中 文 摘 要 當急救的效益遠不如不予急救時,臨床上越來越多的癌症病人家屬傾向簽署不予施行心肺復甦術(Do Not Resuscitate, DNR),研究顯示80%之DNR是由家屬簽署的,但是相關於家屬簽署DNR時之感受的文獻卻很有限。好的臨終照顧除了包含病人本身之照顧之外,亦須含括照顧者家屬的照顧。因此瞭解此類家屬之感受,將有助於醫護人員提供符合此類癌症病人家屬所需之照護服務,進而促進此類病人及其家屬之身、心、靈安適。 本研究為描述性、相關性研究,採橫斷式研究法,探討簽署不予施行心肺復甦術癌症病人照顧者家屬的感受及其相關因素與預測因子。本研究邀請80位簽署DNR之癌症病人照顧者家屬參與,以結構性問卷為研究工具,問卷內容包含:病人及家屬之屬性、家屬照顧情境、臺灣版安德森症狀量表、中文版家屬情緒狀態量表、簡短評估照顧者量表與自擬簽署DNR相關感受之八個題目。資料分析方式,包括:描述性統計、獨立t檢定、單因子變異數分析、皮爾森積差相關與階層式迴歸分析。 本研究採用簡短評估照顧者量表與自擬之簽署DNR相關感受量表測量簽署DNR癌症病人照顧者家屬之感受。研究結果顯示:與簡短評估照顧者量表有關的變項是家屬情緒狀態;與自擬之簽署DNR相關感受有關的變項,包括:病人之年齡、家屬之年齡、教育程度、是否與病人同住、家屬感受到的病人症狀嚴重程度與症狀干擾病人生活感受與功能程度以及家屬之情緒狀態。簽署DNR相關感受的重要預測因子為:病人預立醫療指示、家屬之年齡、性別、是否與病人同住、教育程度以及情緒狀態,其解釋簽署DNR照顧者家屬DNR相關感受之總變異量為73.1%(p=0.00)。 本研究之結果,除了有助於醫護人員瞭解替癌症病人簽署DNR之照顧者家屬的感受與相關因素之外,亦可協助我們發展臨終照顧之相關臨床教育課程。我們希望藉由病人、家屬與醫護人員之有效溝通,能改善此類病人及照顧者家屬的照顧品質,並緩和照顧者家屬於簽署DNR時產生的不良感受。 關鍵字:不予施行心肺復甦術、癌症病人、照顧者家屬
Abstract Title of Thesis:Exploring Family Caregivers’ Experience and Associated Factors While They Consented to “Do Not Resuscitate” for Cancer Patients Institution:Graduate Institute of Nursing, Taipei Medical University Author: Kuo-Min Chu Thesis directed by: Yuan- Mei Liao, Ph.D., Associate Professor More and more cancer patients’ family caregivers tend to choose Do Not Resuscitate (DNR) for their ill family members when an effective cardiopulmonary resuscitation is unlikely to be successful in rescuing patients’ lives. Although about 80% of the DNR consents were gave by family caregivers, however, information related to family caregivers’ experience while they consented to DNR was limited. Good quality of "end of life care" should include not only the care of patients but also the care of family caregivers. Understanding the experience and associated factors of cancer patients’ family caregivers could help health care providers deliver needed care services and further improve cancer patients’ and their family caregivers’ physical, mental, spiritual well beings. This study was a descriptive, correlational, cross-sectional study. Study aim was to explore family caregivers’ experience and associated factors (predictors) while they consented to DNR for cancer patients. Eighty cancer patients’ family caregivers were invited to participate in this study. Study instrument was a structured questionnaire. Content of the instrument included patients’ and their family caregivers’ individual characteristics, caregivers’ caring situation, The Chinese version of the short form of Profile of Mood States, M. D. Anderson symptom inventory: Taiwan Form, Brief Assessment Scale for Caregivers, and 8 self-developed items related to family caregivers’ experience of consenting to DNR. Data analyses included descriptive statistics, independent t-test, one-way ANOVA, pearson’s correlation test, and hierarchical regression analysis. In this study, the Brief Assessment Scale for Caregivers and a self- developed scale related to family caregivers’ experience of consenting to DNR were used to measure caregivers’ experience. Caregivers’ experience measured by Brief Assessment Scale for Caregivers was associated with family caregivers’ emotional status. Patients’ age, family caregivers' age, educational level, living with patients or not, patients’ symptom severity and symptom interference with life and functional status perceived by family caregivers, and family caregivers’ emotional status were related to caregivers’ experience of consenting to DNR. Hierarchical regression model accounted for 73.1% (p=0.00) of variance in family caregivers’ experience of consenting to DNR and the main predictors included patients’ living wills, family caregivers’ age, gender, educational level, living with patients or not, and emotional status. In addition to help health care providers understand family caregivers’ experience and associated factors while they consented to DNR for cancer patients, study results of this study could also be used to develop clinical education programs about end of life care. We hope that effective communications between patients, family caregivers, and health care providers would improve the care of cancer patients and their family caregivers, and ease family caregivers’ negative experience while they consented to DNR. Key works: Do Not Resuscitate, cancer patients, family caregivers
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