晚期肝癌主要照顧者照顧負荷、憂鬱及對生活品質的影響

The Impact of Depression and Care Burden on Quality of Life among Primary Caregivers of Advanced Liver Cancer Patients

本研究目的是，探討中晚期肝癌主要照顧者負荷、憂鬱與生活品質狀態及生活品質的影響因素。以描述相關性、立意取樣法針對某醫學中心中晚期肝癌主要照顧者為對象，運用照顧者反應量表、流行病學研究中心憂鬱量表及台灣簡明版世界衛生組織生活品質問卷，進行資料收集。共116位個案，以女性、已婚居多，平均48.17歲，每日照顧時數以＞8小時最多。照顧負荷以健康衝擊負荷最高，且64.6％個案有憂鬱症狀。生活品質方面，憂鬱程度越高者之各個範疇生活品質都越差；子女照顧者、經濟良好者的生理範疇品質較差；健康衝擊負荷大者的心理範疇品質較差；家庭衝擊負荷大、時間衝擊負荷大者的社會範疇品質較差；宗教信仰可能影響的環境範疇生活品質。本結果提供臨床醫護人員參考，並建議加強照顧者負荷、憂鬱及生活品質的評估，並提供照顧者支持措施，以維護病人照護品質。

The purpose of this study is to explore the care burden, depression and quality of life (QOL) of the caregivers of patients with advanced liver cancer, and the predictors of caregiver QOL. In this study, we included primary caregivers of intermediate to advanced liver cancer patients from a gastroenterology ward of a medical center in northern Taiwan. Structured questionnaires, including Caregiver Reaction Assessment (CRA), the Center for Epidemiologic Studies Depression Scale (CES-D), Taiwan concise version of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), and characteristics of the primary caregivers and their patients were used to evaluate the relationship between care burden, depression and QOL in a total of 116 respondents. The results revealed that caregivers were mostly female, married, mean age of 48.17 years and provided more than 8 hours of caregiving per day. High caregiving burden leads to severe adverse impact on health of caregivers and 64.6% of them suffered from depression (CES-D score >16). In summary, depression negatively affected caregiver QOL in multiple domains, including overall QOL, physical domain of offspring as caregiver and caregiver with high socioeconomic status, psychological domain of who borne higher impact on health and social relationship domain of caregivers with inadequate family support and higher impact on schedule. The environmental domain of QOL was related to religion. In summary, it is recommended to evaluate depression, burden of caregivers and provide supporting measures to improve caregiving and QOL.