本文選題：肝癌 + 照顧者��； 參考：《復(fù)旦大學(xué)》2014年碩士論文

【摘要】：研究背景 原發(fā)性肝癌(Primary liver cancer, PLC,以下簡稱肝癌)是世界范圍內(nèi)發(fā)病率最高的惡性腫瘤之一,發(fā)病率呈上升趨勢,且一半以上發(fā)生在我國。指南推薦經(jīng)導(dǎo)管動脈化療栓塞(transcatheterhepatic arterial chemoembolization, TACE)是不能手術(shù)的患者最主要的姑息治療手段。肝癌對于整個家庭是一件嚴(yán)重的創(chuàng)傷性事件,疾病本身和治療引起的癥狀負(fù)擔(dān),嚴(yán)重影響患者和家庭照顧者(family caregiver, FCG)身心健康。在整個疾病的發(fā)展軌跡過程中,家庭照顧者面臨多重挑戰(zhàn)。研究表明,大部分FCG遭受震驚、沮喪、焦慮和抑郁等和照顧負(fù)擔(dān)的影響。隨著患者病情加重,持久的照顧患者,FCG的照顧能力會不斷下降,從而影響照顧質(zhì)量。所以,對FCG進(jìn)行評估、緩解FCG照顧負(fù)擔(dān)在患者的整體護(hù)理過程中不可或缺。而研究肝癌患者對照顧者生活質(zhì)量的影響是解決上述問題的一種很好的方式。健康相關(guān)生活質(zhì)量(Health related quality of life HRQOL,以下簡稱生活質(zhì)量)是病人對生理、情感、精神、社會、行為等方面健康和功能的感知,受疾病、治療狀況、個人特征、社會經(jīng)濟(jì)地位的影響,是個多維概念。很少有研究同時研究患者和照顧,甚至未見研究TACE肝癌患者及其照顧者。本研究的目的是了解肝癌患者相關(guān)變量和照顧者反應(yīng)之間的關(guān)系,這些關(guān)系隨著時間的變化,及影響照顧者身心健康的潛在不良影響因素。本研究作者根據(jù)Lazarus與Folkman的觀點,綜合運(yùn)用應(yīng)激反應(yīng)理論、癌癥家庭照顧經(jīng)驗概念模型。這些理論提出了病人和照顧者的相關(guān)變量影響照顧經(jīng)驗,上述所以變量反過來影響照顧者的身心健康。因此,我們假設(shè)患者和照顧者相關(guān)變量影響照顧者反應(yīng),上述所有的又會影響照顧者心理和生理健康,并且通過結(jié)構(gòu)方程模型方法來驗證假設(shè)。研究目的構(gòu)建照顧者生活質(zhì)量的綜合模型,驗證并解釋模型,分析各變量之間的因果關(guān)系及直接和間接的作用效果。研究方法采用橫斷面調(diào)查與縱向調(diào)查相結(jié)合的方法。通過理論研究,形成本研究的假設(shè)。收集501對介入治療肝癌患者-家庭照顧者的資料,對假設(shè)進(jìn)行驗證。患者問卷包括：一般資料問卷、記憶癥狀評估量表(MSAS)、抑郁量表(CES-D)。照顧者問卷包括：一般資料問卷、照顧反應(yīng)量表(CRA)、照顧負(fù)擔(dān)量表(SRB)、社會支持問卷(SSRS)、抑郁量表(CES-D)、生活質(zhì)量量表(QOL-scale FAMILY).研究結(jié)果1.本研究發(fā)展了介入治療特異性癥狀條目和修訂了QoLScale-FAMILY量表在肝癌患者家庭照顧者中的應(yīng)用。新增3肝癌特異性條目(發(fā)熱、眼睛皮膚發(fā)黃、隔逆),內(nèi)容效度CVI為0.95。在QoLScale-FAMILY原量表的基礎(chǔ)上,刪除了條目5、18、21、23、24、30、31、32、34、35。探索性因素分析,得到4個因子：生理狀況(1、2、3、4、6、9)、心理狀況(7、8、10、11、12、36、37)、社會功能(24、26、27、28、29、33)、家庭困擾(13、14、15、16、17、19、20、22),覆蓋27個條目的中文版肝癌患者家屬生活質(zhì)量表(QoLScale-FAMILY),驗證性因素顯示數(shù)據(jù)擬合良好(GFI=0.959,AGFI=0924, CFI=0.985, RMSEA=0.031, χ2/df=1.472)。2.構(gòu)建了照顧者生活質(zhì)量影響因素模型。照顧反應(yīng)(時間受打擾維度,經(jīng)濟(jì)困擾,照顧總負(fù)擔(dān)和自尊)在前因變量和結(jié)局指標(biāo)之間(抑郁和生理健康)扮演者重要的中介作用。情景變量作為前因變量對照顧結(jié)局既有直接又有間接的影響作用,分別是患者的癥狀特征、患者抑郁、照顧者抑郁、社會支持。(1)結(jié)構(gòu)方程模型顯示,抑郁對生活質(zhì)量有顯著的負(fù)向影響作用(B=(-0.380)-(-0.490),P0.05)。其中,抑郁對生理維度和心理維度影響顯著(B=(-0.214)一(-0.333),P0.05)。同時,照顧反應(yīng)在抑郁和生活質(zhì)量之間起中介作用B=(-0.157)-(-0.353)。(2)FCG抑郁多因素分析顯示,社會支持、患者抑郁、患者總困擾、照顧負(fù)擔(dān)、FCG時間受打擾進(jìn)入回歸方程,有顯著影響(P0.05),解釋24.7%的變異量。結(jié)構(gòu)方程模型顯示,消極反應(yīng)(時間受打擾和經(jīng)濟(jì)問題)對FCG抑郁有顯著的直接影響作用(標(biāo)準(zhǔn)化回歸系數(shù)B=0.525,p0.05)。社會支持、患者抑郁、總困擾、照顧負(fù)擔(dān)通過照顧反應(yīng)的中介作用對抑郁起間接影響作用。(3)社會支持對照顧者抑郁和生活質(zhì)量起間接影響,中介變量是照顧反應(yīng),社會支持與抑郁呈負(fù)相關(guān),與生活質(zhì)量呈正相關(guān)。(4)照顧反應(yīng)(時間受打擾、經(jīng)濟(jì)問題、自尊維度)與社會支持呈正相關(guān),與患者抑郁呈負(fù)相關(guān)。時間受打擾和經(jīng)濟(jì)問題與生活質(zhì)量四個維度均成負(fù)相關(guān)；自尊維度與FCG生活質(zhì)量的心理狀況維度呈正相關(guān),與家庭困擾維度呈負(fù)相關(guān)。研究結(jié)論1. QoLScale-FAMILY量表的因子載荷順序、因子條目結(jié)構(gòu)應(yīng)考慮到不同癌癥人群的特點進(jìn)行修訂。本研究修訂的肝癌版家庭照顧者QoLScale-FAMILY量表信效度好,適用于此類人群,未來可嘗試推廣。2.研究結(jié)果建議醫(yī)生、護(hù)士和其他健康提供者應(yīng)認(rèn)到照顧者的需求。定期對照顧者開展訪談,并評估其在照顧患者的過程中的感受、需求、和鼓勵。旨在增強(qiáng)照顧者的應(yīng)對能力從而保證照顧者為患者提供高質(zhì)量照護(hù)。3.關(guān)注癌癥患者的生活質(zhì)量,提高社會支持,促進(jìn)照顧者正向的感受,減輕照顧消極反應(yīng),從而提高FCG生活質(zhì)量和照顧的質(zhì)量。
[Abstract]:Background primary liver cancer (Primary liver cancer, PLC, hereinafter referred to as liver cancer) is one of the world's highest incidence of malignant tumors, and the incidence is on the rise, and more than half of them occur in China. The guide recommends that transcatheter arterial chemoembolization (transcatheterhepatic arterial chemoembolization, TACE) is Unoperable. The most important palliative treatment of the patient. Liver cancer is a serious traumatic event for the whole family, the disease itself and the burden of treatment, which seriously affect the physical and mental health of the patient and family caregivers (family caregiver, FCG). Most FCG suffers from shock, depression, anxiety and depression and the impact of care burden. As the patient's condition increases, the patient's care ability will continue to decline, and the care quality of the FCG will affect the quality of care. Therefore, the assessment of FCG is necessary to alleviate the burden of FCG care in the overall nursing process of the patients. The effect of the quality of life of the caregivers is a good way to solve these problems. Health related quality of life HRQOL (hereinafter referred to as the quality of life) is the patient's sense of health and function in physiological, emotional, mental, social, and behavioral aspects, disease, treatment, personal characteristics, and social economic status. The purpose of this study is to understand the relationship between the related variables of the liver cancer patients and the response of the caregivers, and the relationship between the patients with liver cancer and the care of the caregivers. These relationships have changed over time and the potential adverse effects on the physical and mental health of the TACE. According to the view of Lazarus and Folkman, the author combines the theory of stress response and the conceptual model of the family care experience of cancer. These theories suggest that the dependent variables of the patient and caregiver affect the care experience, so the variables in turn affect the physical and mental health of the caregivers. Therefore, we assume that the patients and the caregivers are dependent on the related variables. The response of the caregivers, all of the above will affect the psychological and physiological health of the caregivers, and through the structural equation model method to verify the hypothesis. The purpose of this study is to construct a comprehensive model of the quality of life of the caregivers, to verify and explain the model, to analyze the causal relationship between the variables and to the direct and indirect effects. A combination of cross-sectional survey and longitudinal investigation. Through theoretical study, the hypothesis of this study was formed. 501 cases of interventional therapy for liver cancer patients, family caregivers, were collected to verify the hypothesis. The questionnaire included the general data questionnaire, the memory symptom assessment scale (MSAS), the Depression Scale (CES-D). The caregiver questionnaire included general information. The questionnaire, the care response scale (CRA), the care burden scale (SRB), the social support questionnaire (SSRS), the Depression Scale (CES-D), the quality of life scale (QOL-scale FAMILY). The results of the 1. study developed the specific symptoms items of interventional therapy and the application of the revised QoLScale-FAMILY scale in the family caregivers of the liver cancer patients. 3 new liver cancer was added. Heterosexual items (fever, eye skin yellowish, inverse), content validity CVI was 0.95. based on the QoLScale-FAMILY original scale, deleted item 5,18,21,23,24,30,31,32,34,35. exploratory factor analysis, obtained 4 factors: physiological status (1,2,3,4,6,9), psychological status (7,8,10,11,12,36,37), social function (24,26,27,28,29,33), family distress ( 13,14,15,16,17,19,20,22), the quality of life (QoLScale-FAMILY) of the family members of the Chinese liver cancer patients was covered with 27 items. The confirmatory factor showed that the data fitted well (GFI=0.959, AGFI=0924, CFI=0.985, RMSEA=0.031, Chi 2/df=1.472).2. constructed the caregiver's life quality influence factor model. The care reaction (time disturbed dimension, economic distress) Disturbance, taking care of the total burden and self-esteem) is an important mediator between the antecedent variables and the outcome indicators (depression and physical health). The situational variables, as antecedents, have both direct and indirect effects on the outcome of care, respectively, the symptoms of the patients, the depression of the patients, the depression of the caregivers, and the social support. (1) the structural equation model Depression had a significant negative impact on quality of life (B= (-0.380) - (-0.490), P0.05). Among them, depression had significant effects on physiological and psychological dimensions (B= (-0.214) 1 (-0.333), P0.05). At the same time, the mediating effect of care between depression and quality of life (-0.157) - (-0.353). (2) multi factor analysis of FCG depression showed social support. Holding, patient depression, patient's total distress, burden of care, FCG time being disturbed to enter the regression equation, have significant influence (P0.05), explain 24.7% variation. The structural equation model shows that negative reaction (time being disturbed and economic problems) has a significant direct effect on FCG depression (standardized regression coefficient B=0.525, P0.05). Social support, patients Depression, total distress, care burden has an indirect effect on depression through the intermediary role of care response. (3) social support has an indirect effect on depression and quality of life, mediator variables are care response, social support is negatively related to depression, and the quality of life is positively related. (4) care response (time being disturbed, economic problems, self-esteem) Dimension) was positively correlated with social support and negatively correlated with depression. Time being disturbed and economic problems were negatively correlated with the four dimensions of quality of life; the dimension of self-esteem was positively correlated with the psychological status dimension of FCG quality of life, and negatively correlated with the dimension of family distress. The factor load sequence of the 1. QoLScale-FAMILY scale was the cause of the factor load. The subitem structure should be revised to take into account the characteristics of different cancer groups. The QoLScale-FAMILY scale of the family caregivers of the liver cancer version of this study is good in reliability and validity. It is suitable for this kind of people. In the future, the results of the.2. study can be tried to suggest that doctors, nurses and other health providers should recognize the needs of the caregivers. And assess the feelings, needs, and incentives in the process of caring for the patients. The aim is to enhance the coping ability of the caregivers to ensure that the caregivers provide the patients with high quality care for the.3. to pay attention to the quality of life of the cancer patients, improve social support, promote the positive feelings of the caregivers, reduce the negative reactions to the care of the patients, and thus improve the quality of life and the quality of life of the FCG. Quality of care.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R473.73

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