以計畫行為理論探討慢性腎臟病患選擇不同透析治療之意圖

Application of the Theory of Planned Behavior to Dialysis Modality Choice in Patients with Chronic Kidney Disease

研究目的：大部分的慢性腎臟病（chronic kidney disease, CKD）病患必須從血液透析或腹膜透析擇一作為治療方案。雖然部分CKD病患因為醫療或心理社會之因素而受限於特定的透析方式，但大多數的病人都有選擇的機會。針對可自主選擇透析治療方式的患者，本研究以計畫行為理論為基礎，探討未來準備接受透析治療之慢性腎臟病患者對於不同透析治療的態度、主觀規範、及知覺行為控制之差異值，對其選擇不同透析治療的行為意圖之差異值的預測效果。研究方法：本研究於2013年7月至2014年2月進行調查，以57位（男35人，女22人）能自主選擇治療方式的CKD病患為受試者，年齡介在24-79歲間。以計畫行為理論問卷、慢性腎臟疾病知識問卷，及醫院焦慮及憂鬱量表等三份問卷進行自陳測量。研究結果：在控制了與透析選擇意圖有顯著關聯之其他變項之後，只有態度及知覺行為控制的差異值能顯著預測治療選擇意圖的差異值。研究結論：臺灣的CKD病患選擇其未來可能採用的透析治療，主要受到態度以及知覺行為控制之影響，較不受主觀規範的影響。本研究依此結果進行理論與實務意涵的討論。

Purpose: Patients with chronic kidney disease (CKD) are often offered a choice between hemodialysis (HD) and peritoneal dialysis (PD). This study explores the significant factors that affect dialysis modality selection. Based on the theory of planned behavior, we examine whether attitude, subjective norms, and perceived behavioral control predict behavioral intention in patients’ dialysis modality choice. Methods: Fifty-seven patients (35 men and 22 women, ages 24-79) with CKD were recruited between July, 2013 to February, 2014. All participants completed 3 questionnaires: The Theory of Planned Behavior Questionnaire, The Kidney Disease Questionnaire, and The Hospital Anxiety and Depression Scale. Results: While controlling for the identified control variables for the outcome, the results of hierarchical regression showed that attitude and perceived behavior control predicted behavioral intention. Conclusions: Understanding CKD patients’ attitude and perceived behavior control towards treatment choices is important in the dialysis decision-making process. Theoretical and practical implications are discussed. Reasons that subjective norms did not significantly contribute to behavioral intention were discussed for culture and clinical relevance.