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研究生:李美英
研究生(外文):Mei-ying Lee
論文名稱:安寧共同照護介入對癌末病人生活品質之影響:三種照護模式之比較分析
論文名稱(外文):Impact of hospital-based palliative shared care intervention on quality of life of terminally ill cancer patients– a comparative study of three palliative care models
指導教授:藍忠孚藍忠孚引用關係
指導教授(外文):Chung-fu Lan
學位類別:碩士
校院名稱:國立中山大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2006
畢業學年度:95
語文別:中文
論文頁數:72
中文關鍵詞:生活品質安寧療護共同照顧
外文關鍵詞:palliative carehospital-based palliative shared carecare intervention quality of life
相關次數:
  • 被引用被引用:8
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本研究目的為比較癌末病患生活品質在安寧療護共同照顧計畫之前後是否有差異,與安寧病房之癌末病患生活品質之比是否有差異,研究樣本取自於南部某醫學中心之68名癌症病人。採立意取樣,一般照護20人, 共同照顧取樣17人,安寧照護取樣31人,樣本數共68人。將研究對象分成三組,經過照顧一週後,以生活品質量表(MQOL-台灣版),比較三組研究對象在一般病房、安寧療護共同照顧計畫後之生活品質,與安寧病房之癌末病患生活品質之比,所取得的資料採SPSS for Word 10.0之套裝軟體進行分析處理,並深度訪談一般病房護理長4位、護理人員5位、安寧共同照護師1位,訪談內容為在癌末病人生活品質上或困境上,安寧共同照顧提供了那些實際幫忙?以訪談內容進行資料分析整理。
研究結果顯示安寧療護共同照顧計畫下之癌末病患生活品質比在一般病房,以生活品質量表前、後測來看生活品質無差異,由深度訪談護理人員研究中結果發現以下八點:癌末病人身體症狀受到控制、癌末病人或家屬心靈受到照顧、癌末病人或家屬受到詳細指導後續的照顧、提供癌末病人或家屬指導如何死亡的準備、癌末病人的家屬情緒受到支持、安寧共同照顧提供安寧諮詢,讓一般病房工作人員受到支援,提供改善病人的不適、醫生觀念上改變:提早告知癌末病人或家屬病情,提早讓共照介入、一般病房與安寧共同照顧人員成為共同的團隊,家屬與病人覺得獲得更多人的關心。安寧共同照護對於病人、家屬有助益。安寧病房比安寧共同照護在身體症狀區域構面後測有顯著差異,心理區域構面後測有顯著差異,四個構面平均和後測有顯著差異,在安寧療護介入中以安寧病房比安寧共同照護在改善癌末病人生活品質上更有效益。


藉由此研究了解國民健康局推展「安寧療護共同照顧計畫」之實施成效作為推廣效益之參考,確保病人照護過程之權益,建議政策推行以病人為中心、醫療團隊整合型照護為首推之要。
This study explored the quality of life (QOL) of advanced cancer patients before and after receiving hospital-based palliative shared care; also compared their quality of life with those of terminal ill patients in palliative care units. Sixty-eight cancer patients in a southern Taiwan hospital were selected, purposive sampling, as our study samples. Among these 68 patients in our study were under three care models; 20 patients were under general care, 17 patients were under hospital-based palliative shared care, and 31 patients were under palliative care. One week after their admission into care units, we evaluated their QOL using MQOL –Taiwan version. The QOL data of these three groups of advanced cancer patients ,then grouped and compared as in general care unit, hospital-based palliative shared care unit, and palliative care unit. All data collected were analyzed using SPSS for Word 10.0 statistic software. Furthermore, we have in-depth interviewed with four chiefs of general care units, five patient caretakers, and one professional of hospital-based palliative share care. Contents of the in-depth interviews focused on in what aspects hospital-based palliative shared care provided help to terminally ill patients in terms of quality of life or life difficulty. Contents of the discussion were then analyzed and interpreted.

Results of our analysis, measured by MQOL – Taiwan version, showed there is no significant difference in QOL of advanced cancer patients between hospital-based palliative shared care and general care. But results of our in-depth interview with caretakers and caregives showed interesting aspects: 1. Physical symptoms of advanced cancer patients was brought under control. 2. Psychological symptoms of advanced cancer patients or their family was taken care of. 3. Advanced cancer patients or their family are all benefited from continued advice and instructions. 4. Provide cancer patients and their family with guidance and instructions as to preparing for death. 5. Support the emotional needs of family of advanced cancer patients. 6. Hospital-based palliative shared care offered palliative consultation, supporting patient caretakers and providing improvement QOL for cancer patients. 7. Mindset change to doctors: inform cancer patients or their family of developing cancer symptom so that early intervention can be ensued. 8. Caretakers of general care unit and hospital-based palliative shared care unit formed a joint team, enabling cancer patients and their family feel secured in treatment. In conclusion, hospital-based palliative shared care benefits patients and their family. Comparing with hospital-based palliative shared care, palliative care showed significant improvement in physical symptom domain, psychological domain, and the mean of four domains. In all palliative interventions, palliative care has better effect in improving QOL of cancer patients than hospital-based palliative shared care.
By this study, we examined and evaluated the effectiveness of “Hospital-based Palliative Shared Care Program” promoted by Bureau of Health Promotion, Department of Health, R.O.C. With the in-depth information revealed, we can improve this promotion program and ensure that patient’s needs have been taken care of. We would also recommend any promotion program must focus on patients, and a model of combined effort of palliative shared care should be on top of all.
表目錄 III
圖目錄 IV
誌謝 V
摘要 VI
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 研究流程 3
第二章 文獻探討 4
第一節 安寧療護 4
第二節 癌症病患生活品質 6
第三章 研究方法 9
第一節 研究架構 9
第二節 研究個案介紹 11
第四章 研究結果與討論 17
第一節 研究對象人口基本特性之統計分析 17
第二節 癌末研究對象生活品質分析與討論 31
第三節、護理人員深度訪談分析 35
第五章 結論與建議 53
第一節 結論 53
第二節 建議 55
第三節 研究限制 57
參考文獻 58
附錄 60
中文部份

羅惠敏、徐南麗、蕭正光、劉雪娥(2003).比較疼痛及非疼痛癌症病患不確定感、症狀困擾、社會支持與生活品質關係.慈濟護理雜誌.2(3),70-76
胡文郁(1998).淺談癌末病患之生活品質評估.安寧療護雜誌.10,3-9
胡文郁、戴玉慈、陳慶餘、釋惠敏、陳月枝(2003).從臺灣文化脈絡下剖析與建構癌末病人健康相關生活品質內涵之研究.安寧療護雜誌.8(2) ,113-132。
胡文郁、戴玉慈、陳慶餘、陳月枝(2003).生活品質之概念分析-於探討癌末病人健康相關生活品質之應用.安寧療護雜誌.8(1) ,45-59。
莊榮彬(2005).安寧共同照顧簡介.安寧療護雜誌.10(1) ,39-43。
賴允亮(2004).打造臺灣安寧照顧系統.安寧療護雜誌.9(1)21-27。
姚開屏(2002).健康相關生活品質概念與測量原理之簡介.台灣醫學.6(2) ,183-191。
楊克平、尹祚芊(1999).癌末病患健康相關生活品質內涵之確認.護理研究.7(2) ,129-143。
周繡玲、顧乃平、劉雪娥、白璐(1997).成人急性白血病病患生活品質及其相關因素之探討.護理研究.5(2) ,182-194。
唐婉如、羅文佩、郭小菁、游瓊瑤(2004).臨終與非臨終消化道癌症病患生活品質與其相關因素探討.腫瘤護理雜誌.4(2) ,1-11。
羅惠敏、徐南麗、邱慧洳、廖惠娥、劉欣怡(2004).癌症病患症狀困擾與不確定感關係之探討.慈濟護理雜誌.3(1),72-80。


英文部份
Sulmasy, D.P.,McIlvane, J.M. ( 2002 ), Patients'' ratings of quality and satisfaction with care at the end of life , American Medical Association Journal for All right reserved, 162(14),2098-2104.
Yeung,W.F.B, French,P. & Leung, A.O.S. ( 1999 ), The impact of hospice inPatient care on the quality of life of Patients terminally ill with cancer, International Journal for Quality in Health Care, 22(5),350-357.
Hu, W.Y., Dai, Y.T., Donna Berry, & Chiu, T.y. ( 2002 ), Psychometric testing othe translated McGILL quality of life questionnaire-taiwan vesion in patients with terminal cancer, Med ASSO, 102(2),97-104.
Lo, R.S.k., Woo, J., Zhoc, K.C.H., Li , C.Y.P.., Yeo, W., Johnson, P., Mak, Y. & Lee, J. ( 2002 ), Quality of Life of Palliative Care Patients in the Last Two Weeks of Life, Journal of Pain and Symptom Management, 24(4),388-397.
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網站部份
衛生統計資訊網.(2006), from http://www.doh.gov.tw/statistic/index.htm
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