臺灣博碩士論文加值系統

目的：本研究為瞭解接受安寧病房住院照護末期病人之主要照顧者，其照顧壓力負荷與家庭功能、安寧緩和認知之相關影響因素。

方法：本研究採結構式問卷，收集台灣北部某醫院有提供安寧病房住院照護的兩家院區末期病人主要照顧者，研究內容為主要照顧者基本資料，照顧者壓力負荷情形(壓力負荷量表含生理負荷、心理負荷、經濟負荷與社交負荷四構面)，家庭功能(家庭功能量表含家庭關係功能、系統維持功能及情感表達功能三構面)及安寧緩和認知(安寧緩和認知問卷表含經驗、知識及態度三構面)四部份。進行面對面問卷調查，共計收案60位。以獨立樣本t檢定，單因子變異數分析，皮爾森相關分析檢定變項間相關性，並以逐步複迴歸分析影響末期病人主要照顧者照顧壓力負荷與家庭功能、安寧緩和認知之重要因子。

結果：主要照顧者平均年齡56.6歲、已婚女性、與病人同住、子女/孫子女居多。經分析發現，照顧者的壓力負荷方面，當病人是配偶、病人與照顧者同住、家庭平均月收入在3萬元以下，壓力負荷就較大。照顧負荷與家庭功能呈顯著負相關(r=-0.299*)，尤其在心理負荷(r=-0.266*)及經濟負荷(r=-0.287*)。在安寧認知方面，絕大多數照顧者當醫療治療無效會贊同改採「緩和舒適」減少病痛為主的醫療方式，且絕大多數照顧者當自身罹患生命末期疾病時，會選擇接受安寧緩和療護。但就照顧壓力負荷而言，當醫療治療無效時，照顧者贊同改採「緩和舒適」減少病痛為主的治療方式，其照顧負荷會大於不贊同/沒意見之照顧者。影響接受安寧病房住院照護末期病人主要照顧者之照顧壓力負荷與家庭功能、安寧認知的重要因子，包括家庭功能、照顧者的年齡、病人與照顧者的關係、以及照顧者是否與病人同住、家庭經濟狀況等。整體而言家庭功能較佳(β=-0.47, 95%CI -0.73 -0.20)、照顧者年齡較高(>65歲) (β=-0.79, 95%CI -1.44 -0.14)、病人不是配偶(β=-0.58, 95%CI -1.10 -0.05)、沒有與病人同住(β=-0.47, 95%CI -0.89 -0.04)、家庭經濟狀況較佳(β=-0.63, 95%CI -1.16 -0.09)，照顧壓力負荷相對較低。

結論：
1.主要照顧者照顧負荷之關聯因子為家庭功能、照顧者年齡、病人與照顧者關係及家庭經濟狀況。
2.當治療無效時，照顧者贊同改採「緩和舒適」減少病痛為主的醫療方式，照顧負荷相對較高。

Objectives: To explore the factors influencing on the care burden and family function, concepts of palliative care among primary caregiver of end-stage patients receiving hospitalized hospice care.

Methods: We surveyed primary caregivers of hospitalized hospice patients in two branches of the hospital located at Northern Taiwan. Structured questionnaires were used to assess personal information of caregivers, stress care burden of caregivers(the questionnaires including four dimensions of physical burden, psychological burden, economical burden and societal burden ), and their family functions (the questionnaires including three dimensions of family relationship, system maintenance and emotional expression) and concepts of palliative care(the questionnaires including three dimensions of experience, knowledge and attitude). Totally 60 questionnaires were conducted and effective, with face to face investigation. The data were tested for correlations between variables with one-way ANOVA and Pearson correlation, and analyzed with stepwise multiple regression analysis to determine the important factors affecting stress care burden and family function, concepts of palliative care of primary caregivers of end-stage patients.

Results: The average age of primary caregivers is 56.6 years old, and most of them are married females, living with patients, children/grandchildren of patients. We found that, on the aspect of stress care burden of caregivers, the patient being spouse, living with patient, and family average income below thirty thousand dollars per month, are positively correlated with stress care burden; furthermore, stress care burden and family function is inversely correlated (r=-0.299*), especially in the dimensions of psychological burden (r=-0.266*) and economical burden (r=-0.287*). On the aspect of concepts of palliative care, most of caregivers agree to receive “hospice palliative care” for patients to relieve from pain and other distressing symptoms when diseases are incurable and medical treatments are ineffective; and most of them will choose hospice palliative care for themselves if end-stage diseases strike. However, the care burden will be increased in those caregivers who agree to receive “hospice palliative care” for terminally ill patients, as compared with those of disagreement / no opinion. The primary factors affecting care burden and family function, concepts of palliative care of primary caregivers of end-stage patients are “family function”, “age of caregiver”, “relationship between caregiver and patient”, “living with patient”, and “economic status”. As a whole, better family function(β=-0.47, 95%CI -0.73 -0.20), older age of caregiver (>65 years old) (β=-0.79, 95%CI -1.44 -0.14), patient being not spouse(β=-0.58, 95%CI -1.10 -0.05), not living with patient(β=-0.47, 95%CI -0.89 -0.04) and better economic status(β=-0.63, 95%CI -1.16 -0.09), the care burden is relatively lower.

Conclusion:
1.The correlation factors of care burden among primary caregiver for hospice patients are family function, age of caregiver, the relationship between patient and caregiver and family economical status.
2.The care burden will be relatively increased in those caregivers who agree to receive “hospice palliative care” for terminally ill patients, when medical treatments are ineffective.

中文摘要…………………………………………………………… i
英文摘要…………………………………………………………… ii
目錄……………………………………………………………………… iv
圖目錄……………………………………………………………………vii
表目錄……………………………………………………………………viii
第一章　緒論………………………………………………………1
第一節　研究背景、問題及重要性………1
第二節　研究目的…………………………………………3
第二章 文獻探討………………………………………………4
第一節　安寧緩和療護…………………………………4
第二節　照顧者壓力負荷……………………………6
第三節 家庭功能系統…………………………………8
第四節 安寧緩和醫療的認知…………………10
第三章 研究設計與方法 ………………………………12
第一節　研究流程 …………………………………………12
第二節　研究架構 …………………………………………13
第三節 研究對象與資料來源 …………………14
第四節 研究工具 …………………………………………15
第五節　研究變相操作型定義 …………………18
第六節　問卷信度與效度 ……………………………24
第七節 分析方法 …………………………………………26
第四章 研究結果 ………………………………………………27
第一節　主要照顧者基本資料之描述 ……27
第二節　主要照顧者照顧負荷、家庭功能及安寧緩和議題認知分析 ……………………………………………………………………… 30
第三節 主要照顧者與照顧負荷之變異數分析及Scheffe事後考驗 ……………………………………………………………………… 40
第四節 主要照顧者家庭功能與照顧負荷之相關分析 ………… 43
第五節 主要照顧者對於安寧議題認知與照顧負荷之變異數分析 ……………………………………………………………………… 44 
第六節 主要照顧者對照顧壓力負荷與家庭功能及安寧緩和議題認知之重要因子分析 …………………………………………………… 47
第五章 討論 ………………………………………………………… 58
第一節　主要照顧者基本資料，家庭功能，照顧負荷與安寧議題經驗、知識及態度之分析 ……………………………………………… 58
第二節 主要照顧者壓力負荷與家庭功能系統之影響 ………… 59
第三節 影響末期病人主要照顧者照顧負荷之重要因子 ……… 60
第六章 結論與建議 ……………………………………………62
第一節 結論 ………………………………………………………62
第二節 研究建議 ……………………………………………64
第三節 研究限制 ……………………………………………65
參考文獻 ……………………………………………………………………66
附錄：研究問卷 ………………………………………………………68
附表1至表5 …………………………………………………73

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