- 學位論文
末期腎衰竭治療模式衛教對於透析模式選擇之影響
The influence of patient education program for renal replacement therapy on dialysis modality selection
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摘要
根據2011年第一季台灣腎臟醫學會統計資料：台灣有62963位透析患者，其中56718位選擇血液透析、6245位擇腹膜透析。末期腎衰竭替代療法分為三種治療模式：分別為血液透析治療、腹膜透析治療與腎臟移植，台灣地區腎臟移植因受限於法規限制與文化等因素影響，腎臟捐贈者人數偏低。且腹膜透析治療成長率不如預期，以致目前腎臟替代療法以血液透析為主。病患在接受腎臟替代療法前，醫療院所有責任對病患做完整的治療模式衛教。 本研究主要探討末期腎衰竭病患治療模式衛教對於透析模式選擇的影響，研究樣本為台灣北部地區的腎友團體，以回溯性問卷方式，於對病患接受腹膜透析、血液透析與腎臟移植衛教後，探討末期腎衰竭治療模式衛教對於透析模式的影響。本研究發現接受不同程度的治療模式衛教，對透析模式選擇有顯著差異；參與完整的三種衛治療模式衛教，對腹膜透析課程的滿意度越高，願意選擇腹膜透析治療的勝算比增為6.87倍。曾接受腹膜透析衛教者，衛教的次數對透析模式選擇有顯著影響。在接受全部三種衛教模式病患當中：有『購買個人保險』、『覺得收入足夠者』、『家人支持意願』、『醫護人員曾經告知因醫療因素考量不適合選擇腹膜透析或血液透析』會影響對其透析模式選擇；在接受腹膜透析與血液透析兩種衛教模式病患當中：『住家距離醫院車程在30分鐘以內』與『家人或幫傭可以協助日常生活起居』會影響對其透析模式選擇；在接受僅腹膜透析一種衛教模式病患當中，認為『醫護人員能協助您解決末期腎衰竭治療問題』、『家人或幫傭可以協助日常生活起居』、『醫護人員曾經告知因醫療因素考量不適合選擇腹膜透』會影響對其透析模式選擇；在接受僅血液透析一種衛教模式病患當中，認為『交通便利性會影響透析方式』會影響對其透析模式選擇。 本研究結果可提供醫護人員於日後執行慢性腎臟病衛教評估更多參考依據，並能充分協助病患選擇最適透析治療模式。
並列摘要
According to the data collected from Taiwan Society of Nephrology in the first quarter of 2011, there are 62963 dialysis patients in Taiwan, in which 56718 patients received hemodialysis, and 6245 patients received peritoneal dialysis. Renal replacement therapy ( RRT ) include there modality：hemodialysis, peritoneal dialysis and kidney transplantation. Due to the regulation of organ donation and culture difference in Taiwan, only a small number of people donated their kidney for transplantation. In addition, the growth rate of peritoneal dialysis penetration was not as strong as expected, the majority of patients still choose hemodialysis as their primary treatment option. The healthcare organizations are responsible for delivering a complete patient education program（PDP）for modality selection before deterioration to the end stage renal disease（ESRD）. The aim of this study is to determine the influence of PDP for RRT on dialysis modality selection. The sample was taken from the Association of Dialysis Patients from the Northern Taiwan, in which retrospective questionnaire were conducted. It is found that there exists a significant difference on modality selection depending on the grade of PDP delivered. In the group receiving complete PDP, they were prone to choose the peritoneal dialysis program with high satisfaction rate, and the odds ratio of such selection increase as high as 6.87 times. Among patients who have received PDP for peritoneal dialysis, the frequency of patient education program given has a significant influence on modality selection. For those who received complete PDP, factors that influence patient's modality selection include『purchase personal insurance』、『satisfied income』、『family support』、『Physician or nurse's opinion on not suitable for hemodialysis or peritoneal dialysis』、『Physician and nurse can help to resolve the problem during RRT』. In the group receiving PDP for hemodialysis and peritoneal dialysis, factors such as 『distance within 30 minutes 』、『Family or care-giver can help to deal with ordinary task』、『Physician or nurse's opinion on not suitable for peritoneal dialysis』played a significant role on modality selection. In the group receiving PDP for peritoneal dialysis only,『Physician and nurse can help to resolve the problem during RRT』、『Physician or nurse's opinion on not suitable for peritoneal dialysis』 have strong influence on modality selection. In the group receiving PDP for hemodialysis only,『convenience traffic 』has significant influence on modality selection. The result of the study serves as a reference for the physicians and nurses to enhance further education program for patients with chronic kidney disease. This will also help patients to choose the most suitable modality for renal replacement therapy.
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