探討癌症病人失志程度與主要照顧者照顧負荷之相關與影響因子

Investigating of the Relationships and Influencing Factors of Demoralization of Cancer Patients and Burden of Primary Caregivers

背景：肺癌、大腸癌及乳癌是110年國內發生率最高的三種癌症且需積極治療。癌症病人有高比例於治療期間會面臨失志，影響生理、心理、家庭及靈性等層面，而病人的主要照顧者也面臨中等程度的照顧負荷，影響照顧者的健康及生活品質甚鉅。
目的：描述肺癌、大腸癌及乳癌病人基本屬性與失志程度的情形及關係；其主要照顧者基本屬性及照顧負荷的情形及關係；病人失志與主要照顧者照顧負荷的關係；並分析影響主要照顧者照顧負荷的因素。
方法：本研究為描述性橫斷式研究，採立意取樣選取北部某教學醫院腫瘤科病房罹患肺癌、大腸癌、乳癌病人及其主要照顧者，「中文失志量表」與「癌末病人家屬照顧者照顧負荷量表」收集資料，以獨立樣本t檢定、單因子變異數、皮爾森相關及逐步複迴歸等進行資料分析。
結果：本研究納入癌症病人及主要照顧者共210位(各105位)，病人失志平均41.79分(SD=18.26)，主要照顧者照顧負荷平均87.13分(SD=23.86)，失志與照顧負荷呈現顯著相關(r =.570, p = .000)。逐步迴歸分析結果顯示，當病人失志程度越高(β= .49, p = .000)、主要照顧者為女性(β= - .17, p = .025)、病人無私人保險(β= - .22, p = .007)及照顧者因照顧病人而影響工作者(β= .21, p = .006)，主要照顧者會有較高的照顧負荷，總解釋變異量41.0%。
結論/實務應用：研究結果顯示癌症病人失志程度是高的，主要照顧者照顧負荷達中等負荷程度，且病人的失志越高、無私人健康保險、女性照顧者、以及因照顧而影響工作者是照顧負荷的重要影響因素。根據研究結果可針對失志病人提供情緒支持及相關會診，對主要照顧者協助提供相關資源及轉介措施，以減輕照顧負荷。

Background: In 2021, the three most prevalent cancers in Taiwan were lung cancer, colorectal cancer, and breast cancer, all of which require aggressive treatment. A significant proportion of cancer patients experience substantial demoralization during their treatment, affecting their physiological, psychological, familial, and spiritual well-being. Moreover, primary caregivers of these patients face a moderate level of caregiving burden, which can significantly impact their health and overall quality of life.
Purpose: This study aims to describe the basic characteristics of lung cancer, colorectal cancer, and breast cancer patients, along with their treatment attributes and levels of demoralization. It also explores the correlation between patient demoralization and the caregiving burden experienced by their primary caregivers, as well as the factors influencing this burden.
Methods: A descriptive cross-sectional study design was used. Purposive sampling selected lung cancer, colorectal cancer, and breast cancer patients and their primary caregivers from the oncology ward of a teaching hospital in northern Taiwan. Data were collected using the Mandarin version of the Demoralization Scale (DS-MV) and the Family Caregiver Burden Scale for Family Caregivers of Terminal Cancer Patients. Data analysis included independent samples t-tests, one-way ANOVA, Pearson correlation, and stepwise multiple regression.
Results: The study included 210 participants, comprising 105 cancer patients and their primary caregivers. The average demoralization score for patients was 41.79 (SD = 18.26), while the average caregiving burden for primary caregivers was 89.49 (SD = 25.24). A significant correlation was found between patient demoralization and caregiving burden (r = .570, p < .001). Stepwise regression analysis revealed that higher levels of patient demoralization (β= .49, p < .001), female gender of the primary caregiver (β= -.17, p = .025), absence of private health insurance for the patient (β= -.22, p = .007), and workrelated impacts on the caregiver due to their caregiving role (β= .21, p = .006) were associated with higher caregiving burden. The overall explained variance was 41.0%.
Conclusions/Implications for Practice: The findings indicate a high level of demoralization among cancer patients, with their primary caregivers experiencing a moderate caregiving burden. Key contributors to caregiving burden include higher patient demoralization, absence of personal health insurance, female caregivers, and work-related impacts due to caregiving. Based on these results, it is recommended to provide emotional support and related consultations for demoralized patients, as well as resources and referral measures for primary caregivers to help reduce their caregiving burden.