臺灣博碩士論文加值系統

背景: 肝病(慢性肝炎、肝硬化、肝癌)是華人常見疾病，常因腹水、食道靜脈曲張、肝腦病變等合併症反覆住院治療，病人的生活品質深受影響。研究顯示有41%的病人使用輔助與另類療法(Complementary and Alternative Medicine, CAM)來治療肝病，由於並非醫囑醫病關係處於不是信任及孰悉下，病人大多私下採用CAM，少與醫療人員討論此事。另婦女具肝炎帶原母子垂直感染，停經後之肝纖維化比停經前嚴重等問題，而女性使用CAM比率又高於男性，卻甚少有深入探討婦女使用CAM治療其慢性肝病之研究。
研究目的: 本研究之目的為探討肝病住院婦女使用CAM的情況；有無使用CAM之婦女之生活品質的差異；不同特性之使用CAM的婦女之生活品質的差異；使用CAM婦女之經驗，包含使用的原因，中斷的原因及其自覺成效。
研究方法: 採取質性量性混和研究(mixed method)，於臺灣北部某醫學中心胃腸肝膽科病房進行立意取樣收案，資料收集包含深度訪談以及問卷調查，病人基本資料、輔助及另類醫療問卷、慢性肝病生活品質，質性資料為問卷中之病人自由回答的資料。
結果與建議: 共收集53名住院婦女個案平均年齡為66.9歲(SD = 13.3)，其中有35名曾使用CAM (1年內且長達一個月者)予訪談使用CAM之相關經驗。統計分析結果顯示，使用CAM婦女之生活品質總分高於未使用者，其疲倦與活動力顯著比未使用CAM婦女佳。與家人同住、有固定收入者及罹患肝癌者使用CAM的比例較高。質性資料分析婦女使用CAM之主觀經驗描述，歸納出質性內容分析，包括：使用CAM的原因為解決身體不適、病情惡化、相信天然、草本身體無害、西醫無法根治，在有限的選項中抉擇、親友推薦；於療效自我評值方面為心靈慰藉、解除痠痛、無差異、病情惡化；中斷原因為住院、經濟負擔大、合併症；使用CAM的困境包含吃與不吃的人際矛盾、擔心醫師反對、資訊不足。
本研究可瞭解肝病婦女使用CAM的實際情況及其生活品質，如何協助改善肝病女性病人之疲倦與活動力及肝癌末期者，建議宜更深入結合CAM療法進一步研究，臨床醫療團隊人員應以開放性的態度，主動了解肝病病人使用非西醫的輔助另類療法之原因，與病人討論並提供相關知識，以增進肝病照護品質。

Background: Liver diseases (chronic hepatitis, cirrhosis, liver cancer) is a common diseases in Chinese. Patient often hospitalized due to complications such as ascites, esophageal varices, and hepatic encephalopathy. The quality of life of patients is affected deeply. Literatures reviewing have shown that about 41% of patients use Complementary and Alternative Medicine (CAM) to treat liver diseases.Most patients use the CAM privately, because it is not a doctor's advice and the medical relationship is not trusted. Patients who use CAM less talk about with medical personnels. However, female are infected vertically with mother in hepatitis. The liver fibrosis after menopause is more serious than before menopause. However, there are few studies on situations of female patients of chronic liver diseases with CAM.
Purposes: The purposes of this study involved as follow: The situation of CAM in hospitalized women with liver diseases; The difference in quality of life of women with or without CAM; The difference in quality of life of women who use CAM with different characteristics; The experiences of using CAM wew including the reasons of use CAM, the reasons for the interruption and its conscious effect.
Methods: This study applied the qualitative and quantitative mixed method, and purposive sampling in the Gastroenterology and Hepatology ward of a medical center in northern Taiwan. The data collection includes in-depth interviews and questionnaires survey about patient background data, CAM questionnaires, and Chronic Liver Disease Questionnaire (CLDQ). In addition, qualitative data are about open questions and patients could be free to answer.
Results and recommendations: A total of 53 hospitalized female patients who mean age is 66.9 years old were collected. The 35 cases (66%) had used CAM to interview CAM-related experiences. Effects of female patients with or without CAM on quality of life were measured by the Chronic Liver Disease Questionnaire (CLDQ). Total scores of quality of life is higher while patients using CAM, and the fatigue and activity ratio of patients with CAM are significantly better than the others. Further, there was a high proportion of patients with liver diseases using CAM found that they have fixed incomes, live with family and those with liver cancer. Qualitative data of subjective experience descriptions of female patients using CAM were summarizing as follow: Reasons for using CAM involved about solving physical discomfort, worsening the condition, believing in nature, harmless of herbs, medicine can not cure, choose among limited options, recommend by relatives and friends, and consider physical health other than liver disease; Self-evaluation of efficacy: spiritual comfort, relieve soreness, no difference, worsening condition; Reasons for interruption: hospitalization, financial burden, complication; The predicament of using CAM: interpersonal contradiction between eating and not eating, worried about physicians' opposition, lack of information.
This study can understand the situation of female patients with liver diseases using CAM and quality of life. In addition, how to assist and improve the fatigue and activity of female patients. It is suggested that further study should be carried out in combination with CAM therapy. The team members should take an active attitude to understand the reasons for use of CAM, to discuss with patients and provide relevant knowledge to improve the quality of care.

目 次 I
表 次 III
圖 次 IV
摘 要 V
ABSTRACT 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 3
第三節 研究問題 4
第四節 研究假設 5
第五節 名詞解釋 6
第二章 文獻探討 7
第一節 慢性肝病 7
第二節 輔助另類療法 9
第三節 肝病病人之生活品質 11
第四節 肝病病人使用輔助另類療法與生活品質的相關性 14
第三章 研究方法 16
第一節 研究架構 16
第二節 研究設計 17
第三節 研究工具 18
第四節 資料收集與分析 21
第五節 質性資料嚴謹度 22
第六節 研究人權保護 23
第四章 研究結果 24
第一節 肝病婦女人口學、疾病特性 24
第二節 有無使用輔助及另類療法的肝病婦女特性之差異 27
第三節 有無使用CAM肝病婦女之生活品質的情形 29
第四節 肝病婦女使用輔助及另類療法的經驗 38
第五章 討論 46
第六章 結論與建議 50
第一節 結論 50
第二節 建議 52
第三節 研究限制 53
參考文獻 54
附件一 病人基本資料表 60
附件二 使用輔助及另類療法調查問卷 61
附件三 慢性肝病生活品質量表 67
附件四 研究量表使用同意書 69
作者簡介 71

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