• 沒有找到結果。

第七章 、 討論

第五節 、 研究限制建議

一、未考慮其他非理性因素

本研究僅依照計畫行為理論中的基本假設(人通常很理性且能在行事前盡量蒐集並系統化 比較周遭可得訊息)考量影響 CKD 病患決策之理性因素。但是在臨床場域中可能有更多非理 性因素影響 CKD 病患之選擇例如捷思法(heuristic),建議未來的研究可進一步參考近年關於 非完全理性的相關研究或其他非理性的因素。

二、研究程序

由於本研究程序皆透過研究對象之主治醫師轉介,由於個案並非完全自主、自願參與本研 究,故在填答時可能有任意填答的狀況發生。部分研究對象在填答時可能令個案想起身體、症 狀、生命等議題,因此有出現猶豫停頓、甚至哭泣反應,可能影響作答結果。另外因研究時程 的限制,本研究僅能調查 CKD 病患之選擇意圖,無法將本研究推展至行為部分。建議相關研 究可以進一步執行追蹤調查研究對象往後真實的選擇行為,則更符合 TPB 預測行為的目的。

三、研究工具

本研究採用之知識問卷及負向情緒問卷皆為目前已出版之問卷,但是其內容並未針對選擇 血液透析或腹膜透析之優缺點相關知識及相關情境下的情緒評估,可能是使得本研究中知識、

負向情緒等變項與 TPB 變項無顯著相關性之因素。建議後續的研究可自編與預測之行為/行為 意圖更具關聯性之知識、情緒問卷。

四、研究樣本

主要由於本研究之研究目的及研究對象適配性,符合研究納入條款之研究樣本人數較少,

且主要的樣本來源皆為北部某一醫學中心腎臟科之慢性腎臟病患,故對於居住在北部以外的 CKD 病患納入數量亦不多。因此本研究之樣本有可能在樣本代表性上較不足。未來若能進行 全台灣醫療機構的 CKD 病患作為抽樣母體來源,則更更能反映國人 CKD 病患選擇透析治療 方式之決策情形,也可以比較北部或南部在不同透析治療方式的決策情形是否有差異。

參考文獻

中文參考文獻

中央健保局(2012)。透析總額專業醫療服務品質指標。

王國川(1997)。計劃行為理論各成份量表之信、效度評估-以青少年搭機車戴安全帽之研究 為例。國立中正大學學報,8,73-100。

台灣腎臟醫學會(2010)。慢性腎臟病防治手冊新版。台北:行政院衛生署國民健康局。

伍碧琦、吳麗珍、陳彩鳳、蔡來蔭(2011)。南部某醫學中心住院病人對病人自主態度與其相 關因素之探討。長庚護理,22(4),451-462。

成令方(2002)。醫「用」關係的知識與權力。臺灣社會學,3,11-70。

江慧珣(2003)。多媒體式護理指導對慢性腎功能不全患者知識、態度、行為意向與行為之成 效(碩士),國防醫學院,台北市。

吳哲熊、楊紹佑(2009)。腹膜透析方法與介紹。腎臟與透析,21(4),206-210。

李佩珍(2012)。透析給付方式認知影響透析醫護人員處方行為之研究(碩士),淡江大學,台 北縣。

周麗華(1999)。透析患者的憂鬱現象及其護理處置。台灣腎臟護理學會雜誌,8(2)。

林文源(2008)。腹膜透析推廣與病患選擇:一個動態歷程的觀點。腎臟與透析,20(1),61-64。

紀育君(2007)。比較血液透析及腹膜透析病患醫療利用情形及推廣腹膜透析治療方法之可行 性(碩士),亞洲大學,台中。

涂珮瓊、許文耀、張正雄、陳盈如(2011)。門診癌症患者參與心理社會介入之意圖評估-計 畫行為理論之運用。中華心理衛生學刊,24(3),403-428。

常逸平(2009)。腹膜透析比血液透析便宜嗎?--以初次接受透析治療患者醫療資源耗用為例

(碩士),國立陽明大學,台北。

張芳綺、朱宗信(2009)。腹膜透析在不同疾病的使用建議。腎臟與透析,21(4),221-227。

張碧玉、毛莉雯、黃尚志、黃素貞、簡麗珠、黃麗利、蔡秋月(2000)。透析患者之生活品質 測量:比較血液透析及腹膜透析病患。ActaNephrologica,14(4),307。

張靜芸、洪國欽、曾金鳳、謝湘俐(2009)。現行衛教與醫療給付制度對透析模式選擇之衝擊。

臺灣腎臟護理學會雜誌,8(1)。

梁嘉慧(2007)。慢性腎臟疾病患者選擇腹膜透析模式影響因素之探討(碩士),臺北醫學大學,

台北市。

許建民(2006)。職棒比賽現場觀賞行為意圖之研究—計畫行為理論之應用。國立體育學院論 叢,17(4),11-24。

陳佩英、史麗珠、王正旭、賴裕和、張獻崑、陳美伶(1999)。疼痛對癌症病患焦慮與憂鬱之 影響。台灣醫學。

陳鈺緯、潘吉豐(2008)。夜間居家血液透析。腎臟與透析,20(4),199-202。

黃秀秦(2008)。末期腎病患者選擇透析方式之相關因素探討—以中部某醫學中心為例(碩士),

亞洲大學,台中。

黃其琨、朱惠玲(2012)。以計畫行為理論探討外籍人士品嚐臺灣小吃之行為態度與行為意圖。

臺灣飲食文化暨餐飲管理國際學術研討會論文集,533-554。

黃智英、楊郁(2004)。慢性腎臟病衛教簡介。臺灣腎臟護理學會雜誌,3(2)。

黃圓婷(2005)。花蓮地區長期接受血液透析患者對於疾病與治療的知識、態度及自我照顧行 為相關性之研究(碩士),慈濟大學,花蓮。

劉苑菁(2008)。糖尿病健康促進機構醫師對血糖控制不佳之第 2 型糖尿病人選擇抗糖尿病藥 物之行為意向及其相關因素之探討(碩士),國立台灣大學,台北。

劉照金、劉一慧(2011)。臺灣體育專業人員知識分享成效之研究。臺灣體育運動管理學報,

11(1),1-23。

蕭仕敏、王淑麗、吳鈴珠(2008)。協助一位慢性腎臟疾病患者接受腹膜透析預先植管的護理 經驗。臺灣腎臟護理學會雜誌,7(2),22-33。

鍾昀臻(2006)。運用互動式影音衛教光碟改善末期腎病患者決策、不確定感及生活品質之成 效(碩士),輔英科技大學高雄市。

顏乃欣(2010)。情緒對決策歷程的影響。心理學門熱門前瞻研究,11(4),113-120。

顏如娟、許明暉(2007)。從資訊揭露與醫病雙方共同決策談醫病關係的演化。北市醫學雜誌,

4(8),643-649。

藺汝平(2007)。台灣腎臟專科醫師對 ESRD 病人選擇透析模式的看法(碩士),國立陽明大學,

台北。

英文參考文獻

Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. r.

Beckmann (Eds.), Action-control: From cognition to behavior (pp. 11-39). Berlin ; New York:

Springer-Verlag.

Ajzen, I. (1991). The theory of planned behavior. Organizational behavior and human decision processes, 50, 179-211.

Ajzen, I. (2002a, 2006). Constructing a theory of planned behavior questionnaire. Retrieved 12/9, 2012, from http://people.umass.edu/aizen/pdf/tpb.measurement.pdf

Ajzen, I. (2002b, 2002). Constructing a TpB Questionnaire:Conceptual and Methodological

Considerations. from http://www.socgeo.ruhosting.nl/html/files/spatbeh/tpb.measurement.pdf Ajzen, I. (2002c). Perceived Behavioral Control, Self-Efficacy, Locus of Control, and the Theory of

Planned Behavior. Journal ofApplied Social Psychology, 32(4), 665-683.

Ajzen, I. (2011). The theory of planned behaviour: reactions and reflections. Psychol Health, 26(9), 1113-1127. doi: 10.1080/08870446.2011.613995

Ajzen, I., & Fishbein, M. (1969). The prediction of behavioral intentions in a choice situation.

journal of experimental social psychology, 5(400-416).

Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior.

Englewood Cliffs, N.J.: Prentice-Hall.

Ajzen, I., & Fishbein, M. . (2005). The influence of attitudes on behavior. In D. Albarracín, B.

Johnson & M. Zanna (Eds.), Handbook of Attitudes and Attitude Change: Basic Principles.

(pp. 173–221). Mahwah, NJ: Erlbaum.

Ajzen, I., Joyce, N., Sheikh, S., & Cote, N. G. (2011). Knowledge and the Prediction of Behavior:

The Role of Information Accuracy in the Theory of Planned Behavior. Basic and Applied Social Psychology, 33(2), 101-117. doi: 10.1080/01973533.2011.568834

Armitage, C. J., & Conner, M. (2001). Efficacy of the Theory of Planned Behaviour: a meta-analytic review. Br J Soc Psychol, 40(Pt 4), 471-499.

Arora, N. K., Ayanian, J. Z., & Guadagnoli, E. (2005). Examining the relationship of patients'

attitudes and beliefs with their self-reported level of participation in medical decision-making.

Medical Care, 43(9), 865-872.

Arvola, A., Lahteenmaki, L., & Tuorila, H. (1999). Predicting the intent to purchase unfamiliar and familiar cheeses: the effects of attitudes, expected liking and food neophobia. Appetite, 32(1), 113-126. doi: 10.1006/appe.1998.0181

Bass, Eric B., Wills, Stacey, Fink, Nancy E., Jenckes, Mollie W., Sadler, John H., Levey, Andrew S., . . . Powe, Neil R. (2004). How strong are patients’ preferences in choices between dialysis modalities and doses? American Journal of Kidney Diseases, 44(4), 695-705. doi:

10.1053/j.ajkd.2004.06.011

Berger, A., Edelsberg, J., Inglese, G. W., Bhattacharyya, S. K., & Oster, G. (2009). Cost comparison of peritoneal dialysis versus hemodialysis in end-stage renal disease. Am J Manag Care, 15(8), 509-518.

Brownbridge, G. , & Fielding, DM. (1991). Psychosocial adjustment to end stage renal failure:

comparing hemodialysis, chronic ambulatory peritoneal dialysis and transplantation. Pediatr Nephrol, 5(612-616).

Caballero, Amparo., Carrera, Pilar., & Muñoz, Dolores., Sánchez, Flor. (2007). Emotional Ambivalence in Risk Behaviors:The Case of Occasional Excessive Use of Alcohol. The Spanish Journal of Psychology, 10(1), 151-158.

Chanouzas, D., Ng, K. P., Fallouh, B., & Baharani, J. (2012). What influences patient choice of treatment modality at the pre-dialysis stage? Nephrol Dial Transplant, 27(4), 1542-1547. doi:

10.1093/ndt/gfr452

Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med, 44(5), 681-692.

Chisholm, M. A., Williamson, G. M., Lance, C. E., & Mulloy, L. L. (2007). Predicting adherence to immunosuppressant therapy: a prospective analysis of the theory of planned behaviour.

Nephrol Dial Transplant, 22(8), 2339-2348. doi: 10.1093/ndt/gfm149

Cohen, J., & Hanno, D. M. (1993). An analysis of underlying constructs affecting the choice of accounting as a major. Issues in Accounting Education, 8(2), 219-238.

Cukor, D., Cohen, S. D., Peterson, R. A., & Kimmel, P. L. (2007). Psychosocial aspects of chronic disease: ESRD as a paradigmatic illness. J Am Soc Nephrol, 18(12), 3042-3055. doi:

10.1681/ASN.2007030345

Cukor, D., Coplan, J., Brown, C., Friedman, S., Cromwell-Smith, A., Peterson, R. A., & Kimmel, P.

L. (2007). Depression and anxiety in urban hemodialysis patients. Clin J Am Soc Nephrol, 2(3), 484-490. doi: 10.2215/CJN.00040107

Devins, G. M., Binik, Y. M., Mandin, H., Letourneau, P. K., Hollomby, D. J., Barre, P. E., & Prichard, S. (1990). The Kidney Disease Questionnaire: a test for measuring patient knowledge about end-stage renal disease. J Clin Epidemiol, 43(3), 297-307.

Duckett, L., Henly, S., Avery, M., Potter, S., Hills-Bonczyk, S., Hulden, R., & Savik, K. (1998). A theory of planned behavior-based structural model for breast-feeding. Nurs Res, 47(6), 325-336.

Eng, Jeffrey J., & Martin Ginis, Kathleen A. (2007). Using the theory of planned behavior to predict leisure time physical activity among people with chronic kidney disease. Rehabilitation Psychology, 52(4), 435-442. doi: 10.1037/0090-5550.52.4.435

Fincham, D., Kagee, A., & Moosa, R. (2008). Dietary and fluid adherence among haemodialysis patients attending public sector hospitals in the Western Cape. South African Journal of Clinical Nutrient, 21(2), 7-12.

Finkelstein, A., Hausleiter, J., Doherty, T., Takizawa, K., Bergman, J., Liu, M., . . . Makkar, R. (2004).

Intracoronary beta-irradiation enhances balloon-injury-induced tissue factor expression in the porcine injury model. Int J Cardiovasc Intervent, 6(1), 20-27. doi:

10.1080/14628840410030351780UT9B2WHX9T6PD [pii]

Fishbein, Martin, & Ajzen, Icek. (1975). Belief, attitude, intention, and behavior : an introduction to theory and research. Reading, Mass.: Addison-Wesley Pub. Co.

Fishbein, Martin, & Ajzen, Icek. (2010). Predicting and changing behavior : the reasoned action approach. New York: Psychology Press.

Francis, J., Eccles, M., Johnston, M., Walker, A., Grimshaw, J., Foy, R., . . . D., Smith L. & Bonetti.

(2004). Constructing questionnaires based on the theory of planned behaviour: A manual for health services researchers. Report to ReBEQI: Research Based Education and Quality Improvement, University of Newcastle.

Goeree, R., Manalich, J., Grootendorst, P., Beecroft, M. L., & Churchill, D. N. (1995). Cost analysis of dialysis treatments for end-stage renal disease (ESRD). Clin Invest Med, 18(6), 455-464.

Golper, T. (2001). Patient education. can it maximize the success of therapy? Nephrol Dial Transplant, 6(7), 20-24.

Goovaerts, T., Jadoul, M., & Goffin, E. (2005). Influence of a pre-dialysis education programme (PDEP) on the mode of renal replacement therapy. Nephrol Dial Transplant, 20(9), 1842-1847. doi: 10.1093/ndt/gfh905

Hagger, Martin S., Chatzisarantis, Nikos L.D., & Biddle, Stuart J.H. (2002). A meta-analytic review of the theories of reasoned action and planned behavior in physical activity: Predictive validity and the contribution of additional variables. Journal of Sport & Exercise Psychology, 24(1), 3-22.

Harwood, L., & Clark, A. M. (2012). Understanding pre-dialysis modality decision-making: A meta-synthesis of qualitative studies. Int J Nurs Stud. doi: 10.1016/j.ijnurstu.2012.04.003 Harwood, L., Wilson, B., Sontrop, J., & Clark, A. M. (2012). Chronic kidney disease stressors

influence choice of dialysis modality. J Adv Nurs, 68(11), 2454-2465. doi:

10.1111/j.1365-2648.2012.05943.x

Hawley, S. T., Lantz, P. M., Janz, N. K., Salem, B., Morrow, M., Schwartz, K., . . . Katz, S. J. (2007).

Factors associated with patient involvement in surgical treatment decision making for breast cancer. Patient Educ Couns, 65(3), 387-395. doi: 10.1016/j.pec.2006.09.010

Hemodialysis Adequacy 2006 Work Group. (2006). Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis, 48 Suppl 1, S2-90. doi: S0272-6386(06)00554-3 [pii]10.1053/j.ajkd.2006.03.051

Holst, Anne., & Iversen, Julie Maria. (2011). An Application of a Revised Theory of Planned Behavior: Predicting the intention to use personal care products without endocrine

disrupting chemicals. (Master), Copenhagen Business School, Copenhagen. III. Treatment modalities for ESRD patients. (1997). Am J Kidney Dis, 34(2 Suppl 1), S51-62. doi:

10.1053/AJKD034s00051

Jager, Kitty J., Korevaar, Johanna C., Dekker, Friedo W., Krediet, Raymond T., & Boeschoten, Elisabeth W. (2004). The effect of contraindications and patient preference on dialysis modality selection in ESRD patients in The Netherlands. American Journal of Kidney Diseases, 43(5), 891-899. doi: 10.1053/j.ajkd.2003.12.051

Jassal, S. V., Krishna, G., Mallick, N. P., & Mendelssohn, D. C. (2002). Attitudes of British Isles nephrologists towards dialysis modality selection: a questionnaire study. Nephrol Dial Transplant, 17(3), 474-477.

Jung, B., Blake, P. G., Mehta, R. L., & Mendelssohn, D. C. (1999). Attitudes of Canadian nephrologists toward dialysis modality selection. Perit Dial Int, 19(3), 263-268.

Just, P. M., de Charro, F. T., Tschosik, E. A., Noe, L. L., Bhattacharyya, S. K., & Riella, M. C. (2008).

Reimbursement and economic factors influencing dialysis modality choice around the world.

Nephrol Dial Transplant, 23(7), 2365-2373. doi: 10.1093/ndt/gfm939

Kalender, B., Ozdemir, A. C., Dervisoglu, E., & Ozdemir, O. (2007). Quality of life in chronic kidney disease: effects of treatment modality, depression, malnutrition and inflammation. Int J Clin Pract, 61(4), 569-576. doi: 10.1111/j.1742-1241.2006.01251.x

King, K., Witten, B., Matkin-Grumke, J., Whitlock, RW., & Waterman, AW. (2008). The Missouri Kidney Program’s Patient Education Program : A 12-year retrospective analysis. Nephrology News and Issues, 44-54.

Klang, B., Bjorvell, H., & Clyne, N. (1999). Predialysis education helps patients choose dialysis modality and increases disease-specific knowledge. J Adv Nurs, 29(4), 869-876.

Korevaar, J. C., Feith, G. W., Dekker, F. W., van Manen, J. G., Boeschoten, E. W., Bossuyt, P. M., . . . Group, Necosad Study. (2003). Effect of starting with hemodialysis compared with peritoneal dialysis in patients new on dialysis treatment: a randomized controlled trial. Kidney Int, 64(6), 2222-2228. doi: 10.1046/j.1523-1755.2003.00321.x

Lee, Anne., Gudex, Claire., Povlsen, Johan. V., Bonnevie, Birgitte., & Nielsen, Camilla. P. . (2008).

Patients' views regarding choice of dialysis modality. Nephrol Dial Transplant, 23, 3953-3959. doi: 10.1093/ndt/gfn365

Levey, A. S., Coresh, J., Balk, E., Kausz, A. T., Levin, A., Steffes, M. W., . . . Eknoyan, G. (2003).

National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med, 139(2), 137-147. doi: 200307150-00013 [pii]

Levey, A. S., Eckardt, K. U., Tsukamoto, Y., Levin, A., Coresh, J., Rossert, J., . . . Eknoyan, G.

(2005). Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int, 67(6), 2089-2100. doi:

KID365 [pii]10.1111/j.1523-1755.2005.00365.x

Levy, J., Edwina, B., Christine, D., & Anastasia, L. (2009). Oxford handbook of dialysis (3rd ed.).

Oxford ; New York: Oxford University Press.

Lew, S. Q., & Piraino, B. (2005). Quality of life and psychological issues in peritoneal dialysis patients. Semin Dial, 18(2), 119-123. doi: 10.1111/j.1525-139X.2005.18215.x

Li, P. K., & Chow, K. M. (2003). How to have a successful peritoneal dialysis program. Perit Dial Int, 23(2), S183-S187.

Li, P. K., & Szeto, C. C. (2008). Success of the peritoneal dialysis programme in Hong Kong.

Nephrol Dial Transplant, 23(5), 1475-1478. doi: 10.1093/ndt/gfn068

Liang, C. H., Yang, C. Y., Lu, K. C., Chu, P., Chen, C. H., Chang, Y. S., . . . Chou, K. R. (2011).

Factors affecting peritoneal dialysis selection in Taiwanese patients with chronic kidney disease. Int Nurs Rev, 58(4), 463-469. doi: 10.1111/j.1466-7657.2011.00913.x

Factors affecting peritoneal dialysis selection in Taiwanese patients with chronic kidney disease. Int Nurs Rev, 58(4), 463-469. doi: 10.1111/j.1466-7657.2011.00913.x