晚期肺癌病人之主要照顧者的照顧負荷、負荷型態及其相關因素之探討-縱貫式研究

Abstract

照顧者負荷是家屬照顧者常見的心理困擾問題之一，家屬照顧者在照顧極具威脅生命的晚期肺癌病人可能經歷照顧負荷的問題。然而，目前仍缺乏針對晚期肺癌病人診斷後六個月內之家屬照顧者的負荷經驗、負荷型態及其相關因素之探討。本研究主要目的：(一) 探討六個月追踪期間之家屬照顧者在整體照顧者負荷之變化及其不同次型態之變化；(二) 探討六個月追踪期間影響整體照顧者負荷之變化與不同次型態的相關因素。 本研究為緃貫式設計，將於北部某醫學中心收錄符案條件的第IIIb-IV期之晚期肺癌病人及其家屬照顧者，接受四次時間點之訪談，治療前 (T1)、治療後第1個月 (T2)、治療後第3個月 (T3)、及治療後第6個月 (T4)，並於不同時間點收集病人與家屬照顧者之相關資料，運用廣義推估模式進行相關因素的探討，並以潛在成長模式進行次型態的分析。 結果顯示，家屬照顧者於病人診斷後六個月期間，整體照顧負荷程度隨時間保持中等程度之變化，相關因素包括：家屬照顧者仍有其他家人需照顧、家屬照顧者沒有輪替者、家屬照顧者的疼痛程度、家屬照顧者的疲倦程度、及其本身對癌症因應的信心程度；雖然主要來自於家屬照顧者本身的因素，但病人的身體功能與照顧者負荷仍存在低程度的相關，且於治療後第1個月時，病人的身體功能狀態與家屬照顧者的疲倦程度呈低等程度相關，治療後第3個月時，病人的身體功能狀態與家屬照顧者的疼痛呈中等程度相關。再則，本研究發現有三個次型態的負荷變化，第一種型態 (較高程度之負荷型態) ：三分之一的家屬照顧者 (34.7%) 在這個次型態之中，呈現相對較高程度的負荷變化，相關因素包括：病人食慾不佳症狀、家屬照顧者沒有輪替者、家屬照顧者的疼痛程度、及家屬照顧者對癌症因應的信心程度；第二種型態 (中等程度之負荷型態)：大多數的家屬照顧者 (56.0%) 在這個次型態之中，隨時間呈現中等程度的負荷變化，相關因素包括：照顧男性病人的家屬照顧者、病人的憂鬱程度、已婚的家屬照顧者、病人的配偶照顧者、家屬照顧者的疲倦程度、及家屬照顧者對癌症因應的信心程度；第三種型態 (較低程度之負荷型態)：少數的家屬照顧者 (9.3%) 在這個次型態之中，呈現較低程度之負荷變化，且隨時間持續下降至T3時間點，在T4時間點時，家屬照顧者的負荷程度再微微上升，相關因素只有家屬照顧者對癌症因應的信心程度。 家屬照顧者在癌症照顧上扮演核心的角色，本研究發現大多數的晚期肺癌家屬照顧者至少經歷六個月之中等程度以上的負荷問題，因此，臨床上應著重照顧者的負荷問題；再則，本研究發現與整體照顧者負荷和三種次型態照顧者負荷的相關因素將可提供臨床照護之資訊，並發展與測試完善之介入措施以減輕家屬照顧者的負荷程度，進而達更好的癌症照護品質。

Caregiver burden is one of the major psychological stressors for family caregivers (FCs). FCs caring for patients with life-threatening advanced lung cancer may experience this burden. However, there is relatively limited longitudinal research in this field. The purposes of this study were to explore the changes and sub-patterns of overall caregiver burden, and to examine the factors that predict changes and sub-patterns in overall caregiver burden over 6 months after lung cancer diagnosis. A longitudinal design with consecutive sampling was conducted to recruit newly diagnosed lung cancer patient and FC dyads in a medical center in Taiwan. Four time measurements were taken: pre-treatment (T1), 1st (T2), 3rd (T3) and 6th (T4) month post-treatment. Levels of overall caregiver burden were measured at each time point. Latent Class Growth Analysis (LCGA) was conducted to identify the numbers of sub-patterns of overall caregiver burden, while Generalized Estimating Equations (GEE) were used to identify the factors related to changes and sub-patterns of overall caregiver burden and their related factors. This research found that FCs reported steady moderate levels of overall caregiver burden during the study period and factors that predicted a higher level of burden were FCs who had another sick family member, FCs who did not have another person to provide alternative care, FCs with pain, FCs with fatigue, and FCs with lower self-efficacy in coping with cancer. Even though factors predicting overall caregiver burden were all FC-related factors, patients’ physical function did have a mild correlation with overall caregiver burden. In addition, patients’ physical function had a mild relationship with FCs’ fatigue at the 1st month post-treatment and had a moderate relationship with FCs’ pain at the 3rd month post-treatment. Furthermore, three sub-patterns of overall caregiver burden were identified: (1) Pattern I (higher pattern, 34.7%): FCs in this group reported “relatively higher levels of burden over time” and factors that predicted the burden were FCs who had patients with poor appetite, FCs who did not have another person to provide alternative care, FCs with pain and FCs with lower self-efficacy in coping with cancer; (2) Pattern II (moderate pattern, 56.0%): most FCs in this group reported “steady moderate levels of burden over time” and factors that predicted the moderate level of burden were FCs with male patients, FCs who had patients with higher levels of depression, married FCs, spousal FCs, FCs with fatigue, and FCs with lower self-efficacy in coping with cancer; (3) Pattern III (lower pattern, 9.3%): FCs in this group reported “relatively lower levels of burden”, which showed a small drop at 3rd month post-treatment. The factors that predicted the lower level of burden was FCs’self-efficacy in coping with cancer. FCs play a central role in providing cancer care. The findings in this study showed that the majority of FCs had at least moderate levels of burden over 6 months after lung cancer diagnosis. Therefore, FCs’ burden distress should be addressed in clinical settings. Factors related to the changes and sub-patterns of FCs’ burden provide further information for clinical setting and designing timely and comprehensive interventions to reduce FCs’ burden, for a better quality of cancer care.