臺灣博碩士論文加值系統

由文獻得知，接受緩和性治療癌症病人之照顧者在照顧病人過程中必須承擔病人病情不穩定、照顧需求大、照顧負荷沉重及生活品質降低的現象；接受可癒性治療癌症病人之照顧者，除承受病人罹患癌症之痛苦外，並在短時間內必須學習照顧的技巧，以及面對治癒成效的壓力，其生活品質亦受到影響。故無論接受可癒性或緩和性治療癌症病人之照顧者各自均有其困境，因此臨床護理人員毋須主觀判斷兩組照顧者之生活品質孰輕孰重，應可透過實證研究瞭解接受不同治療方式之癌症病人照顧者生活品質有無顯著差異，並探討影響照顧者生活品質的因素，以給予接受可癒性或緩和性治療癌症病人之照顧者實質協助。
因此，本研究除了比較接受可癒性與緩和性治療癌症病人之照顧者的生活品質之外，並分析於控制病人社會人口學、疾病及治療相關資料、執行日常活動的依賴程度、症狀困擾程度、主要照顧者社會人口學及健康狀況、照顧工作強度及照顧負荷等因素之後，接受不同治療方式之癌症病人照顧者其生活品質有無真正差異？期望藉由此研究結果有助於護理人員暸解兩組照顧者生活品質的差異，以及治療方式是否真為影響照顧者生活品質的因素，以作為護理人員提供接受可癒性或緩和性治療癌症病人之照顧者實質協助之依據。
本研究採橫斷性問卷調查，以方便取樣進行。自95年12月6日至96年2月14日於北部某醫學中心共收集接受可癒性與緩和性治療癌症病人之照顧者各50位的資料。研究工具包含（一）病人社會人口學、疾病及治療相關資料；（二）Enforced Socal Dependency Scale－執行日常活動的依賴程度（三）Symptom Distress Scale－症狀困擾程度；（四）主要照顧者社會人口學及健康資料表；（五）照顧工作強度；（六）Caregiving Reaction Assessment－照顧負荷；及（七）Caregiver Quality of Life Index-Cancer—主要照顧者的生活品質。研究者以查閱病歷及親自訪談方式收集資料，並使用描述性統計及多變項中之複迴歸統計方法進行統計分析。
本研究結果發現，雖然單變項分析中接受可癒性治療癌症病人之照顧者生活品質顯著比接受緩和性治療癌症病人之照顧者好，但多變項統計分析卻發現控制其他影響因素之後，「治療方式」非影響照顧者生活品質的因素。因此，癌症病人照顧者的生活品質與治療方式無關，癌症病人症狀困擾、照顧者的照顧負荷、教育程度及經濟運作等變項為影響照顧者生活品質的因素。病人的症狀困擾愈嚴重，照顧者的生活品質愈差；照顧者教育程度為高中以下、經濟運作不足者，及照顧負荷愈重，其生活品質愈差。故護理人員需對所有接受治療的癌症病人及其照顧者，都賦予全心的照顧之責，並且對於症狀困擾程度高之癌症病人、教育程度較低、經濟狀況較差及照顧負荷沉重之照顧者，更應留意其需要及困難，並適時給予照顧者最好的照顧及護理。

關鍵字：可癒性治療、緩和性治療、主要照顧者、生活品質

The literature has shown that those who take care of cancer patients receiving palliative therapy must accept the situations that accompany the patient’s unstable illness, such as the high demand for care, the heavy burden of care, and a reduced quality of life. On the other hand, those who take care of cancer patients receiving curative therapy must bear the suffering due to the patient’s illness, acquire the skills required for providing care in a limited period of time, face the stress owing to treatment efficacy, and accept the compromised quality of life as well. Therefore, caregivers face difficulties whether patients receive curative or palliative treatments. Clinical nurses should not subjectively judge the level of quality of life between these two caregiver groups, but should understand if there are any differences in the quality of life between these two groups through evidence-based research. Moreover, clinical nurses should investigate factors influencing the quality of life of caregivers in order to offer them practical assistance.
Therefore, this study not only compared the quality of life of those caring for patients receiving curative therapy with those caring for patients receiving palliative therapy, but also investigated, after adjusting for the impact of the social demographics, disease-related factors, level of dependence in daily activities, and level of symptom distress of the patients, as well as the social demographics, health status, work intensity, and subjective caregiving burden of the family caregivers, whether there were any differences in quality of life between these two types of caregivers. The purpose of this study was to help nursing staff understand the differences in quality of life between these two caregiver groups and to determine if the type of therapy was really a factor impacting the quality of life of the caregivers, and further, to be a source of evidence for nurses in providing pracital assistance to caregivers.
A cross-sectional survey was conducted by using a convenience sample of 50 caregivers who had patients receiving curative therapy and 50 caregivers who had patients receiving palliative therapy from a northern medical center between 6 December 2006 and 14 Feburary 2007. Instruments used in this study included the following: (1) the social demographics, and disease- and treatment-related data of the patients; (2) the Enforced Social Dependency Scale—for measuring the level of dependence of daily activities of the patients; (3) the Symptom Distress Scale—for the level of symptom distress of the patients; (4) the demographics and health data of the primary caregivers; (5) the work intensity of the primary caregivers; (6) the Caregiver Reaction Assessment—for the subjective caregiving burden of the primary caregivers; and (7) the Caregiver Quality of Life Index-Cancer—for the quality of life of the primary caregivers. Medical chart reviews and personal interviews were used for data collection. Descriptive statistics and multiple regression were used for statistical analysis.
The results of this study suggested that in univariate analysis, caregivers who have patients undergoing curative therapy had a significantly better quality of life than their counterparts who provided palliative care to patients. However, the “type of treatment” was not an influencing factor of the caregiver’s quality of life when multiple regression analysis was conducted and other influencing factors were controlled. Therefore, the quality of life of a cancer patient’s caregiver was not associated with the type of treatment, but was influenced by the patient’s level of symptom distress, as well as educational level, financial status and subjective caregiving burden of family caregivers. When patients suffered from a higher level of symptom distress, and their family caregivers had an educational level less than high school, reported that their financial status could not make ends meet, as well as experienced greater subjective caregiving burden, the quality of life of family caregivers would be lower. Nurses should provide the best care and services to cancer patients as well as to their caregivers, on an equal basis, no matter what kind of treatments the patients received. In addition, nurses should pay special attention to those caregivers who are at a disadvantaged status, such as with lower educational level and insufficient financial status, and make every effort to appropriately manage symptom distress of the patients and relieve the subjective caregiving burden of family caregivers. With these efforts, the quality of life of family caregivers may be improved to achieve the optimual level.

Key words:
Curative therapy, Palliative therapy, Primary caregiver, Quality of life

指導教授推薦書………………………………………………………..
口試委員會審定書……………………………………………………..
授權書………………………………………………………………..… iii
誌謝……………………………………………………………………. iv
中文摘要………………………………………………………………. v
英文摘要…………………………………………………………….…. xi
目錄…………………………………………………………………..… xi
第一章 研究動機與重要…………………………………………… 1
第一節 研究動機…………………….…………………….. 1
第二節 研究重要性………………………………………… 9
第二章 文獻查證…………………………………………………….. 14
第一節 可癒性與緩和性治療之定義……………………… 14
第二節 生活品質的定義…………………………………… 15
第三節 癌症病人之照顧者的生活品質………………….. 17
第四節 接受可癒性治療之癌症病人照顧者的生活品質… 23
第五節 接受緩和性治療之癌症病人照顧者的生活品質… 24
第六節 比較癌症病人接受可癒性與緩和性治療之照顧者的生活品質……………………………………….. 26
第七節 影響癌症病人照顧者生活品質的因素…………… 28
第八節 研究問題…………………………………………… 37
第三章 研究方法…………………………………………………….. 38
第一節 研究架構…………………………………………… 38
第二節 名詞界定…………………………………………… 39
第三節 研究設計…………………………………………… 39
第四節 研究場所及對象…………………………………… 40
第五節 研究工具…………………………………………… 41
第六節 資料收集步驟……………………………………… 49
第七節 統計方法…………………………………………… 53
第四章 研究結果與分析………………………………………..…… 60
第五章 討論………………………………………………………… 82
第六章 結論與建議…………………………………………………. 95
參考文獻………………………………………………………………. 104
附錄……………………………………………………………………. 120
附錄一 病人社會人口學及醫療資料表……………………………. 120
附錄二 被迫性社會依賴量表………………………………………. 121
附錄三 症狀困擾評估表……………………………………………. 123
附錄四 照顧工作強度量表…………………………………………. 125
附錄五 照顧者反應量表…………………………………………….. 126
附錄六 家屬生活品質量表………………………………………… 128
附錄七 主要家屬照顧者之社會人口學及健康資料表……………. 130













圖表目錄

圖3-1 研究架構…………………………………………………….. 38
圖3-2 生活品質之標準化殘差值的次數分配直方圖…………….. 56
圖3-3 生活品質之標準化殘差值的常態機率分佈圖…………….. 56
圖3-4 生活品質之預測值與殘差散佈圖………………………….. 57
圖3-5 生活品質變項之盒狀圖…………………………………….. 57
表3-1 Edwards與Ung（2002）提出CQOLC各層面生活品質之題號及內容………………………………………………….. 48
表4-1 接受可癒性與緩和性治療之病人特性…………………….. 61
表4-2 接受可癒性與緩和性治療病人之照顧者特性…………….. 65
表4-3 接受可癒性與緩和性治療病人之照顧者照顧負荷的比較 69
表4-4 接受可癒性與緩和性治療病人之照顧者生活品質的比較（依據Weitzner, Jacobson等（1999）提出CQOLC生活品質及次量表） 71
表4-5 接受可癒性與緩和性治療病人之照顧者生活品質的比較（依據Edwards與Ung（2002）提出CQOLC生活品質及次量表）………………………………………………… 73
表4-6 以t /F檢定病人特性與照顧者生活品質之相關性………... 75
表4-7 以Pearson’s correlation檢定病人特性與照顧者生活品質之相關性……………………………………………………………… 75
表4-8 主要照顧者特性與生活品質的相關分析結果……………. 77
表4-9 主要照顧者特性與生活品質的相關分析結果…………….. 79
表4-10 主要照顧者生活品質之預測變項………………………….. 81

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