肝癌患者失志程度、因應行為與其主要照顧者生活品質之相關性探討

背景：肝癌為十大癌症發生率第四位，近幾年蟬聯十大癌症死亡率第二，為高復發率且容易遠端轉移的癌症，對於癌症病患和家庭來說，是一個高壓的情境，因治療方式多元常出現不同程度的疾病症狀，使得照護的工作更顯困難，導致主要照顧者沈重的照顧負荷，影響其生活品質。癌症患者生理症狀、心理反應及因應行為與主要照顧者生活品質可能密切相關。目的：本研究目的為了解1.肝癌患者人口學和疾病特性、失志程度和因應行為、主要照顧者人口學和生活品質之現況；2.肝癌患者人口學和疾病特性、失志程度、因應行為和主要照顧者人口學與生活品質之關係；3.探討肝癌患者主要照顧者生活品質之重要預測因子。方法：本研究採橫斷性、描述性和相關性之研究設計，以方便取樣方式，利用結構式問卷於南部某醫學中心肝膽科門診和病房進行資料收集，共收取187組肝癌患者與其主要照顧者。研究工具包括「肝癌患者人口學和疾病特性問卷」、「簡明因應量表」、「中文版失志量表」、「主要照顧者人口學問卷」和「癌症主要照顧者生活品質問卷」，使用統計方法包括描述性統計、獨立樣本t檢定、單因子變異數分析、皮爾森積差相關分析和階層線性迴歸模型分析。研究結果：本研究結果顯示肝癌患者之主要照顧者生活品質平均分數為88.82分，屬於中等程度。68.4%肝癌患者屬高失志，失志程度與主要照顧者生活品質呈顯著中度負相關。肝癌患者最常使用問題取向因應行為，問題取向因應行為和情緒取向因應行為與主要照顧者生活品質呈顯著低至中度正相關。肝癌患者之BCLC分期、失志程度、問題取向因應行為是主要照顧者生活品質之重要預測因子，分別對主要照顧者的解釋力為20.1%、11.2%、9.9%，三個變項共可解釋41.2%的主要照顧者生活品質總變異量。即肝癌患者之失志程度愈高，主要照顧者生活品質愈差；肝癌患者之BCLC分期愈低、愈常使用問題取向因應行為，主要照顧者生活品質愈好。結論：本研究結果顯示肝癌患者與主要照顧者生活品質為互相顯著影響之關係，醫療團隊應將癌症病患和主要照顧者視為一個照護個體，以「全家」的概念給予照護。建議未來研究針對高危險族群提供護理介入措施，降低肝癌患者之失志程度並增加其問題取向因應行為，以提升主要照顧者生活品質。

關鍵字

肝癌；失志；因應行為；主要照顧者；生活品質

並列摘要

Background: Hepatocellular carcinoma (HCC) has the fourth highest incidence among cancers and is the second leading cause of cancer mortality. HCC has high recurrence rates and can metastasize easily. Cancer is a high-pressure situation for both patients and their families. Patients require multiple treatments, resulting in them showing treatment-related adverse effects as well as symptomatic disease. These factors contribute to the increase in difficulties experienced by caregivers while caring for HCC patients. Cancer and related treatment create a heavy care load that affects the quality of life of caregivers. The quality of life of caregivers has been closely linked with cancer patients. Negative psychological responses and coping behaviors of cancer patients can lower the quality of life of their caregivers. Purpose: The aims of this study were: 1.) to evaluated the degree of HCC patients’ demoralization, coping behaviors and caregivers’ quality of life; 2.) to determine the relationship between HCC patients’ demographics, demoralization, coping behaviors, caregivers’ demographics and caregivers’ quality of life; 3.) to examine the important determinators of caregivers’ quality of life. Methods: This study was a descriptive and cross-sectional design. The data was collected by structured questionnaires, including demographic data of patients and caregivers, Demoralization Scale Mandarin Version (DS-MV), Brief COPE and Caregiver Quality of Life-Cancer (CQOL-C). A convenience sampling from the hepatobiliary outpatient departments and wards of a medical center in southern Taiwan was performed. A sample of 187 sets of HCC patients and their caregivers were enrolled into this study. The data were analyzed by descriptive statistic, t-test, one-way ANOVA, Pearson’s correlation and hierarchical multiple regression analysis. Results: Our results showed that the average CQOL-C questionnaire score was 88.82, which fell in the moderate range. High demoralization was observed in 68.4% of HCC patients. The degree of demoralization showed a significant negative correlation with the quality of life of caregivers. Problem-focused coping was most frequently used by HCC patients; the least used coping behavior was dysfunctional coping. The frequency of problem-focused coping and emotion-focused coping showed a significantly low-moderate positive correlation with the quality of life of caregivers. Barcelona Clinic Liver Cancer (BCLC) stage, demoralization, and problem-focused coping in HCC patients were important determinants of caregivers’ quality of life that 41.2% of variance could be explained. Conclusion: This study shows that HCC patients have a significant effect on caregivers’ quality of life. Cancer patients and caregivers should be treated as a whole by the medical team, resulting in whole-family care. Nursing interventions may be provided for high-risk HCC patients to reduce demoralization and increase the use of problem-focused coping behavior that subsequently improve the quality of life of caregivers.

並列關鍵字

Hepatocellular Carcinoma ； Demoralization ； Coping behavior ； Caregiver ； Quality of life

參考文獻

Mehnert, A., Vehling, S., Hocker, A., Lehmann, C., & Koch, U. (2011). Demoralization and depression in patients with advanced cancer: validation of the German version of the demoralization scale. Journal of Pain and Symptom Management, 42(5), 768-776. doi:10.1016/j.jpainsymman.2011.02.013

方俊凱(2013)•癌症病人的失志症候群•台灣醫學，17(2)，149-154。 doi:10.6320/fjm.2013.17(2).07