Care Needs and Its Correlates in Primary Caregivers of Lung Cancer Patients

本研究目的為探討肺癌病患主要照顧者的照護需求及其相關因素。研究設計採橫斷性、描述相關性研究法，以立意取樣針對北部某醫學中心100對肺癌患者與其主要照顧者為研究對象；而為探討照顧者照護需求是否與病人有關，本研究使用Karnofsky身體功能狀態、症狀嚴重度、醫院焦慮憂鬱量表與基本資料表來評估肺癌病患；照顧者照護需求部分則使用「支持性照護需求量表-照顧者44 (SCNS-P&C 44)」，此量表共分為七層面次量表，訊息需求、法律/經濟需求、心理/情緒需求、健康照護專業人員/健康照護需求、日常生活需求、溝通/人際關係需求與其他需求。研究結果顯示主要照顧者未滿足需求部分，前十項未滿足之需求中，以健康照護專業人員/健康照護層面需求為最多，共包含五項 (37%~50%)，二項屬於心理/情緒層面需求 (45%~58%)，二項與法律/經濟層面 (43%~52%) 有關，另三項屬於訊息需求層面 (40%~45%)。病患無職業、年齡較大、身體功能較差、焦慮程度較高、症狀較嚴重及年齡較大的女性、沒有結婚且受教育年數較少之主要照顧者有較多的照護需求。本研究有助於臨床醫護人員對於肺癌主要照顧者照護需求有更深入的了解，並提供未來臨床照護與研究方面的參考依據。The purpose of the study was to identify the care needs and related factors in primary caregivers of lung cancer. A cross-sectional, correlational study was conducted. One hundred pairs of eligible patients and caregivers were recruited from the pulmonary outpatient clinics in a medical center in Taiwan by convenience sampling. A set of questionnaires was used to assess patients’ needs, including the Karnofsky’s Performance Status Index, Symptom Severity Scale (SSS), and Hospital Anxiety and Depression Scale (HADS) and Background Information Form; the caregivers’ care needs was evaluated using the Supportive Care Need Survey-Partners & Caregivers 44 (SCNS-P&C 44), the Supportive Care Need Survey-Partners & Caregivers 44 (SCNS-P&C 44) include the seven domains, information needs• health care professional/health care service needs• daily needs• coummnication / interpersonal needs• Legal/Financial Needs• psychological/emotional needs and other needs.The results indicated that : (1) primary caregivers’ reported top ten unmet needs with the five items in the “health care professional/health care service needs” domain (37%~50%), two items were in “psychological/emotional needs” domain (45%~58%), two items were in “legal/financial needs” domain (43%~52%) and three items in “information needs” domain (40%~45%). Patients without work, older age, lower performance status, higher anxiety, symptom severity, female caregivers’ with older age, unmarried and less education level that their primary caregivers had more likely care needs. In conclusion, our data provides more information about care needs by primary caregivers in lung cancer for further clinical care and related studies.口試委員審定書謝............................................................................................................................Ⅱ文摘要....................................................................................................................Ⅲ文摘要....................................................................................................................Ⅳ錄............................................................................................................................Ⅴ目錄.......................................................................................................................Ⅵ目錄.......................................................................................................................Ⅵ一章 緒論...........................................................................................................1一節 研究背景與動機.........................................................................1二節 研究目的.....................................................................................4.二章 文獻查證...................................................................................................5一節 肺癌.............................................................................................5二節 照顧者需求概念.........................................................................8三節 癌症照顧者需求的相關研究...................................................10四節 影響照顧者需求之相關因素...................................................15三章 研究方法.................................................................................................18一節 研究設計...................................................................................18二節 研究假設...................................................................................19三節 研究場所及對象.......................................................................20四節 研究架構...................................................................................21.五節 名詞解釋...................................................................................22六節 研究工具...................................................................................23七節 資料收集及資料分析...............................................................26八節 倫理考量...................................................................................28四章 研究結果.................................................................................................29一節 肺癌病患及主要照顧者之基本資料與疾病特徵分析...........29二節 肺癌病患心理狀態與症狀嚴重度狀況...................................36三節 主要照顧者照護需求情形.......................................................39四節 肺癌病患及主要照顧者之基本資料與疾病特徵與照護需的相關...................................................................................43 第五節 肺癌病患之症狀嚴重度與心理狀態及照顧者需求的相關.......51 第六節 照顧者照護需求預測變項...........................................................53.五章 討論.........................................................................................................56一節 肺癌病患症狀嚴重度及心理狀態程度...................................56二節 主要照顧者照護需求情況.......................................................58三節 影響主要照顧者照護需求之相關因素...................................60六章 結論與建議.............................................................................................63考文獻...................................................................................................................65目錄 表一 推論統計方式.......................................................................................27 表二 肺癌病患人口學特質...........................................................................31 表三 肺癌病患疾病特徵...............................................................................33 表四 照顧者人口學特徵與照顧型態...........................................................34 表五 肺癌病患心理狀態...............................................................................37 表六 肺癌病患症狀嚴重度一覽表...............................................................38 表七 肺癌照顧者照護需求得分情形...........................................................40 表八 肺癌照顧者未滿足照護需求得分情形...............................................41 表九 肺癌照顧者照護需求與病患人口學及疾病特徵之相關性...............44 表十 肺癌照顧者照護需求與人口學及照顧型態之相關性.......................48. 表十一 照顧者照護需求及肺癌病患症狀嚴重度與心理狀態之相關性分析 ...........................................................................................................52 表十二 照顧者照顧需求預測變項...............................................................55目錄 圖一 研究架構...............................................................................................2