復原力與社會支持及自我效能之相關暨對透析患者疾病逆境與健康相關生活品質調節效果之探討

研究背景：台灣末期腎臟病發生率與盛行率長期高居世界第一，而末期腎臟病患大多在全民健保的給付下採取血液透析或腹膜透析的方式維持腎臟功能以延續生命。2016年末期腎臟病盛行率已達3,392 /每百萬人口(USRDS 2018)，且台灣透析病患約佔全民康保納保人口的0.3%，但卻花費10.4%的全民健保費用，成為健保的沉重負擔。接受透析治療的病人除了飲食、飲水的限制外，生活型態及人際關係也遭遇重大的轉變，這些都會影響病患的生理及心理生活品質。復原力是指一個人具有的特質或能力，能使處於危機或壓力情境的個人，免於高危險情境、慢性壓力、或長期嚴重創傷之影響，已在心理、健康等領域受到廣泛探討，也有研究探討復原力與癌症或糖尿病病患生活品質之間的相關性，近年在心理學領域已有多國針對復原力的調節效果進行研究。復原力作為一種可以被強化的能力，受到個人內在與外在的影響，其中由家人或朋友提供的社會支持以及隨環境、年齡、知識變動的自我效能皆可以透過改變提升，進一步使復原力得到強化。研究目的：探討復原力是否有具調節透析病患疾病逆境與健康相關生活品質之效果，以及復原力與社會支持、自我效能之間的相關性。研究設計：本研究採橫斷性研究，以問卷調查的方式，經由訪員面訪收集問卷資料。問卷發放採立意抽樣，研究對象為臺大醫院、臺大醫院北護分院、部立臺北醫院與敏盛醫院穩定透析三個月以上之血液透析與腹膜透析病患。測量工具包含腎臟疾病生活品質量表、復原力量表、社會支持量表與透析自我效能量表，共461份有效問卷。研究結果：未加入復原力作為調節變項前，透析病患的疾病逆境分數越高、復原力的分數越低，生理層面與心理層面的生活品質分數皆越低。社會支持和自我效能與復原力呈現正向相關(p<0.0001)。檢驗復原力的調節效果後，復原力未對生理層面生活品質的分數有顯著調節效果，對腎臟疾病的負擔與心理層面生活品質的分數有調節效果。擁有高復原力的透析病患即使有較高的腎臟疾病負擔，心理層面生活品質的分數下降較少(p<0.0001)。結論：復原力對透析患者腎臟疾病的負擔與生理層面生活品質有調節效果，社會支持和自我效能與復原力有顯著正向相關。關鍵字：健康相關生活品質、復原力、社會支持、自我效能、血液透析、腹膜透析

關鍵字

健康相關生活品質；復原力；社會支持；自我效能；血液透析；腹膜透析

並列摘要

Background: The incidence and prevalence rate of end-stage renal disease in Taiwan has ranked first in the world for a long time, and most end-stage renal disease patients in Taiwan receive hemodialysis or peritoneal dialysis treatment under National Health Insurance. In 2016, prevalence rate of end-stage renal disease in Taiwan had reach 3,392 per million population. Patients receiving dialysis treatment accounts for 0.3% of National Health Insurance population, while they use 10.4% of total budget. This has become a serious burden for National Health Insurance. Patients under dialysis treatment suffer from water and food restriction, their life style and interpersonal relationship also face with dramatic changes. These can all affect dialysis patients’ psychical and mental quality of life. Resilience is a personal trait or ability to bounce back from pressure or adversity, avoiding further effect from chronic pressure or long-term trauma. Resilience has been widely researched in psychology and health over different countries. There are researches about the association between resilience and cancer or diabetes, and in recent psychology researches, resilience is treated as a moderator. Resilience as an ability that can be reinforced, is affected by endogenous and exogenous factors. Social support from family and friends, self-efficacy, which can change according to environment, age and knowledge, can both be boosted and eventually reinforce resilience. Objectives: The aim of this study is to explore the moderation effect of resilience between disease adversity and health-related quality of life, also explore the association between social support, self-efficacy and resilience. Method: This is a cross-sectional study; questionnaires were collected by trained interviewers by face-to-face interview. The questionnaire was purposive sampling. The subjects were patients under hemodialysis or peritoneal dialysis treatment for more than three months at National Taiwan University Hospital, National Taiwan University Hospital Bei-Hu branch, Ministry of Health and Welfare Taipei Hospital and Min-Sheng General Hospital. Measurement tools in this questionnaire include Kidney Disease Quality of Life 36 (KQOL-36), 10 items The Connor-Davidson Resilience Scale (CD-RISC), 16 items Interpersonal Support Evaluation List (ISEL-16) and Perceived Kidney/Dialysis Self-Management Scale (PKDSMS). A total of 461 valid questionnaires. Results: Before adding resilience as a moderator, the higher the disease adversity and lower the resilience score is, the lower physical and mental component quality of life score is. Social support and self-efficacy are significantly positive associated with resilience (P<0.0001). After testing the moderation effect of resilience, it does not have any moderation effect on physical component quality of life score, but has a moderation effect on burden of kidney disease and mental component quality of life score. Dialysis patients with high resilience score can maintain higher mental component quality of life score even with high burden of kidney disease (P<0.0001). Conclusion: Resilience has a moderation effect on dialysis patients’ burden of kidney disease and mental component quality of life score. Social support and self-efficacy are significantly positive associated with resilience. Key words: Health-related quality of life, resilience, social support, self-efficacy, hemodialysis, peritoneal dialysis

並列關鍵字

Health-related quality of life ； resilience ； social support ； self-efficacy ； hemodialysis ； peritoneal dialysis

參考文獻

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