居家照顧癌症轉移病患之主要照顧者的照顧負荷、憂鬱與生活品質之探討

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居家照顧癌症轉移病患之主要照顧者的照顧負荷、憂鬱與生活品質之 探討

The Caregiving Burden、Depression and Quality of Life of Primary Caregivers of Metastatic Cancer Patients Receiving Home Care

胡綾真 Lin-Jean Hu 長庚大學護理學研究所碩士 陳美伶 美國馬里蘭大學護理學哲學博士,現任長庚大學護理學研究所助理教 授。 陳明岐 約翰霍布金斯大學公衛學院生統博士,現任長庚大學公衛科助理教 授。 林佳靜 美國維斯康辛大學護理學哲學博士,現任台北醫學院護理學研究所副 教授。

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中文摘要 本研究欲探討癌症轉移病患於出院後四週內,居家照顧者的照顧 負荷、憂鬱與生活品質之變化情形,同時,瞭解壓力性照顧負荷對憂 鬱與生活品質之影響。係採縱貫式相關設計調查法(longitudinal correlation survey),以某家提供一般癌症病房之醫學中心,經立意 取樣,以 41 位癌症轉移病患之居家照顧者為研究對象,分別於病患 出院時(T0)、出院後第一週、第二週及第四週(T1-T3)追蹤觀測 其研究變項的變化。 研究結果顯示:(一)照顧者在病患病情穩定及症狀良好控制下, 照顧負荷可稍微下降,而對照顧者生活品質及憂鬱程度之影響沒有顯 著的改變,(二)照顧者照顧負荷、憂鬱和生活品質之間有顯著的相 關,(三)且出現壓力性照顧負荷者有顯著較高的憂鬱程度及較低的 生活品質。顯示目前的居家醫療照護對擔任照顧任務之照顧者未有加 重其照顧負荷,仍可維持其生活品質與憂鬱程度,同時,良好的病患 症狀控制下,照顧者之照顧負荷會有下降之趨勢。值得注意的是,照 顧者在出現壓力性照顧負荷時,對其憂鬱程度及生活品質具有負向影 響,所以,針對壓力性照顧負荷者於出院後之照顧需求,提出壓力性 照顧負荷之預防計劃是重要的。 關鍵字:癌症、居家照顧、照顧者、照顧負荷、憂鬱、生活品質

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英文摘要

The purpose of this study was to (1) describe the change of caregiver’s burden, depression and quality of life during the 4 weeks following hospital discharge; (2) to determine the relationship between caregiver’s burden, depression and quality of life. (3) The effects of stress burden on caregiver depression and quality of life.

Data were collected through longitudinal correlation survey. A convenience sample of forty-one family caregivers of cancer patients from a medical center of northern Taiwan was obtained. The Caregiver Strain Index (CSI), the Center for Epidemiological of Depression (CES-D) and Caregiver Quality of Life Index(CQOL) were administered within 48 hours of discharging to hospital (T0) and 1, 2, & 4 weeks post-discharge (T1-T3).

Patients’ symptom distress and function status, caregivers’ depression and quality of life remained stable from T0 to T3. The caregiver burden scores as T0 were higher than as T1-T3. Higher caregiver burden was associated with higher levels of caregiver depression and lower levels of quality of life. And the caregivers of stress burden had more higher depression and lower quality of life.

The findings suggest that caregiver burden will reduce on good patient symptom control. The need for caregivers having stress burden as at-home caregiving process is important to protect the result of caregiver depression and low quality of life.

Key words: cancer, at-home care, caregiver, burden, depression, quality of life.

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