非癌病人與癌症病人於居家安寧心理照護需求之差異

Comparison of the Psychological Care Needs of Non-cancer Patients and Cancer Patients in Home-based Palliative Care

10.6537/TJHPC.202203_26(2).01

沈晏羽(Yan-Yu Shen)；吳曉聞(Hsiao-Wen Wu)；周庭筠(Ting-Yun Chou)；沈孟筑(Meng-Zhu Shen)；李沂蓁(Yi-Jhen Lee)；楊啟正(Chi-Cheng Yang)

非癌病人 ； 心理照護 ； 居家安寧療護 ； 癌症病人 ； non-cancer patients ； psychological care ； palliative care ； cancer patients

安寧療護雜誌

26卷2期（2022 / 03 / 01）

105 - 119

繁體中文

目的：目前僅有相當少數的非癌末期病人使用安寧緩和照護。然而疾病過程中經歷到的生理症狀與心理、靈性的需求，並不亞於癌症病人，且返家後同樣會面臨疾病適應與壓力因應議題。因此，本研究欲分析非癌病人及家屬在生命末期心理照護議題上的現況及與癌症病人的差異。方法：採用次級資料分析法分析2019年1月至2020年3月底，臺北市某區域醫院於居家安寧階段的受試者共169位，其中非癌病人有78人，癌症病人有91人。所有受試者皆評估其人口學變項、心理服務項目與臨床醫療變項。結果：非癌病人與癌症病人在以病人本身及家屬為主要服務對象時，其心理照護議題皆以情緒困擾為主。其比例分別為非癌病人61.9%，癌症病人59.6%；非癌病人家屬35.7%，癌症病人家屬40.0%。然而，兩群病人在家庭為主的心理照護議題有部分相異。非癌病人以家庭溝通（50.0%）為主，其次是壓力因應（36.4%）；癌症病人則以情緒困擾（22.0%）為主，再來是醫病溝通（22.0%）。結論：癌症病人及非癌病人在自身、家屬與家庭同樣需要心理照護之協助，且議題有所異同。因此，針對非癌病人之特定需求提供全面且深入的心理專業服務，在居家安寧照護中甚為重要。

Purpose: Only a small number of non-cancer patients use palliative care. However, those patients experience physical symptoms, psychological and spiritual needs during the disease process like cancer patients. When non-cancer patients return home, they will still face life adaptation and stress adjustment situation. This study thus aims to further compare the difference between non-cancer and cancer patients’ psychological issues. Method: This study used the secondary data analysis to examine the psychological records for patients with palliative care. A total of 169 participants who had accepted home-based palliative care with psychological services were enrolled in this study from January 2019 to the end of March 2020, of which 78 were non-cancer patients and 91 were cancer patients. The demographic, psychological issues and clinical variables were recorded by the psychologists. Result: The results show both non-cancer patients and cancer patients and their relatives have issues with emotional distress. The portion of non-cancer patients is 61.9%, cancer patients is 59.6%. The portion of non-cancer patients' relatives is 35.7%, cancer patients' relatives is 40.0%. On the other hand, non-cancer patients' family mostly have issues of family communication (50.0%) and pressure adjustment (36.4%), while cancer patients mostly have issues with emotional distress (22.0%) and communication between doctors and patients (22.0%). Conclusion: Patients and families with non-cancer diseases both need psychological cares. Therefore, provide psychological cares to non-cancer patients is important in home-based palliative care.

1. 邱啟潤,許淑敏,吳淑如(2003)。居家照護病患之主要照顧者綜合性需求調查。醫護科技學刊，5(1)，12-25。
   連結：
2. 邱啟潤,許淑敏,吳瓊滿(2002)。主要照顧者負荷。醫護科技學刊，4(4)，273-290。
   連結：
3. 翁瑞萱,施至遠,洪香蓮(2015)。居家生命末期照顧新思維：以台大醫院金山分院社區居家安寧為例。安寧療護雜誌，20(3)，258-268。
   連結：
4. 黃惠娟,王麗華,張秀如(2015)。社區慢性失能族群之心理健康促進。護理雜誌，62(4)，34-40。
   連結：
5. Lynn, J,Chaudhry, E,Noyes Simon, L,Wilkinson, AM,Sauster, JL.(2007).The Common Sense Guide to Improving Palliative Care.New York, NY:Oxford University Press.
6. Mounsey, L,Ferres, M,Eastman, P(2018).Palliative care for the patient without cancer.Australian journal of general practice,47(11),765-769.
7. Oechsle, K,Ullrich, A,Marx, G,(2019).Psychological burden in family caregivers of patients with advanced cancer at initiation of specialist inpatient palliative care.BMC Palliat Care,18,102.
8. Traue DC, Ross JR(2005).Palliative care in non-malignant diseases.Journal of the Royal Society of Medicine,98(11),503-506.
9. Ullrich, A,Marx, G,Bergelt, C(2021).Supportive care needs and service use during palliative care in family caregivers of patients with advanced cancer: a prospective longitudinal study.Supportive care in cancer,29(3),1303-1315.
10. 方俊凱。癌症病人的情緒起伏與焦慮狀態。2021 年 5 月 31 日，取自https://www.ttcc.org.tw/wp-content/uploads/2011/07/%E7%99%8C%E7%97%87%E7%97%85%E4%BA%BA%E7%9A%84%E6%83%85%E7%B7%92%E8%B5%B7%E4%BC%8F%E8%88%87%E7%84%A6%E6%85%AE%E7%8B%80%E6%85%8B.pdf。
11. 李雅雯(2015)。台中，逢甲大學統計學系。
12. 胡梅(2016)。台北市，國立臺灣師範大學社會教育學系。
13. 高綺吟,胡文郁,邱泰源(2012)。癌症病人末期病情告知與心理情緒之相關性研究。安寧療護雜誌，17(3)，288-299。
14. 許淑敏,邱啟潤(2003)。家庭照顧者的壓力源與因應行為──以一個支持團體為例。護理雜誌，50(5)，47-55。
15. 陳明玉(2010)。台中，中國醫藥大學醫務管理學系碩士班。
16. 黃英惠(2008)。台北，國立陽明大學臨床暨社區護理研究所。
17. 蔡佩真(2010)。先進國家安寧療護喪親關懷服務之探討。安寧療護雜誌，15(1)，47-62。
18. 衛生福利部。109 年死因統計表。2021年 8 月 19 日，取自 https://www.mohw.gov.tw/cp-5017-61533-1.html。
19. 鄭如芬,林雅卿,黃百后,韋至信,孫嘉玲(2014)。癌症末期病人靈性照護模式。護理雜誌，61(6)，93-97。
20. 簡浩正。長照照顧者調查親人最常吵架是這原因。2021 年 6 月 18 日，取自https://health.udn.com/health/story/5999/4005413。