癌末病患主要家屬照顧者照顧負荷影響因素之探討

中文摘要本研究目的在探討癌末病患之基本屬性、疾病特性、癌末症狀和日常活動功能與主要家屬照顧者之基本屬性、照顧情形、自覺健康和疲憊與照顧負荷之相關性，以及照顧負荷的預測因子。採橫斷式的描述相關性研究法，在高屏地區的一家醫學中心、一家區域醫院及二家地區醫院，以立意取樣方式，分別選擇100位住院罹患癌症第四期，醫師建議接受安寧療護者的病患和其主要家屬照顧者為研究對象。研究工具使用結構性問卷，包括病患與照顧者的基本屬性調查表、病患的癌末症狀量表、巴氏量表與主要家屬照顧者的SF-12健康量表、台灣版的疲憊量表、照顧負荷量表來進行資料的收集，並以SPSS 12.0中文版電腦套裝軟體作資料的分析。研究結果發現：病患的平均年齡為59.73歲，以男性居多；主要家屬照顧者的平均年齡為45.8歲，以女性居多。照顧負荷平均值82.79(±24.46)，屬於中等程度，依每題的平均得分來看，其中以主要家屬照顧者的「靈性負荷」（2.66）最大，其次依序為經濟負荷（2.56）、生活負荷（2.50）、身心負荷（2.45）、因應負荷（2.40）。癌末病患巴氏量表之平均值為28.15(±27.13)，屬於嚴重依賴。主要家屬照顧者自覺健康之平均值為32.46 (±5.51)，屬於中上的健康狀況；主要家屬照顧者的疲憊平均值為30.78±(21.7)，屬於輕度疲憊。癌末病患有宗教信仰（t98＝-2.14, p＜.05）、入住在一般病房（t98＝2.12, p ＜.05）時，家屬照顧者的照顧負荷愈大；而主要家屬照顧者自覺的經濟狀況愈差（t98＝2.22, p＜.05），且需要照顧其他家人（t98＝-2.58, p＜.05）者的照顧負荷較高。癌末病患的年齡與照顧負荷呈負相關（r = -.33, p＜.01）；主要家屬照顧者的年齡（r = -.22, p＜.05）、自覺健康（r = -.49, p＜.01）與照顧負荷呈負相關，疲憊與照顧負荷呈正相關（r = .54, p＜.01）。照顧負荷的預測因子為癌末病患的年齡、入住病房與主要家屬照顧者的自覺健康、疲憊，可解釋照顧負荷的42％總變異量。本研究建議醫護人員應評估癌末病患家屬照顧者照顧負荷的程度，給予照顧上的協助，且未來研究可以藉由介入措施來減少照顧者的照顧負荷。

關鍵字

癌末病患；照顧負荷；主要家屬照顧者

並列摘要

Abstract The purposes of this study are to explore the relationships among patients’ personal characteristics, disease characteristics, terminal cancer symptoms, activities of daily living (ADL), their family caregivers’ personal characteristics, care conditions, perceived health, fatigue and caregiver burden , and to explore the predictors of caregiver burden in family caregivers of terminal cancer patients. This study used a cross-sectional descriptive correlation design with the purposive sampling method to recruit one hundred hospitalized terminal cancer patients and their family caregivers from a medical center, a regional and two district hospitals in Kaohsiung and Pingtung. Structural questionnaires used in this study including patients and caregivers’ personal characteristics, patients’ terminal cancer symptoms questionnaire , Barthel Index and caregivers’ Short-Form 12-item Health Survey, Brief Fatigue Inventory-Taiwan Form, and caregiver burden scales for data collection. SPSS 12.0 window version software was used for statistical analyses. The results showed: The mean age of patients was 59.73 years, and male patients were more than female patients. The mean age of their family caregivers were 45.80 years. Female caregivers were more than male caregivers. The mean of caregiver burden was 82.79 (±24.46), which accounted for moderate degree. The highest caregiver burden was spirit burden (53.29), the second was economic burden (51.20), the third was life burden (50.08), the fourth was physical-psychological burden (48.98), and the last was coping burden (47.96). The mean of Barthel Index was 28.15 (±27.13), which accounted for severe dependent function. The mean of family caregivers’ perceived health was 32.46 (±5.51), which accounted for moderately high degree. The mean of family caregivers’ fatigue was 30.78(±21.7), which accounted for mild degree. Terminal cancer patients, who had religion (t98＝-2.14, p＜.05）and hospitalized in oncology ward, had higher caregiver burden than their counterparts. Caregivers, who had low income（t98＝2.22, p＜.05）and need to care other family members（t98＝-2.58, p＜.05）had higher caregiver burden than their counterparts. Patients’ age was significantly correlated with caregiver burden （r = -.332, p＜.01）. Family caregivers’ age（r = -.219, p＜.05）and perceived health were significantly (r = -.487, p＜.01）correlated with caregiver burden. Caregivers’ fatigue was positively correlated with caregiver burden（r = .544, p＜.01）. The predictors of caregiver burden were patients’ age, hospitalized ward and caregivers’ perceived health, fatigue. They accounted for 42％ total variance of caregiver burden. The study results suggest that clinicians shall assess the degree of care burden in family caregivers, and provide respite care to family caregivers. Prospective study is encouraged to test the effect of intervention in reducing caregivers’ caregiver burden in the future.