口腔癌病人及其主要照顧者的照護需求之其相關因素之探討—以南部某醫學中心為例

Exploring the Care Needs and Related Factors of the Oral Cancer Patients and Primary Caregivers–Example of a Medical Center in Southern Taiwan

余縈沁(Ying-Cin Yu)

指導教授 ： 翁世峰

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士班/碩士(2019年)

摘要

研究目的
口腔癌發生率不斷攀升，高居國人癌症死亡率第四位。口腔癌的好發年齡為在40-70歲，病人多是家庭中主要的經濟支柱。罹病過程中，不僅病人需面臨巨大衝擊，也深切造成家庭關係及需求的改變。近年來，以家庭為中心的護理已逐漸受到重視，而主要照護者之照護需求與病人息息相關，這是一整體性、連續性與個別性的護理理念，強調家屬需要被支持，需求也應該被滿足，才能增強家屬的生活品質，進而提升對癌症病患的照護品質。本研究針對口腔癌病人及其主要照護者之照護需求及影響因素做深入了解，希藉由此研究，有助於臨床照護者在照護過程中，能評估口腔癌病人的症狀及生活品質，並了解主要照護者的照護需求其相關影響因素，進而能提升醫護照護品質。
研究方法
本研究採橫斷面式(A cross-sectional design)研究設計，以南部某醫學中心為收案場所，以立意取樣（purpose sampling）的方式進行收案，收案對象為口腔癌病人120名及主要照顧者120名，藉由結構式問卷進行調查及資料蒐集，由取樣對象自行或協助填寫問卷，再以 SPSS 20.0 版統計軟體進行資料分析。研究資料以平均值、標準差、百分比、排序、獨立樣本t檢定、皮爾森相關係數、單因子變異數、卡方檢定、線性回歸作分析。
研究結果
本研究結果顯示: 病人照護需求從平均數來看，以關係需求為最大，平均值為0 .73±0.26分，以心理情緒支持需求最為低，平均值為0.38±0.29分。病人健康生活品質，分越高代表生活品質越好或功能越好，得分最高者為『社會關係』54.17±13.00分，而得分最低者是『心理』42.67±10.49分。主要照顧者的支持性照護需求，分數越高代表需求越高，得分最高者為『健康照護需求』43.18±18.81分，而得分最低者則是『其他需求』20.69±15.09分。口腔癌病人生活品質影響因子：病人年齡在社會關係有顯著的影響：65歲（含）以上的患者較於64歲（含）以下(ref)高12.152分（p=0.018）。病人的教育程度，在心理方面有顯著的影響：碩士/博士較小學以下(ref)高25.899分（p=0.006）。疾病分期方面在生理方面有顯著的影響：第二期較第一期(ref)少7.777分（P=0.007）。口腔癌病人照護需求影響因子：病人關係變項對於各項需求皆有顯著影響；父母相較於配偶(ref)在心理情緒支持需求高32.649分（p=0.019）。兄弟姐妹相較於配偶(ref)在關係需求少27.086分（p=0.019）。口腔癌病人主要照顧者的支持性照護需求影響因子：照護病患時間對心理情緒需求影響最多：4-8小時、8-12小時、12-16小時、16小時以上較1-4小時(ref)高12.177分(p=0.039）、15.111分(p=0.018）、12.657分(p=0.043）、13.996分(p=0.034）。
結論與建議
本研究結果可得知，口腔癌病人以64歲以下的青壯年男性人口居多。病人年齡、疾病分期、病人教育程度對口腔癌病人照護需求及生活品質和主要照顧者的支持性照護需求有顯著影響。台灣65歲以上的病人占所有癌症病人的60%；預計到2030年，65歲以上的病人將占所有癌症病人的70%。本研究65歲以上病人數只有37位，因此建議未來的研究可針對65歲以上病人為主，探討老年癌症病人常見的問題，了解及掌握病人在每個階段的調適情況，給予更適切的治療及幫助與支持。

關鍵字

口腔癌 ； 生活品質 ； 照護需求 ； 主要照護者 ； 支持性照護需求

並列摘要

Objective
The oral cancer is most likely ranking fourth among the major cancer deaths in Taiwan. During the rickety process, patients must face huge impacts, include family relationships, changes in needs, and so on. In recent years, family-centered care has gradually gained attention. This study provides an in-depth understanding of the care needs and impact factors of oral patients’and primary caregivers to elevate the quality of patient care.
Methods
A cross-sectional correlational design was used for this study. Conducting data analysis through structured questionnaire and data collection completed by the samplers. Adopting independent sample t-test, Pearson Correlation Coefficient and One-way Analysis Of Variance to analyze the correlation of oral cancer patients. Conducting the analysis by Chi-square Test, Linear Regression Analysis to analyze the impact factors.
Results
The average number of patients’ care needs part, the “Relationship demand” was the highest, and the “Psychological support” was the lowest. The health quality of life of patients part, the “Social relationship” was the highest, the mentality was the lowest. The supportive care need of primary caregivers part, “Health Needs” was the highest and “Other Needs” was lowest.Impact factors of oral patients’ quality of life: the age of the patients has a significant effect on social relationship: patients of 65 and above are higher than 64 and above. The educational level of patients has a significant psychological impact: the master/doctoral degrees were higher than elementary degree. The disease stage has a significant physiological impact: the second period was less than the first period. Impact factors of oral patients’ care needs: patients relationship variables have significant impact on various needs; parents has a higher psychological support requirement than siblings and their spouses. Impact factors of the primary caregivers’ supportive care needs for oral patients: Time spent on patient care has the most impact on psychological and emotional needs: 4-8 hours, 8-12 hours, 12-16 hours, 12-16 hours, 16 hours and above were higher than 1-4 hours.
Conclusion and Suggestion
This study have shown that the majority of young adults with oral cancer are under the age of 64. The age, disease stage and education level of patients affects significantly on the care needs and quality of life of oral cancer patients and the supportive care needs of primary caregivers.It is suggested that research can focus on patients over 65 years old, to explore common problems in elderly cancer patients and to understand and to master the adjustment of patients at each stage in order to give more appropriate treatment and help and support in future.

並列關鍵字

oral cancer ； quality of life ； caring needs ； primary caregiver ； supportive care needs

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