慢性腎臟病患者疾病自我管理的心理需求評估—以症狀治療藥物為例

Abstract

慢性腎臟病患者從初期的無症狀到後期尿毒症的症狀，治療過程中需要大量的藥物，相較於其他慢性病患者，更需要了解藥物治療的益處與風險，甚至是疾病的自我管理。但在藥物治療過程中，除了面對藥物對生理上的衝擊，藥物治療對於患者以及照護者們所帶來的心理感受，除了困惑、抗拒、憂鬱低落，各種情緒上以及心理上的壓力，過去研究均已提出相關證據。但是若在自我管理的情況下，在慢性腎臟病各分期針對的藥物使用，所可能產生的各種心理需求，並無完整研究進行整合。 本前驅性研究利用質性研究方法中焦點團體以及參與式觀察，與量性數據的生活品質量表評估，採用三角交叉分析方法，得到以下結論： 1. 對於疾病控制所產生的結果期望，與藥物使用上的信念、了解上，有出現相關性，希望能積極改善病情的，對於藥物的看法及討論也提出較多。 2. 藥物的使用、調整和了解其作用，若持有較正面或積極的態度，對於自我照護與管理的表達能力較強，遵醫囑性較高。對於但在生活品質各構面，個人的滿意度並未因此而提升。 3. 對於症狀及疾病控制，對於藥物、飲食、生活型態等，所產生的情緒反應會與個人生活品質的滿意度有相關，情緒反應波動大者，對於生活品質各構面的滿意度也有較差的情況。 若能針對藥物治療讓患者及照護者有更多資訊可取得、理解時，患者情緒上較有機會獲得舒緩，將有機會改善生活品質，甚至是照護品質。而在本研究中發現，病友團體的形式不僅可提供資訊流動，舒緩患者身心上的壓力，且可進一步推動良好的醫病關係，進而改善照護品質。未來慢性病照護應加入心理健康照護策略的同時，可採用病友團體方式切入，將更有效提升國家整體健康狀況與競爭力。

Chronic kidney disease (CKD) patients in varied stages, would need multiple pharmacotherapy. Comparing with other different chronic disease, they need more information about benefit and risk of pharmacotherapy and disease self-management. In the process of pharmacotherapy, there has been proved that patients and their caregiver, not only facing the physical influenced, also the psychological impact about confusion, struggle and emotional depressed. However, there’s no complete integrated research to understand that in the course of disease self-management of different stages in CKD, there would be what kind of psychological needs in the varied pharmacotherapy. This pilot study use mixed method, integrated the focus group, participate observation and data of life quality, to assess the psychological needs. The result is shown below: 1. There are relations about the result expected to disease control and belief and understand of drug using. The more they want to improve their condition, the more they bring out thoughts and discussion about their drugs. 2. The more positive attitude about understanding, arranging their drug, the better ability to achieve self-management and expression. However, the self-satisfaction in the different aspect to quality of life, is not related to the positive attitude. 3. The bigger emotional impact is, the worse of quality of life. There are also relations between the disease control, the emotional impact to drug, daily food, life style between self-satisfaction of quality of life. If there is more information and opportunity to understand about pharmacotherapy for patients and caregivers, the less psychological impact. It is a chance to improve quality of life and quality of medical care. In this research, peers group helps to give information fluently and relief patients pressure in the physical and psychological aspects. This is a method to build the good doctor-patient relationship and improve the quality of care. In the future, psychological health care strategy also need integrate into chronic disease care, peers group could be a way to go. It also promote the overall health and competitive strength of our country.