主要照顧者對安寧居家療護照護需求之看法及其滿意度

Perception of the Hospice Home Care Needs and Satisfaction among the Primary Caregivers

張淑真(Shu-Chen Chang) ； 机昑惠(Chin -Hue Chi) ； 黃靜宜(Chin-Yi Huang)

《The Changhua Journal of Medicine》 7卷3期 (2002/07) Pp. 160-167

摘要

背景及目的：惡性腫瘤為彰化地區主要死亡原因之第一位，每年約有一千八百名彰化縣民死於癌症。本院於1993年設立安寧居家服務，提供癌症末期病患之照護，服務的對象已超過1700人。雖然國內的安寧療護發展已有多年，但安寧居家服務相關的研究仍非常有限，因此本研究旨在：(l)探討主要照顧者認為癌末病患在接受安寧居家療護之身、心、靈及社會方面需求；(2)瞭解安寧居家療護服務是否符合其需求；(3)主要照顧者對安寧居家療護服務的滿意度；及(4)探討影響主要照顧者對安寧居家療護服務滿意度之因素，以做為提昇本院安寧居家療護服務品質，並提供國內醫院有意發展安寧居家療護之參考。
方法：本研究之樣本母群體為自民國86年6月23日至民國87年3月31日之間接受彰化基督教醫院安寧居家療護且已死亡之病人的主要照顧者共111人，資料收集以郵寄問卷、電話訪談為主，共得有效樣本計54人。
結果：研究發現主要照顧者以子女為主(38.9%)，女性居多(70.4%)。在需求程度方面，依次為身體症狀控制(90.6%)、家屬心理支持(79.6%)、死亡診斷書的索取(77.8%)。在需求與服務符合程度方面，以經濟協助(100%)、身體症狀控制(97.9%)、家屬心理支持(97.7%)為前三項。在滿意度方面，約75%以上的樣本對各項服務表示滿意或非常滿意，最滿意為護理人員的服務態度，最不滿意的是協助病患情緒反應的處理。影響滿意度之主要因素為訪視次數。
結論：此次研究顯示安寧居家主要照顧者仍以女性為主，疼痛為病患最需要之症狀處理問題，病患較少表達出自己靈性上有需求(30%)，92.6%的病患選擇自家為其臨終地點，故安寧居家服務方式應可協助家屬減少害怕與擔憂，又可以實現病患對臨終地點選擇之期望，居家訪視次數關係著家屬對服務之滿意度，故適度增加居家訪視次數可提高家屬對安寧居家療護服務之滿意度。

關鍵字

安寧居家療護 ； 癌末患者需求 ； 滿意度

並列摘要

Background and purpose: Cancer is the leading cause of death in Changhua county, and more than 1,800 residents died of cancer each year. The hospice home care program was established in 1993 in our hospital and has served more than 1,700 patients. Although hospice programs in Taiwan has been over 10 years, research on hospice care has been limited. To improve the quality of the hospice home care programs, this study was designed to (1) explore the bio-psychosocial needs of terminally ill patients in a hospice home care environment, (2) evaluate the fulfillment of these needs, (3) determine the satisfaction of the primary caregivers with the service, and (4) explore the factors that influence the primary caregiver's satisfaction.
Method: One hundred and eleven families were recruited in this study. Data were collected from self-administered questionnaires. The majority of the subjects were members of the patient's immediate family, and 54 subjects returned valid questionnaires.
Results: The majority of the caregivers were either children of the patients (38.9%) or women (70.4%). The top three needs were identified as symptom control (90.6%), familial emotional support (79.6%), and death certificate acquirement (77.8%). These caregivers were most satisfied with financial assistance provided (100%), symptom control (97.9%), and emotional support given to family members (97.7%). They were least satisfied with the patient's emotional support. The caregivers were most satisfied with the nurse's attitude, and 75% of the caregivers were satisfied or very satisfied with the service. The significant factor influencing satisfaction level was the number of home care visits.
Conclusion: The majority of caregivers were female. Pain is the major care issue in symptom control. Only 30% of patients express their spiritual needs. Home care service can reduce caretaker's anxiety and fear, and also fulfill the patients' expectation to die at home. Increasing the number of home care visits will increase the satisfaction of the caregivers.

並列關鍵字

hospice home care ； needs ； satisfaction