安寧共同照護模式對提升癌末照護品質之成效

The Effects of Hospital-based Palliative Care Team on Quality of Care with Terminal Cancer

高綺吟(Chi-Yin Kao)

指導教授 ： 胡文郁

國立臺灣大學/醫學院/護理學研究所/碩士(2007年)

https://doi.org/10.6342/NTU.2007.02077

摘要

本研究目的為探討安寧共同照護模式對提升癌末照護品質之成效。採準實驗設計(quasi-experimental design)，自2005年11月至2006年7月止，於北臺灣某醫學中心進行資料收集，採症狀困擾量表、醫院焦慮憂鬱量表、靈性安適狀態量表及社會支持量表予以病人前測，施測後依照護模式的不同，分為原單位治療且未接受安寧共同照護模式（31位）、原單位治療但有接受安寧共同照護模式（33位）以及直接轉入安寧病房（36位）三組。一週後，再以相同量表進行後測，以瞭解安寧共同照護模式的照護品質之成效。
重要研究結果發現，癌末病人之照護問題呈多面向，其中前三項主要問題分別為生理 (60%)、心理 (58%)以及病情告知(24%)問題。生理問題的發生頻率以疲倦、口乾、疼痛、食慾不振及腹脹最常見，困擾度由高而低依序為腹水、疼痛、大小便失禁、疲倦及食慾不振；心理問題以癌末病人疑似有憂鬱狀態為主（平均分數為8.84分）。此外，安寧共同照護模式確實能有效改善症狀困擾、焦慮及憂鬱狀態，並且提高靈性安適狀態、社會支持度以及簽署DNR比例。結果也發現得知病情者比未知病情者較不焦慮且靈性安適狀態較佳。且癌末病人知不確定感與病情認知度及靈性安適狀態呈負相關，與焦慮呈正相關；症狀困擾總數則與焦慮呈正相關、與靈性安適呈負相關；焦慮與憂鬱呈正相關；靈性安適狀態與焦慮及憂鬱成負相關，與社會支持呈正相關。簽署DNR組之癌末照護品質較未簽署DNR組佳。
故安寧共同照護模式能顯著且有效地緩解病人的症狀困擾、降低焦慮及憂鬱程度、提升靈性安適狀態、增加社會支持度及簽署DNR比例，為臨床實務中值得推廣的末期醫療照護模式。

關鍵字

安寧共同照護模式 ； 癌末 ； 照護品質 ； 症狀困擾 ； 憂鬱

並列摘要

The primary aim of the study was to explore the effects of hospital-based palliative care team on quality of care with terminal cancer. Pretest-posttest quasi experimental design was adopted. Between November 2005 through July 2006, we investigated 100 eligible patients with terminal cancer in a medical center in north of Taiwan. 33 patients received hospital-based palliative care team services compared with 31 patients receiving traditional supportive care and 36 patients admitted to palliative care unit directly. Data was collected using the questionnaires include “Symptom Distress Scale, Hospital Anxiety and Depression Scale, Spiritual Well-Being Scale and Social Supportive Scale” on two occasions.
The main needs for terminal cancer patients’ care were physical care (60%), psychological care (58%) and truth telling (24%). Fatigue, dry mouth, pain, loss of appetite, and abdominal distention were common physical symptoms. Ascites, pain, feces and urine incontinence, fatigue, and appetite loss were most distressed for physical symptoms. Depression was a significant symptom in psychological problem (mean score was 8.84). There were significant improvements in physical symptoms, anxiety and depression, spiritual well-being, social support and DNR approval in hospital-based palliative care team. Truth telling was also significant reduction in anxiety degree and improvements in spiritual well-being. Truth telling and uncertainty were negatively correlated. Uncertainty and anxiety were positively correlated, but uncertainty and spiritual well-being were negatively correlated. Amounts of symptoms and anxiety were positively correlated, but amounts of symptoms with spiritual well-being were negatively correlated. Anxiety and depression were positively correlated, but anxiety with spiritual well-being was negatively correlated. Depression and spiritual well-being were negatively correlated. Quality of care with patients whose DNR consent form orders were signed was greater than patients not signed DNR consent form.
In conclusion, hospital-based palliative care team improved symptoms, anxiety and depression, spiritual well-being, social support and DNR approval in patients with terminal cancer.

並列關鍵字

hospital-based palliative care team ； terminal cancer ； quality of care ； symptom distress ； depression

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