「現狀–期待」差距對慢性腎臟病病人反應轉移的影響

Response Shift in Patients with Chronic Kidney Disease: The Influence of a Have-Want Discrepancy

研究目的：過去對慢性腎臟病病患的生活品質研究顯示，透析患者的生活品質不見得比腎臟病前期的患者來得差。反應轉移理論以病人在評估生活品質時的內在標準改變（重新校準）、內在價值改變（重新權重）、以及構念的定義改變（重新構念）來嘗試解釋這個現象。本研究的目的是檢驗透析和未透析患者的生活品質差異，若兩組患者的生活品質差異未達顯著，是否因透析患者產生反應轉移所致。同時印證文獻的論點，認為當病患的現狀與期待出現差距時，才會產生反應轉移。研究方法：自2013年2月到11月，本研究共募集了85位病人，含3-5期慢性腎臟病病人28位（平均年齡56.5歲，14名男性），一年內進行血液和腹膜透析病人57位（平均年齡48.1歲，31名男性）。本研究收集兩個時間點（間隔三個月）的個人化生活品質評量表—直接權重版（SEIQoL-DW）加上重溯測驗（then test）。「現狀—期待」差距是SEIQoL-DW各提名領域的現狀期待差距絕對值取其平均。研究結果：經由2*2 ANCOVA（透析與否組別*前後測）的分析，透析和未透析組在SEIQoL-DW總分上不具顯著差異。兩組的反應轉移指標差異也不具統計顯著性。將所有受試以前測現狀期待差距取前33%及後33%方式，取高低兩組。從2*2 ANCOVA（高低組*前後測）的分析得知，差距高組較低組，在兩點間顯著提升了SEIQoL-DW的總分，並且在重新構念和重新校準指標達顯著差異。研究結論：本研究支持現狀期待差距是反應轉移發生與否的因素之一。

Purpose: Quality of life (QoL) studies of patients with chronic kidney disease (CKD) showed that the QoL of dialysis patients is not worse than the QoL of patients with earlystage CKD who do not need dialysis. According to response shift theory, this result may be due to a change in the individual’s internal standards (recalibration) or values (reprioritization), or due to a reconceptualization of QoL. This study aimed to test the response shift theory to determine whether the equivalence in QoL of these two groups is due to a response shift for the dialysis patients. We hypothesized that patients would generate a response shift only if they had a have-want discrepancy. Methods: A total of 85 patients were recruited from February to November 2013, including 28 (mean age was 56.5, 14 male) with stage 3-5 CKD, and 57 (mean age was 48.1, 31 male) who had been undergoing dialysis for their past year. All patients completed the Schedule for Evaluation of Individual Quality of Life--Direct Weighting (SEIQoL-DW) twice with three months between tests and then test. Have-want discrepancy was the average absolute difference of ideal scores and satisfaction of each domains of SEIQoL-DW. Results: The two-way repeated measures ANCOVA showed no significant difference in QoL between the dialysis group and the non-dialysis group. Neither was the difference of response shift indices between these two groups significant. Patients were divided into high, middle, and low discrepancy groups according to their have-want discrepancy. A two-way repeated measures ANCOVA revealed that the high discrepancy group significantly raised their reported QoL. The recalibration and reconceptualization indices also differed significantly between the two groups. Conclusions: This study supported the response shift theory and identified the havewant discrepancy as one of the mechanisms triggering a response shift.