等待肝臟移植病人的症狀困擾、症狀困擾因應及移植決定之經驗探討

Exploring experience of symptom distress, coping and transplant decision in patients waiting for liver transplantation

楊蓉甄(Jung-Chen Yang)

指導教授 ： 林淑媛

高雄醫學大學/護理學院/護理學系碩士班/碩士(2019年)

摘要

肝臟移植為急性肝功能衰竭或末期肝病病人唯一的治療途徑，但由於器官的匱乏，等待肝臟移植病人於器官遙遙無期的等待期間，常因疾病所帶來身體、心理、社會及家庭各方面許多的困擾;本研究主要目的為探討等待肝臟移植病人因疾病所帶來的症狀困擾、症狀困擾因應及移植決定之經驗。採混合性研究(mixed methods)設計，收案期間自2017年12月至2018年5月，針對南部某準醫學中心及區域醫院等待肝臟移植病人為研究對象，資料收集分兩階段進行，第一階段採方便取樣方式，以「病人基本屬性問卷」、「疾病特性問卷」及「慢性肝臟疾病量表(Chronic Liver Disease Questionnaire,CLDQ)」作為研究工具，共收案88人，並從第一階段收案樣本數中，採立意取樣方式，選取已列入器官移植登錄中心等候名單之病人，以「質性訪談大綱」進行第二階段訪談，共收案24人，問卷資料以SPSS Window18.0進行描述性統計、獨立樣本t檢定及單因子變異數分析，而質性訪談則採用內容分析方法做資料分析。
研究結果顯示:等待肝臟移植病人最困擾之症狀為擔憂，其次依序為疲憊、全身性症狀、活動力、情緒功能、腹部症狀。內容分析結果包含三個核心主題及其屬類:(一)飽受肝病的症狀困擾－身體症狀困擾、心理困擾、日常生活困擾、家庭運作失衡;(二)嘗試因應症狀的困擾－飲食控制、症狀控制、生活與工作的調整、心理及資源的支持;(三)等待肝臟移植的心路歷程－被告知需接受移植的反應、對移植的不確定、隨緣順命。本研究結果有助於臨床醫療人員更深入瞭解等待肝臟移植病人在症狀困擾、症狀困擾因應及做移植決定的感受與經驗，並提供日後評估及照護需求之參考。

關鍵字

等待肝臟移植 ； 症狀困擾 ； 症狀因應 ； 移植決定

並列摘要

Liver transplantation is the only treatment for patients with acute liver failure or end-stage liver disease. However, due to the lack of organs, patients perceive long waiting times for liver transplant. During the waiting time, they will suffer from physical, psychological, social and family problems. The aims of this study were to investigate the symptom distress, coping, and the patients' experiences of waiting for a liver transplantation. This study was a mixed methods design. Patients were recruited from the waiting lists of a medical center and a regional hospital in southern Taiwan, and the data was collected from December 2017 to May 2018. The data collecting was done in two phases. In the first phase, patients were recruited using convenience sampling and the data was collected by structured questionnaires, including Demographic Characteristics Questionnaire, Disease Characteristics Questionnaire and Chronic Liver Disease Questionnaire (CLDQ). The sample consisted of 88 patients while waiting liver transplant. Among the cases in the first phase, the patients who were included in the waiting list of the organ transplant registration center were selected using purposive sampling for the interview in the second phase, in which 24 patients were involved. The data in this study were used descriptive statistical analysis, Independent T-test and One way ANOVA by SPSS 18.0. The content analysis method was used for the qualitative interviews.
The results of this study show that worry was the most disturbing as symptom, followed by fatigue, systemic symptoms, activity, emotional function, and abdominal symptoms. The results of the content analysis include three themes: 1) Suffering from the symptoms of liver disease - physical symptoms, psychological distress, daily life problems, and imbalances in family operations; 2) Try to coping with the symptoms - diet control, symptom control, life and work adjustment, psychological and resource support; 3) Waiting for liver transplantation - the responses of being informed to receive liver transplant, their uncertainty and their obedience about liver transplantation.
The results of this study provide healthcare professionals useful information of the feelings, experiences, symptoms distress, coping and their transplant decisions of patients while waiting for liver transplantation. Also, this study provide the healthcare professionals to set the effective strategies of assessment and care needs.

並列關鍵字

waiting for liver transplantation ； symptom distress ； coping ； transplant decision

參考文獻

陳怡呈、蔡淑玲、蔡昌雄、黃珊(2012)．肝硬化合併腹水病患之調適經驗．新臺北護理期刊，14 (2)，13-21。

中文參考文獻

王麗雲(2002)．等待心臟移植患者自我照顧行為、希望與社會支持之相關性探討．未發表的碩士論文，台北：台北醫學大學護理學研究所。

王秋惠(2006，7月4日)．肝性腹水病患之居家照顧．2018年11月24日取自http://www.tccf.org.tw/old/magazine/vol10/vol10_15.htm

中華民國教育部(2010，無日期)．教育部重編國語辭典修訂本．2018年11月16日取自http://dict.revised.moe.edu.tw/cgi-bin/cbdic/