題目:癌末照顧者睡眠困擾及影響因素之探討 蔡淑華1、李國箴1,2 1. 中國醫藥大學護理學系 2. 中國醫藥大學附設醫院 通訊作者:李國箴助理教授 中國醫藥大學護理學系;中國醫藥大學附設醫院 台中市北區學士路 91 號 Email:rubylee@mail.cmu.edu.tw
Title: Factors related to sleep disturbance among caregivers of advanced cancer patients Shu-Hua Tsai, RN, MSN, Kwo-Chen Lee, RN, Ph.D.1,2
1. School of Nursing, China Medical University
2. Department of Nursing, China Medical University Hospital, Taichung, Taiwan
Correspondence : Kwo-Chen Lee RN, Ph.D.
School of Nursing, China Medical University; Department of Nursing, China Medical University Hospital, Taichung, Taiwan. 91, Hsueh-Shin Road, Taichung, Taiwan
題目:癌末照顧者睡眠困擾及影響因素之探討
Title: Factors related to sleep disturbance among caregivers of advanced cancer patients 研究目的 癌末照顧者所承擔的繁重的照顧工作，常導致產生睡眠障礙。本研究目的 為 1)了解癌末病人照顧的睡眠困擾情況; 2)探討影響癌末照顧者睡眠困擾之相 關因素。 研究方法 本研究採前瞻性，橫斷型研究設計，立意取樣 176 個癌末病人之照顧者。 參與者條件為 1)經腫瘤專科醫師診斷為末期癌症病人所認定主要提供照顧之親 屬。2)實際參與照顧工作超過 6 小時。研究工具為睡眠日誌、匹茲堡睡眠品質 問卷指數、個人疲勞強度問卷、情境與特質焦慮量表、憂鬱量表、病人症狀困 擾量表、被迫性社會依賴量表和腕動計測量。資料分析為 SPSS 17.0 套裝軟體， 以 Multiple-regression 為主要分析方法。 研究結果 結果呈現，約51.5%-72.2% 的癌末照顧者在客觀和主觀的睡眠測量上，均 顯示有睡眠困擾。回歸分析發現，照顧者有高度的疲倦感(β=.30,p=<.001)、憂 鬱(β=.18,p=.007)和照顧負荷(β=.20, p=.003)為影響其睡眠障礙之重要因素。此 外，照顧者為女性，每天照顧工作超過16小時，自認很了解病人的感受和照顧
腦部轉移的病人，均顯示顯著的睡眠困擾。,
護理上的運用
護理人員必須主動評估照顧者的睡眠品質，進而找出緩解照顧者的疲倦、
憂鬱及照顧負荷之策略，將有助於提升照顧者的睡眠品質。
Title: Factors related to sleep disturbance among caregivers of advanced cancer patients
Abstract Purpose
Family Caregivers(FCs) for cancer patients play an important role. Caring for a cancer family member can be extremely stressful, and stress is known to have a negative on physical health. Sleep disturbance is a normal response when a family member receives a diagnosis of cancer in Taiwan.
Objective: This study examined 1) to explore sleep problem experience by FCs with terminal cancer in Taiwan, 2) to identify factor associated with sleep disturbance of FCs.
Method
The prospective, cross-sectional and will conduct 176 caregivers among advanced cancer patient. Caregivers are enrolled if they meet these criteria: (1) identified by the patient as the family member most involved with their actual care, (2) care recipient had terminalstagecancerasjudged by thepatient’sphysician,(3) age 21 years or older, (4) willing to participate and able to communicate with data collectors. FCs were excluded if they reported being diagnosed with a major depressive disorder, insomnia, and heart disease.
Participants were recruited by convenience from FCs of advanced cancer patients at medical centers in middle Taiwan. The instruments include sleep log, Pittsburgh Sleep Quality Index(PSQI), Chinese Version of Checklist Individual
Strength Questionnaire (CIS), State-Trait Anxiety Inventory(STAI), The Center for
Epidemiologic Studies Depression Scale(CES-D), Caregiver Reaction Assessment(CRA), Symptom Distress Scale(SDS), Enforced Social Dependency
Scale (ESDS) and wrist actigraphy. The data will analyze by descriptive statistics, Multivariate multiple regression statistics. All statistical analyses were conducted using the SPSS 17.0. p<0.05 will consider statistically significant.
Result:
Approximately 51.5%-72.2% of FCs reported sleep disturbance depend on whether clinically significant cutoff for subjective and objective measures were used to calculate rates. TheprevalenceofFCs’sleep disturbancewas52.9%. FCs
experienced ahigherlevelofsubjectivefatigue(β=.30,p=<.001), greater depressive
felling (β=.18,p=.007),highercaregiverburden (β=.20,p=.003), if caregivers were
female(β=.22,p=<.001), caregivers who spent over 16hours providing EOL care to
their ill relative per day (β=.14,p=.01), reported more understanding patients feeling
(β=.14,p=.01),and caring patientswith brain meta(β=.11,p=.03) reported
significantly greater sleep disturbance. Implications for practice:
Family caregivers with advanced cancer patient need to be assessed. Reducing FCs’fatigue,depression, and caregivering burden may improve sleep disturbance for caregivers.
