接受居家安寧療護之生命末期病人主要照顧者照顧準備度、負荷與生活品質之探討

研究背景:面對生命末期，大部分個案都希望回到自己熟悉的家中安養，但末期病人因疾病造成身體逐漸衰退，在護理照護及協助需求增加下，照顧工作更加複雜，對於家庭也造成很大的衝擊，主要照顧者的需求及負荷容易被忽略，因此以居家安寧家屬的主要照顧者負荷情況更需進一步探討，以提供關注家屬的需求，適時提供照護介入，以提升其生活品質。研究目的:本研究目的主要了解生命末期病人之主要照顧者面對居家安寧療護照顧準備度、負荷、及生活品質的概況。同時探討生命末期病人之主要照顧者人口學特質、面對居家安寧療護照顧準備度、負荷及對其生活品質的影響性。研究方法:採橫斷式相關研究設計，以方便取樣，以有收案居家安寧之各醫院附設之居家護理所、獨立型居家護理所之個案家屬為選樣對象，共收案138位接受安寧療護之生命末期病人主要照顧者，採用獨立t檢定、皮爾森積差相關、及階層迴歸分析進行統計資料分析。研究結果：研究顯示不同年齡 ( t = 0.084，p = 0.005)、性別 (t = -2.201，p = 0.029)、教育程度 (t = -2.986， p = 0.003)、每月經濟狀況 ( t = -4.410，p = < 0.001)、工作狀態 (t = - 2.362，p = 0.020)、每天照顧個案時間 (t = 3.151， p = 0.002)、照顧者本身身體狀況 ( t = 4.190，p = < 0.001) 於生活品質表現都有顯著差異。此外，主要照顧者準備度、負荷分別與生活品質呈現顯著正相關 (r = .258， p = <.001)與負相關 (r = -.547，p = <.001)。亦即照顧者準備度越低、負荷越高，他們的生活品質越低。而階層迴歸分析顯示每月經濟狀況、照顧者本身身體狀況及負荷是生活品質的重要影響因子，調整後解釋力是38.2%。結論與建議：本研究發現照顧者每月收入較低 (3萬5千以下)、照顧者本身有慢性疾病、及照顧負荷越高者，他們的生活品質也越低，因此，我們建議醫護專業人員需針對家庭經濟較弱及照顧者本身有慢性疾病者，提供更適切的介入照護，並於居家安寧的照護多一些心理層面的支持及協助，未來更應加強社工師及心理師的資源鏈結及轉介資源，讓居家照護的主要照顧者能達到身心靈的調適，是未來的居家安寧療護照護需要努力推進的方向。

Background: Facing the end of life, most patients prefer to receive palliative care at home, but terminal illnesses lead to gradual physical decline, increasing the complexity of caregiving needs. This situation significantly impacts families, often neglecting the needs and burdens of primary caregivers. Therefore, it is crucial to investigate further the burden experienced by primary caregivers in home palliative care settings to address their needs and provide timely caregiving interventions, thereby enhancing their quality of life.Objective: this study aims to understand the preparedness, burden, and quality of life among primary caregivers of terminally ill patients receiving home palliative care. It also explores the demographic characteristics of primary caregivers, their reparedness for home palliative care, burden levels, and their impact on quality of life.Methods: A cross-sectional correlational study design was employed, utilizing convenience sampling. Participants were selected from family members of patients receiving home palliative care from various hospital-affiliated and independent home care facilities. A total of 138 primary caregivers were enrolled. Statistical analyses included independent t-tests, Pearson's correlation coefficients, and hierarchical regression analysis.Results: The study revealed significant differences in quality of life based on age (t = 0.084, p = 0.005), gender (t = -2.201, p = 0.029), education level (t = -2.986, p = 0.003), monthly economic status (t = -4.410, p < 0.001), employment status (t = -2.362, p = 0.020), daily caregiving hours (t = 3.151, p = 0.002), and caregiver's health condition (t = 4.190, p < 0.001). Additionally, caregiver preparedness and burden showed significant positive (r = .258, p < .001) and negative (r = -.547, p < .001) correlations with quality of life, respectively. Hierarchical regression analysis indicated that monthly economic status, caregiver's health condition, and burden were significant predictors of quality of life, explaining 38.2% of its variance.Conclusion and Recommendations: The study suggests that lower monthly income (below 35,000 units), caregiver's chronic illness, and higher caregiving burden are associated with lower quality of life for caregivers. Therefore, healthcare professionals should provide tailored interventions for caregivers with weaker financial backgrounds and chronic illnesses, including psychological support in palliative care settings. Future efforts should strengthen the referral and resource networks involving social workers and psychologists to facilitate holistic adjustments for primary caregivers in-home palliative care.