家屬照顧者於癌症病人接受免疫治療期間之支持性照護需求及其相關因素探討

隨著科技醫療的進步，現今的癌症治療已進入新興免疫療法階段，促使愈來愈多癌症病人接受免疫治療，有著持續存活的機會，也表示有更多的家屬照顧者需要提供更長時間的照護工作，更突顯家屬照顧者的重要。反觀臨床上，病人及其家屬照顧者對免疫治療的療效、副作用的不確定性外，還有著諸多的心理壓力問題，但家屬照顧者不滿足的支持性照顧需求相關的研究卻十分有限，故本研究將針對癌症病人接受免疫治療期間之家屬照顧者支持性照護需求進行探討。本研究採橫斷式描述性和相關性研究設計，經倫理委員會審查通過後，以立意取樣方式於北部某醫學中心腫瘤科病房收案，運用結構式問卷收集共70位成對之病患及家屬照顧者，研究工具包含：病人人口學特性與疾病特徵資料表（含財務安適度評估COST-FACIT）、免疫治療相關嚴重度評估分級表（CTCAE 5.0）、症狀困擾量表（SSS）、情緒溫度計量表（DT）；家屬照顧者人口學特性與照顧相關特性資料表、症狀困擾量表、情緒溫度計量表、照顧者反應評估量表（CRA）、支持性照護需求量表（SCNS-P C），以描述性及推論性統計進行分析。研究結果顯示：（1）免疫治療相關不良事件常見為皮膚乾燥、搔癢、丘疹；（2）病患及家屬照顧者症狀困擾前三名皆為疲倦、睡眠問題及疼痛；（3）病患及家屬照顧者情緒困擾分數平均各為3.6分與3.8分，大於等於4分以上，建議需要進一步轉介的比例各為47%及44%；（4）治療期間家屬照顧者之整體照顧負荷平均2.6分；（5）照顧者支持性照護需求前三項依序為訊息需求51.2分、免疫治療照護需求50.9分、健康照護服務需求41.9分；（6）病患症狀困擾、情緒困擾以及家屬照顧者的職業、經濟狀態、症狀困擾、情緒困擾、與整體照顧負荷程度皆與照顧者本身之支持性照護需求有顯著相關。本研究結果發現接受免疫治療病患症狀如口腔炎，家屬照顧者症狀如疲倦、睡眠困擾的處理，以及情緒支持都是滿足家屬照顧者各層面支持性照顧需求的重要相關因素，顯見醫護人員對於情緒評估的重要性，此外；家屬照顧者的經濟狀態與照顧負荷程度也是重要相關因素，必要時，可以與醫療團隊討論並進行適當轉介；在家屬照顧者的免疫治療照護需求層面，建議未來能設置完善的後續居家照護諮詢管道，以滿足家屬照顧者的支持性照護需求。

關鍵字

癌症；免疫療法；家屬照顧者；支持性照護需求

並列摘要

Background With the advancement of medical science and technology, current cancer treatment has entered the stage of emerging immunotherapy, which has prompted an increasing number of cancer patients to receive immunotherapy and have the chance to survive. It also means that more family caregivers need to provide longer-term care; this highlights the importance of family caregivers. In addition to the uncertainty of the efficacy and side effects of immunotherapy, patients and family caregivers also experience psychological stress. However, studies on family caregivers’ supportive care needs are very limited. This study explored the supportive care needs of family caregivers among cancer patients during immunotherapy. Method This study adopted a cross-sectional, descriptive, and correlation research design. After being reviewed and approved by Institutional Review Board (IRB), 70 advanced cancer patient-caregivers dyads was recruited from the oncology wards of the northern parts of the medical center using purposive sampling. Research tools included patient demographic characteristics and disease characteristics data sheet (including financial wellbeing assessment), Immune-Related Adverse Events Assessment Scale (CTCAE 5.0), Symptom Severity Scale (SSS), and Distress Thermometer (DT); and family caregiver demographic characteristics and care-related characteristics data sheet, Symptom Severity Scale, Distress Thermometer, Caregiver Reaction Assessment Scale (CRA), and The Supportive Care Needs Survey for Partners and Caregivers (SCNS-P C). Data were analyzed using descriptive and inferential statistics by Mann–Whitney U test, Kruskal-Wallis H test and Spearman Correlation. Results The following results were obtained. First, the most immune-related adverse events were dry skin, pruritus, and rash. Second, the top three symptoms of patients and family caregivers were fatigue, sleep disturbance, and pain. Third, the average emotional distress score of the patients was 3.6 and of the family caregivers was 3.8. The proportion of recommended further referrals (4 points or more) were 47% and 44%, respectively. Fourth, the burden of family caregivers averages was 2.6. Fifth, the top three supportive care needs of caregivers were information needs (51.2), immunotherapy care needs (50.9), and health care service needs (41.9). Sixth, patients’ symptom distress and emotional distress, and family caregivers’ occupation, economic status, symptom distress, emotional distress, and caregiver burden were all significantly related to the caregivers’ supportive care needs. Conclusion This study found that the symptoms of patients during immunotherapy such as oral mucositis, and the family caregivers’ symptoms such as fatigue, sleep disturbance, and emotional support were relevant factors to meet the caregivers’ supportive care needs. The importance of emotional assessment was clearly highlighted. In addition, the financial status and care burden of family caregivers were also important related factors. We suggest that if necessary, care workers can engage in discussions with the medical team and make appropriate referrals. Furthermore, home care consultation services can be set up in the future to meet the family caregivers’ supportive care needs.