精神疾病患者生活品質及其測量

Quality of Life in Psychiatric Patients and Its Assessment

鄭若瑟(Joseph J. Cheng) ； 高家常(Chia-Chan Kao)

《台灣精神醫學》 19卷3期 (2005/09) Pp. 179-191

https://doi.org/10.29478/TJP.200509.0003

摘要

傳統上對精神疾病患者預後研究之指標多為「症狀消除」與「功能恢復」的價值評斷模式，不能完全反應病人的狀態。健康相關生活品質的概念由於反應以病人為中心之治療目標和消費者觀點，逐漸廣泛地被引用。但其定義至今未有共識，測量方式和範疇亦有不同看法。在精神疾病患者由於受症狀或人格特質影響，其測量容易出現天花板或地板效應。綜合文獻可歸納出：生活品質是測量病人「健康相關的身心和生活狀態」，是多向度測量，包括病人對生活良好感（生活感受）、過得如何（生活功能）、擁有些什麼（生活標準）三大範疇之主客觀測量。其量表分為：一般，廣用型及特定疾病三種。應依研究目的、對象、社會文化之特性、信效度、概念範圍、反應度、敏感度、解讀性及負荷選擇適當量表。生活品質可應用在：（一）預後指標，（二）臨床試驗及治療結果測量指標，（三）成本效果或效益評估，（四）需求調查與政策資源配置，（五）治療方案規劃。生活品質研究有其社會和文化特異性，國內相關研究不多，值得進一步探索。

關鍵字

生活品質 ； 治療結果測量 ； 精神疾病患者 ； 量表

並列摘要

In contemporary psychiatric research, outcome measurement is no longer limited to the classical concepts of symptom elimination and recovery of function. Health related quality of life (HRQOL) has become an increasingly important assessment which represents both patient centered value and consumer perspectives. However, the definition of HRQOL in psychiatric research has yet to be standardized, and many issues about measurement methodology including objective versus subjective measurements, and the adequacy of coverage of life domains remain controversial. HRQOL is an inherently multidimensional assessment, and its measurement should therefore cover different constructs and perceptions in life domains. In brief, HRQOL covers patients' sense of well being (perception of life), how they are doing (functional status), what they have (standard of living), with both subjective and objective measurements treated as equally important. There are three types of QOL scales: general QOL, generic HRQOL, and disease-specific HRQOL. For selecting a scale, in addition to validity and reliability, the conceptual model, responsiveness, sensitivity, interpretability and burden should be considered under the context of the research purpose, patient characteristics and culture. HRQOL assessment is useful in: (1) prognosis and risk factors research, (2) as an outcome measure in clinical trials and health services research, (3) as an index of cost effectiveness and benefit research, (4) for health needs assessments of populations and resources allocation, (5) for the planning of clinical care of individual patients. HRQOL research is socially and culturally specific. The limited number of studies from Taiwan that have investigated HRQOL suggests the need for further emphasis of this important measure.

並列關鍵字

quality of life ； outcome measurement ； psychiatric patients ； scale

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