急診癌症病人之家屬照顧者居家期間的支持性照護需求探討

Abstract

背景：由於癌症治療有許多相關症狀會於返家後才發生，致使家屬照顧者成為居家照護癌症病人之重要角色，然而，病人常因疾病本身或治療導致身心不適等問題，居家期間未能有醫療人員可提供立即諮詢與處理，都可能提高病人反覆前往急診尋求協助，這凸顯家屬照顧者居家照護病人之支持性照護需求探討的重要。 目的：本研究之目的為（一）深入瞭解癌症病患之家屬照顧者居家照護之經驗。（二）探討急診癌症病患及其家屬照顧者之身心現況。（三）探討家屬照顧者居家期間照護癌症病患之支持性照護需求及其相關因素。 方法：本研究為橫斷式質量性混合性研究，採立意取樣，於北部某醫學中心急診收案，以開放式訪談家屬照顧者之居家照護經驗，及結構式問卷瞭解家屬照顧者的支持性照顧需求。運用內容分析法瞭解家屬照顧者之照護經驗，及運用SPSS 26.0 進行平均值、標準差、百分比、曼惠特尼(Mann-Whitney) U 檢定、斯皮爾曼相關分析(Spearman Correlation)，確認支持性照護需求現況及其相關因素。 成果：本研究質性訪談結果發現成為照顧者對家屬照顧者其本身之身體、心理及經濟皆產生影響，因缺乏可諮詢照護問題的窗口，需要醫療協助時，只能前往急診以尋求問題解決方法；而量性研究結果發現病患入急診原因前三名為感染、呼吸狀況、疼痛，且七成病患有情緒困擾；家屬照顧者面臨的問題之前三名為疲憊、不確定感、及照護資訊取得不易，且超過五成家屬照顧者有情緒困擾。本研究結果提供癌症患者急診求醫原因及身心狀態、家屬照顧者身心狀態與未滿足支持照護需求的實證資料，提供急診癌症病人居家期間的衛教指導與處置之重要依據。

Background: Many treatment-related symptoms will occur after cancer patients return home, making family caregivers essential for in-home care for cancer patients. However, family caregivers have not yet received good professional training. Their physical and mental stress will rise when patients suffer from physical and mental discomfort due to the disease or anti-cancer treatment. During the home period, there are no medical staffs who can provide counseling immediately. It may make the patients go to the emergency department for assistance often, which lets the supportive care needs assessment of family caregivers' home care patients become essential in improving the quality of cancer care at home. Purpose: This study aims to (1) understand the home care experience of family caregivers of cancer patients. (2) understand the physical and mental condition of family caregivers with cancer patients,and (3) the factors related to supportive care needs in family caregivers with cancer patients during home care. Method: This study was designed as a cross-sectional qualitative mixed study with a deliberate sample selection. The cases will be received in the emergency department of a medical center in northern Taiwan. The experience of family caregivers will be learned through an open-ended interview to explore the experience of family caregivers, and a structured questionnaire will be used to explore factors related to the supportive care needs of family caregivers.Use content analysis to understand the care experience of family caregivers.Data will be analyzed by SPSS 26.0 for mean, standard deviation, percentage, Mann-Whitney U test, and Spearman correlation to identify the factors related to supportive care needs in family caregivers with cancer patients. Results: Becoming the primary caregiver significantly impacts the caregiver, such as physical exhaustion, psychological burden, and economic pressure.Some family caregivers express that there is nowhere they can consult for care issues. When patients have their condition changed or need medical assistance, they would like to go to the emergency room to seek the quickest solution to their medical problems. In this research, the top three reasons for patients entering the emergency department were ranked first. The first was infection problems, followed by respiratory system problems, and pain. The questionnaire results also showed that more than 70% of the patients experienced emotional distress in the past week. Family caregivers' mainly face problems with physical fatigue, uncertainty, and difficult access to care information. The questionnaire results also showed that more than 50% of the patients experienced emotional distress in the past week Moreover, the related factors are the care needs of family caregivers and cancer diseases. The results of this study provide substantial evidence on why cancer patients seek emergency care, their physical and mental conditions, and the physical and mental conditions and unmet supportive care needs faced by their family caregivers and provide an essential basis for the design of the vital health education guidance and disposal content.