥

並列摘要

Objectives: Many patients with tracheostomy have significant communication and swallowing difficulties, impairing their quality of life. They also have eating problems because they cannot eat by mouth, and require tube-feeding to receive adequate nutrition. Furthermore, most conscious tracheostomy patients need to communicate with body language because they have difficulties in verbal communication. The patients' treatment rate in speech therapy is not high, and the medical staff in different medical branches have varying degrees of awareness. Few studies exist in Taiwan on the needs of tracheostomy patients to treat the problems of their communication and swallowing. Methods: We conducted a survey to understand the status of tracheostomy patients who were receiving speech therapy. We used copies of questionnaire to survey 50 hospitalized patients and 80 medical staff at a medical center in Taipei. Results: The results of this study showed that over 90% of patients felt the use of tracheostomy tube impairing their swallowing and communication skills, that more than 70% of patients would like to receive speech therapy, but that only 16% of tracheostomy patients actually received speech therapy. We also found that tracheostomy patients with family support had a higher acceptance for speech therapy as well as that the gap between supply and demand affected the patients on life satisfaction and increased the family and social costs. In addition, the medical staff who had taken care more tracheostomy patients did not have higher referral rate for their patients to get speech therapy. Medical staff had been aware of communication and swallowing being impacted by tracheostomy, but only 33.8% of them referred their tracheostomy patients to receive speech therapy, that 45% of them understood communication and swallowing therapy was given by trained speech therapists, and that most of them did not have a clear understanding of patients' referral processes and methods. Conclusion: Although tracheostomy patients have impaired communication and swallowing, but they rarely receive treatment. Speech-language pathologists and multidisciplinary team can provide patients with related information and knowledge. Speech-language pathologists should put more effort to enhance medical staff's knowledge of speech therapy, to improve tracheostomy patients’ communication and swallowing abilities, and to improve quality of life of both patients and care givers.

並列關鍵字

medical personnel ； referral ； communication ； swallow