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研究生:周碧玲
研究生(外文):Pi-Ling Chou
論文名稱:癌症病人及家屬之疼痛教育對改善病人服藥遵從性及疼痛控制之成效
論文名稱(外文):The Effectiveness of a Pain Educational Program for Cancer Patients and Their Family Caregivers
指導教授:林佳靜林佳靜引用關係
指導教授(外文):Chia-Chin Lin
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:護理學系
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2003
畢業學年度:91
語文別:中文
中文關鍵詞:疼痛教育癌症病人及家屬服藥遵從性疼痛控制
外文關鍵詞:pain educationcancer patients and family caregiverscompliancepain control
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本研究目的為探討疼痛教育是否能長期降低癌症病人及家屬的障礙因子、增進病人服用止痛藥物之遵從性、降低疼痛強度及疼痛對生活的干擾程度。研究對象為診斷為癌症,目前使用口服止痛藥物治療之病人及家屬,定期於門診追蹤者,而研究地點為台北市某醫學中心及某區域醫院之腫瘤科門診。
本研究以中文版簡明疼痛量表、止痛藥障礙因子問卷、服藥遵從性測量問卷、及口服藥物劑量比率換算表進行資料收集。採類實驗研究法,共收集實驗組31對病人及家屬,對照組30對病人及家屬(N=122)。實驗組給予疼痛教育手冊及進行系統性疼痛教育措施,對照組僅接受常規性的門診追蹤照護,並未提供衛教手冊,而兩組均進行前測一次的資料收集,及於第二週及第四週進行後測追蹤。研究結果以SAS 8.0版套裝軟體進行GEEs(Generalized Estimating Equations)統計分析來測試兩組在疼痛教育介入成效之差異。
本研究為第一個使用GEEs(Generalized Estimating Equations)統計方式進行疼痛教育對改善病人及家屬之服藥遵從性及疼痛控制長期成效之研究,其能有效控制介入型研究中兩組的不對等狀態、對照組的成長效應及混淆因素的干擾中,來檢定疼痛介入的成效為何。而本研究證實了疼痛教育在改善病人及家屬的障礙因子、病人的服藥遵從性、最劇烈疼痛強度、疼痛對生活干擾程度的顯著成效,也說明家屬因同時獲得疼痛教育的諮詢增進他們於疼痛處置上的知識,而能在病人的疼痛控制中發揮相輔相成的結果。同時本研究也支持多次給予病人及家屬面對面疼痛教育、及長期追蹤評值病人疼痛強度的在癌痛處置中的重要貢獻。
The purpose of this study was to explorer the pain educational program for cancer patient and their family caregivers could reduce the barriers to taking analgesics, improve the analgesic compliance, decrease the degree of pain and lower the impacts on daily life. The sample who had been diagnosed as cancer and their family caregivers, and had been taking pain medications.
The Barriers Questionnaire-Taiwan Form (BQT), Brief Pain Inventory-Short Form (BPI), compliance Self-report assessment tool and oral analgesics prescriptions ratio were used in this study. This study include experiment group of 31 pair patient and their family caregivers, and control group of 30 pair of another patient and their family caregivers. (N=122). The outcomes of pain education were measured at two times after the intervention. Data were analyzed by descriptive analysis and GEE(Generalized Estimating Equations).
Results showed a significant increase in pain knowledge and analgesics compliance in patients who received the pain education program and a significant decrease in severe pain intensity. This research project is the first pain education and counseling program for both cancer patient and families by GEE(Generalized Estimating Equations).The finding of this research contribute to the literature on cancer pain management and improve of quality of cancer pain management.
目錄
頁數
致謝………………………………………………………………….. I
中文摘要…………………………………………………………….. II
英文摘要…………………………………………………………….. V
目錄………………………………………………………………….. VII
圖表目次…………………………………………………………….. X
第一章 緒論………………………………………………………… 1
第一節 研究動機……………………………………………… 1
第二節 研究重要性…………………………………………… 3
第三節 研究目的……………………………………………… 6
第二章 文獻查證………………………………………………….... 7
第一節 癌症疼痛問題現況…………………………………… 7
第二節 疼痛處置品質現況…………………………………… 9
第三節 癌症疼痛處置成效不彰的原因……………………… 10
第四節 病人及家屬對止痛藥物的迷思……………………… 12
第五節 服藥遵從性…………………………………………… 14
第六節 家屬於疼痛處置中之角色及重要性………………… 16
第七節 疼痛教育……………………………………………… 17
第三章 研究架構…………………………………………………… 22
第一節 研究架構……………………………………………… 22
第二節 研究假設……………………………………………… 23
第三節 名詞解釋……………………………………………… 24
第四章 研究方法……………………………………………… 25
第一節 研究設計……………………………………………… 25
第二節 研究場所及對象……………………………………… 26
第三節 研究工具……………………………………………… 27
第四節 研究過程……………………………………………… 30
第五節 介入性措施…………………………………………… 31
第六節 資料分析……………………………………………… 34
第五章 結果………………………………………………………… 35
第一節 描述性統計…………………………………………… 35
第二節 疼痛教育介入措施之成效…………………………… 64
第六章 討論………………………………………………………… 95
第一節 癌症病人及家屬對於止痛藥物的障礙因子………… 95
第二節 癌症病人對於服用止痛藥物之服藥遵從性………… 99
第三節 癌症病人的疼痛強度及對生活的干擾程度………… 100
第四節 疼痛教育是否能長期降低癌症病人及家屬
對止痛藥物的障礙因子………………………………
102
第五節 疼痛教育是否能長期改善病人的服藥遵從性……….. 106
第六節 疼痛教育是否能長期降低癌症病人的疼痛強度…….. 108
第七節 疼痛教育是否能長期降低疼痛對生活的干擾程度….. 112
第七章 結論……………………………………………………… 116
第八章 研究限制及建議………………………………………… 117
第一節 研究限制…………………………………………….. 117
第二節 研究建議…………………………………………….. 118
參考資料………………………………………………………….. 120
中文部分…………………………………………………….. 120
英文部分…………………………………………………….. 121
附錄……………………………………………………………….. 128
附錄一 同意書……………………………………………… 128
附錄二 基本資料…………………………………………… 129
附錄三 藥物紀錄表………………………………………… 131
附錄四 中文版止痛藥障礙因子問卷……………………… 132
附錄五 簡明疼痛量表……………………………………… 133
附錄六 服藥遵從性換算比率問卷………………………… 136
附錄七 服藥遵從性測量問卷……………………………….. 137
圖表目次
圖一 研究價構圖………………………………………………… 22
圖二 研究過程流程圖…………………………………………… 33
圖三 實驗組與對照組病人障礙因子平均分數比較…………… 66
圖四 實驗組與對照組家屬障礙因子平均分數比較…………… 69
圖五 實驗組與對照組服藥遵從性得分比較…………………… 73
圖六 實驗組與對照組服用止痛藥物比率比較………………… 76
圖七 實驗組與對照組平均疼痛強度比較……………………… 80
圖八 實驗組與對照組平均疼痛干擾程度比較………………… 84
圖九 實驗組與對照組最劇烈疼痛強度比較…………………… 88
表一 研究假設及統計檢定方式………………………………… 34
表二 實驗組與對照組病人基本資料表比較表………………… 37
表三 實驗組與對照組病人基本資料表比較表………………… 39
表四 實驗組與對照組家屬基本資料表比較表………………… 40
表五 實驗組與對照組家屬基本資料表比較表………………… 42
表六 實驗組病人止痛藥障礙因子變化趨勢…………………… 44
表七 控制組病人止痛藥障礙因子變化趨勢…………………… 45
表八 實驗組與控制組病人(前測)之各項障礙因子獨立
t檢定……………………………………………………….
46
表九 實驗組家屬止痛藥障礙因子變化趨勢…………………… 48
表十 控制組家屬止痛藥障礙因子變化趨勢…………………… 49
表十一 實驗組與控制組病人(前測)之各項障礙因子獨立
t檢定………………………………………………………..
50
表十二 服藥遵從性得分描述性統計分析…………………………
表十三 服用止痛藥物比率描述性統計分析…………………….. 52
53
表十四 實驗組病人各類疼痛強度變化趨勢…………………….. 55
表十五 控制組病人各類疼痛強度變化趨勢…………………….. 56
表十六 實驗組與控制組(前測)之各項疼痛
強度獨立t檢定…………………………………………..
57
表十七 實驗組病人疼痛干擾程度變化趨勢……………………. 59
表十八 控制組病人疼痛干擾程度變化趨勢…………………….. 60
表十九 實驗組與控制組(前測)之各項疼痛干擾程度
獨立t檢定…………………………………………………
61
表二十 實驗組及對照組於各項疼痛強度第二週及第四
週獨立t 檢定……………………………………………..
63
表二十一 實驗組與對照組病人止痛藥障礙因子差異結果……… 67
表二十二 實驗組與對照組病人止痛藥障礙因子平均得分
及調整各效應後之得分表………………………………
68
表二十三 實驗組與對照組家屬止痛藥障礙因子差異結果……… 70
表二十四 實驗組與對照組家屬止痛藥障礙因子平均得分
及調整各效應後之得分表………………………………
71
表二十五 實驗組與對照組病人服藥遵從性差異結果…………… 74
表二十六 實驗組與對照組病人服藥遵從性及調整
各效應後之得分表………………………………………
75
表二十七 實驗組與對照組病人服用止痛藥物比率差異結果…… 77
表二十八 實驗組與對照組病人服藥遵從性及調整各效應後
之得分表…………………………………………………
78
表二十九 實驗組與對照組病人平均疼痛強度差異結果…………
表三十 實驗組與對照組病人平均疼痛強度及調整
各效應後之得分表……………………………………… 81
82
表三十一 實驗組與對照組病人平均疼痛對生活干擾程
度差異結果………………………………………………
85
表三十二 實驗組與對照組病人平均疼痛干擾程度調整
各效應後之得分表……………………………………… 86
表三十三 實驗組與對照組病人最劇烈疼痛強度差異結果……… 89
表三十四 實驗組與對照組病人最劇烈疼痛強度及調整
各效應後之得分表………………………………………
90
表三十五 實驗組及對照組於各項障礙因子第二週及第四週
GEE檢定表………………………………………………
92
表三十六 實驗組及對照組於各項疼痛干擾程度因子第二週
及第四週GEE檢定表…………………………………..
94
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