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  • 學位論文

應用符合戒菸行為階段模式於門診病患的戒菸方案:隨機控制試驗研究

A randomized controlled trial of stage-matched tailored intervention for smoking cessation in outpatient clinics

指導教授 : 黃芷苓

摘要


背景:吸菸是冠狀動脈心臟病與糖尿病的危險因子之ㄧ,戒菸治療有非常高的經濟效益,國外研究已針對門診冠狀動脈心臟病與糖尿病患的戒菸進行臨床試驗研究,國內相關研究仍顯不足。 目的:本研究符合戒菸階段模式為基礎,由護理人員針對慢性病門診吸菸患者,執行戒菸方案之成效評價,其目的為:(1)比較實驗組與對照組三個月與六個月的7天與30天點戒菸率;(2)比較實驗組與對照組三個月與六個月的戒菸階段改變成效;(3)比較實驗組與對照組三個月與六個月的每日吸菸量減少一半以上之比率。 方法:本研究設計為實驗性研究,於2010年12月至2012年6月在南部某區域醫院門診進行研究,針對冠狀動脈心臟病與糖尿病吸菸患者進行戒菸介入。以擲銅板方式隨機分配個案至實驗組(n=108)與對照組(n=92),實驗組的個案接受4次面對面戒菸諮商,每次諮商約20-30分鐘,合併3次電話關懷,介入時間共3個月;而對照組個案接受初次基本資料收集,之後每月接受電話追蹤;兩組皆在第3個月接受肺部吐氣一氧化碳驗證,且完成3個月介入後,每月接受電話追蹤戒菸情形至第6個月。資料分析使用JMP 9.0統計軟體,運用t檢定、卡方檢定與邏輯式回歸模式,分析比較兩組人口學變項、3個月與6個月7天與30天點戒菸率、戒菸階段改變以及每日吸菸量減少一半以上比率之成效。 結果:實驗組3個月7天點戒菸率為13.1%高於對照組10.0%(p=.50);實驗組與對照組之3個月30天點戒菸率為12.2%高於對照組10.0%(p=.63),以上兩項結果沒有達到統計顯著性差異;實驗組的3個月戒菸階段改變率為10.3%顯著高於對照組2.2%(p<.05);實驗組3個月每日吸菸量減少一半以上比率為28.0%顯著高於對照組14.4%(p<.05);實驗組6個月7天點戒菸率為22.4%顯著高於對照組10.1%(p<.05);實驗組6個月30天點戒菸率為22.4%高於對照組10.1%(p<.05),達統計顯著差異;實驗組的6個月戒菸階段改變率為31.8%顯著高於對照組12.4%(p<.01);實驗組6個月每日吸菸量減少一半以上比率為32.7%顯著高於對照組19.1%(p<.05)。 結論:本研究提供初步的研究結果,證實應用符合戒菸階段模式的門診病患戒菸方案,能夠有效改善6個月7天與30天點戒菸率,以及3個月和6個月戒菸階段改變與每日吸菸量減少一半以上。未來研究將增加研究場所及樣本數,以促進本研究結果的推論性。

並列摘要


Background: Smoking is one of important risk factors for coronary artery disease and diabetes mellitus. Smoking cessation treatment is highly cost-effective for both diseases. Previous studies have confirmed the effects of smoking cessation in randomized controlled trials among outpatients. However, it is lack of such study in Taiwan. Objective: A nurse-delivered outpatient smoking cessation intervention based on the stage-matched tailored to patients’ levels of readiness to quit was evaluated. The aims of this study were to: (1) compare the 7-day and 30-day point quit rates between the intervention group and control group at 3 months and 6 months; (2) compare the progress to ulterior stages of change between the intervention group and control group at 3 months and 6 months; (3) compare the decreased daily cigarette consumption50% between the intervention group and control group at 3 months and 6 months. Method: The study design was experimental. All participants were recruited between December 2010 and June 2012 at outpatient clinics of a regional hospital in southern Taiwan. The trial was targeted to smoking patients with coronary heart disease or diabetes. Participant assignment was randomized by a coin toss determined to intervention group (n=108), and usual care group (n=92). The intervention group received 4 counseling sessions by 20-30-minute face-to-face and 3 sessions by telephone counseling in 3 months. The usual care group received basic information collection, after initial contact received telephone follow up in every month. Both groups also received biochemically validated tobacco abstinence at 3 months. After completing 3-month intervention, both group received telephone follow-up for 6 months. Data analysis was performed using the JMP 9.0. We compared the baseline characteristics of patients using x² test for categorical variables and t-test for continuous variables between the intervention and control groups. We used the x² test and Logistic regression to assess the effect of 7-day and 30-day point-prevalent smoking cessation rates, progress to ulterior stages of change and decreased daily cigarette consumption50% at 3 and 6 months. Results: The 7-day point-prevalent quit rates in the intervention group and usual care group at 3 months 13.1% and 10.0% (p=.50), respectively. The 30-day point-prevalent quit rates in the intervention group and usual care group at 3 months 12.2% and 10.0% (p=.63), respectively. The rate of progress to ulterior stages of change in the intervention group was significantly higher than usual care group at 3 months, respectively 10.3% and2.2% (p<.05). Decreased daily cigarette consumption50% of the intervention group were significantly higher than usual care group at 3 months, respectively 28.0% and 14.4% (p<.05). The 7-day point-prevalent quit rates in the intervention group was significantly higher than usual care group at 6 months, respectively 22.4% and 10.1% (p<.05). The 30-day point-prevalent quit rates of the intervention group was higher than usual care group at 6 months, respectively 22.4% and 10.1% (p<.05). The rate of progress to ulterior stages of change in the intervention group was significantly higher than usual care group at 6 months, respectively 31.8% and 12.4% (p<.01). Decreased daily cigarette consumption50% of the intervention group was significantly higher than usual care group at 6 months, respectively 32.7% and 19.1% (p<.05). Conclusions: This study provided preliminary evidence. The results showed that stage-matched tailored smoking cessation intervention in outpatient clinics significantly increased 7-day and 30-day point-prevalent smoking cessation rates at 6 months, progression to ulterior stages of change, and decreased daily cigarette consumption50% at 3 and 6 months. Further studies are needed to increase multiple study sites and sample size to promote the generalization of the study results.

參考文獻


Chen, C. C., Yen, L. L., & Chao, K. Y. (2008). The Effectiveness of Outpatient Smoking Cessation Therapy and Related Factors Taiwan Journal of Public Health, 27(1), 44-56.
Cheng, H. Y., & Lee, R. P. (2009). Smoking Cessation Behavior and Self-Efficacy in Subjects of a Smoking Cessation Clinic. Formosan Journal of Medicine, 13(3), 223-230.
Chang, T. C., Pan, R. S., & Chang, C. J. (2006). The Effects of Single-Session and Multiple-Session Telephone Counseling for Smoking Cessation. Formosa Journal of Mental Health, 19(3), 213-229.
American Nurses Association. (2008). Nursing leadership in global and domestic tobacco control. Retrieved November,25, 2011, from http://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/Leadership-in-Tobacco.pdf
Barth, J., Critchley, J., & Bengel, J. (2006). Efficacy of psychosocial interventions for smoking cessation in patients with coronary heart disease: a systematic review and meta-analysis. Annals of behavioral medicine, 32(1), 10-20.

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