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提供终末期癌症患者临终关怀时的照料负担的纵向变化及其预测因素。

Longitudinal changes and predictors of caregiving burden while providing end-of-life care for terminally ill cancer patients.

机构信息

School of Nursing, China Medical University and China Medical University Hospital, Taichung, Taiwan.

出版信息

J Palliat Med. 2013 Jun;16(6):632-7. doi: 10.1089/jpm.2012.0499. Epub 2013 Apr 4.

Abstract

BACKGROUND

The effect of caring for a dying cancer patient on caregiving burden has been explored primarily in Western-based studies with small samples or in studies that did not follow up until the patient's death, but has not yet been investigated in Taiwan.

OBJECTIVE

The study's goals were (1) to identify the trajectory of caregiving burden for family caregivers (FCs) of terminally ill cancer patients in Taiwan, and (2) to investigate the determinants of caregiving burden in a large sample and with longitudinal follow-ups, until the patient's death.

METHOD

A prospective, longitudinal study was conducted among 193 FCs. The trajectory and determinants of caregiving burden were identified by a generalized estimation equation approach.

RESULTS

Caregiving burden did not change as the patient's death approached. FCs experienced heavy caregiving burden when their relative suffered from greater symptom distress or if they were spousal caregivers; provided high intensity of assistance to the patient while spending fewer hours providing care; reported financial insufficiency; or had lower social support, fewer psychological resources, or less confidence in caregiving.

CONCLUSIONS

Taiwanese family caregivers' carry moderate caregiving burden which did not change significantly as the patients' death approached. The effects of caregiving burden while providing EOL care to terminally ill cancer patients may be tempered substantially by enhancing family caregivers caregiving confidence, social support, and psychological resources.

摘要

背景

照顾临终癌症患者对护理负担的影响主要在以西方为基础的研究中进行了探索,这些研究样本较小,或者在没有跟踪到患者死亡的情况下进行了研究,但在台湾尚未进行过调查。

目的

本研究的目的是(1)确定台湾临终癌症患者家属照顾者(FCs)的护理负担轨迹,(2)在一个大样本中并进行纵向随访,直到患者死亡,调查护理负担的决定因素。

方法

对 193 名 FCs 进行了前瞻性、纵向研究。通过广义估计方程方法确定护理负担的轨迹和决定因素。

结果

随着患者死亡的临近,护理负担并没有改变。当亲属遭受更大的症状困扰或照顾者为配偶时,FCs 会经历沉重的护理负担;为患者提供高强度的帮助,同时花费较少的时间提供护理;报告财务不足;或社会支持较少、心理资源较少、或对护理信心较低。

结论

台湾家庭照顾者的护理负担中等,随着患者死亡的临近,护理负担没有明显变化。在为临终癌症患者提供 EOL 护理时,护理负担的影响可以通过增强家庭照顾者的护理信心、社会支持和心理资源来大大缓解。

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