社會支持、透析疾病支持、感受性自主支持對腹膜透析患者自我效能及健康相關生活品質之相關性探討

研究背景：台灣末期腎臟病人者發生率與盛行率高居世界第一，而末期腎臟病病人之病人多採取透析方式來維持腎臟功能，透析病人在台灣盛行人數高達75,442人，且透析患者整體總醫療點數佔整體全民健保2013年為10.6%，讓健保有有沈重負擔。末期腎臟病病人(ESRD)須定期接受透析治療外，針對飲食限制、飲水限制、注意廔管或導管照顧、生活型態改變等複雜的治療或照護，皆會影響到社會功能、身體及心理功能，而透析病人過去對於自我效能、自我管理與生活品質之研究已被驗證，若能夠增加病人自我效能及自我管理，對於病人之生活品質有顯著提升。而自我效能是動態的，會隨著不同環境、年齡、新知識獲得而有所變動，故是可以透過改變而提升，近期亦有多數研究針對社會支持與自我效能之影響做研究，透過社會夥伴的支持能夠幫助病人更有信心地面對生活型態改變的困難。故本篇研究希望透過探討不同來源與構面之社會支持，來探討腹膜透析患者所需要來自於社會支持、透析疾病支持或感受性自主支持之需求評估。研究目的：探討腹膜透析患者之自我效能是否與社會支持、透析疾病支持、感受性自主支持有相關性，而進而與健康相關生活品質有相關。另外，本研究要一般社會支持、透析疾病支持、感受性自主支持、自我效能與健康相關生活品質之間相關性探討與模型建立。研究設計：本研究為橫斷性研究，利用問卷調查方法，一對一面訪進行問卷資料收集。問卷發放採立意抽樣，研究對象為包含台大醫院、敏盛醫院、部立台北醫院之腹膜透析3個月以上之病人。測量工具包含一般社會支持量表(ISEL-16, Interpersonal Support Evaluation List)、透析疾病支持量表(Illness support scale)、感受性自主支持(Health Care Climate Questionnaire,HCCQ)、透析自我效能量表(Perceived Kidney/Dialysis Self-Management Scale, PKDSMS) 及腎臟疾病生活品質量表(Kidney Disease Quality of Life 36, KDQOL-36)，共發放319份有效問卷。研究結果：本篇之腹膜透析患者自我效能對於健康相關生活品質有顯著相關（P<0.05）。一般社會支持對於自我效能有顯著相關（P<0.01），且一般社會支持對於健康相關生活品質也有顯著相關（P<0.001），一般社會支持可直接或間接透過自我效能與健康相關生活品質產生關係；感受性自主支持對於自我效能有顯著相關（P<0.001），但感受性自主支持對於健康相關生活品質無顯著相關（P=0.849），故感受性自主支持需透過自我效能與健康相關生活品質相關。而透析疾病支持對於自我效能與健康相關生活品質均無顯著相關（P=0.414; P=0.655）。結論：一般社會支持能夠自我效能間接與健康相關生活品質產生相關，亦可直接與健康相關生活品質產生正向相關，一般社會支持對於腹膜透析患者健康相關生活品質有正向顯著的關係，亦可以改善病人自我管理的信心，進而有較好的健康相關生活品質；而感受性自主支持需要透過增加自我效能才能和健康相關生活品質有正向相關，故在醫護人員感受性自主支持的部分需要能夠增加腹膜透析患者自我管理的自信心，才能對於健康相關生活品質產生正向相關。在透析疾病支持部分本研究團隊分析，由於腹膜透析患者的年齡較輕、有自我照顧自主能力且採用腹膜透析之患者本身條件需要受到限制，故對於透析疾病支持自我效能與健康相關生活品質均無顯著關係。關鍵字：社會支持、透析疾病支持、感受性自主支持、自我效能、健康相關生活品質、腹膜透析

關鍵字

社會支持；透析疾病支持；感受性自主支持；自我效能；健康相關生活品質；腹膜透析

並列摘要

Background: The incidence and prevalence rate of end-stage renal patients in Taiwan ranks first in the world, while patients with end-stage renal disease patients take dialysis to maintain renal function. The number of dialysis patients prevails in Taiwan is as high as 75,442, and the total medical cost of dialysis patients accounts for 10.6% of the overall expenditure on National Health Insurance in 2013, which puts a heavy burden on health insurance. End-stage renal disease (ESRD) are required to receive regular dialysis treatment. Complex treatment or care such as dietary restrictions, drinking water restrictions, attention to fistula or catheter care, and lifestyle changes can affect social function, physical and mental function. In the past, dialysis patients have been tested on self-efficacy, self-management and quality of life. If the patient's self-efficacy and self-management can be increased, the quality of life of patients will be significantly improved. Self-efficacy is dynamic and will change with different environments, ages, and new knowledge. It can be improved through change. In the near future, most studies have also studied the impact of social support and self-efficacy through social partners. Support can help patients feel more confident about the difficulty of changing lifestyles. Therefore, this study hopes to explore the needs of peritoneal dialysis patients from social support, dialysis-related support or perceived autonomy support. Objectives: To explore whether the self-efficacy of peritoneal dialysis patients is related to social support, dialysis-related support, and perceived autonomy support, and thus related to health-related quality of life. In addition, this study wants to establish the model and find the correlation between social support, dialysis-related support, perceived autonomy support, self-efficacy and health-related quality of life. Method: This study is a cross-sectional study, using questionnaires to collect data by one-on-one interviews. The questionnaire was purposive sampling. The subjects were patients who had peritoneal dialysis for more than 3 months including National Taiwan University Hospital, Min-Sheng General Hospital and Ministry of Health and Welfare Taipei Hospital. Measurement tools include the International Social Support Scale (ISEL-16), the Illness support scale, the Health Care Climate Questionnaire (HCCQ), and the Dialysis Self-Energy Questionnaire (Perceived Kidney /Dialysis Self-Management Scale, PKDSMS) and Kidney Disease Quality of Life 36 (KDQOL-36), a total of 319 valid questionnaires. Results: The self-efficacy of peritoneal dialysis patients in this article was significantly correlated with health-related quality of life (P<0.05). Social support was significantly associated with self-efficacy (P < 0.01), and social support was also significantly associated with health-related quality of life (P < 0.001). Social support can directly or indirectly through self-efficacy to be associated with health-related quality of life. Perceived autonomy support was significantly associated with self-efficacy (P < 0.001), but perceived autonomy support was not significantly associated with health-related quality of life (P = 0.849), so perceived autonomy support needs to be related to the health-related quality of life through self-efficacy. There was no significant correlation between dialysis-related support and self-efficacy. Conclusion: Social support can be related to health-related quality of life indirectly, and can be directly related to health-related quality of life. Social support has a positive and significant relationship to the health-related quality of life of peritoneal dialysis patients, and can also improve the patient's self-management confidence, which in turn leads to better health-related quality of life. Furthermore, perceived autonomy support needs to be positively related to health-related quality of life by increasing self-efficacy. It’s necessary to increase confidence of self-management in peritoneal dialysis patients through perceived autonomy support by medical staff, then be related to the health-related quality of life. In the dialysis-related support section, the research team analyzed that because of the younger age of peritoneal dialysis patients, self-care autonomy and the need to limit the conditions of patients undergoing peritoneal dialysis, there is no significant relationship between dialysis-related support, self-efficacy and health-related quality of life. Key words: Social support、dialysis-related support、perceived autonomy support、self-efficacy、health-related quality of life、Peritoneal Dialysis