介入整合性睡眠支持計畫提升癌末病人之照顧者的睡眠品質之效益

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Title:	介入整合性睡眠支持計畫提升癌末病人之照顧者的睡眠品質之效益 Effectiveness of the integrated sleep support to enhance the sleep quality of caregivers of advance cancer patient
Authors:	江迎君;Ying-Juong Jiang
Contributors:	護理學系碩士班
Keywords:	照顧者;整合性睡眠支持計畫;睡眠品質;caregiver;integrated sleep support program;sleep quality
Date:	2014-06-03
Issue Date:	2014-10-02 09:49:01 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	一、背景：癌症末期病人出現複雜且多樣症狀，照顧者面對複雜任務及挑戰，承受極大的照顧負荷，此易導致照顧者身心健康問題，其中以睡眠品質低下最為常見。二、研究目的：本研究目的為1)介入整合性睡眠支持計畫以改善提升照癌症病人顧者之睡眠品質。2)檢視影響癌末病人照顧者睡眠品質之預測因子。三、研究方法：本研究採前驅性、隨機實驗分配之研究設計。研究對象為中部某醫學中心癌症病房之癌症病人照顧者，收案共41人(控制組n=20,實驗組n=21)。收案條件為：1)經由醫師宣布或病理報告記載出現遠端器官轉移之病人的主要照顧者，2)照顧者為病人認定，每日照顧時間大於6小時，3)可用國台語溝通，4)非慣用手可配合配戴Actigraph)，5)PSQI≧5分，6)居家住址於大台中地區。隨機分派病人至實驗組和控制組。實驗組介入措施為期11週包含整合性睡眠支持計畫。研究工具包含主客觀資料收集，主觀資料：匹茲堡睡眠品質指數(Pittburgh Sleep Quality Index)中文版、美國流行病學研究中心憂鬱量表(Center for EpidemiologicalStudies Depression Scale)中文版、情境-特質焦慮量表(State-Trait Anxiety Inventory)中文版為每2週測量一次，客觀資料：生理測量腕動計紀錄參與者睡眠相關數據。主要統計方法為廣義估計方程式(generalized estimating equations, GEE)並設定p>.005為顯著差異。四、研究結果：介入整合性睡眠支持計畫後實驗組照顧者在PSQI平均得分(β=-2.74,p=0.01)、睡眠中斷時間(β=-33.3,p=0.01)及睡眠潛伏期(β=-4.88,p=0.01)顯著低於控制組。但在睡眠總時間、睡眠效能和睡眠百分比並未出現顯著差異。依據GEE預測睡眠困擾的相關因素發現，出現高憂鬱、協助病人日常生活程度高提供和沒有使用酒精習慣之照顧者其睡眠品質較差。五、研究結論：整合性睡眠支持計畫介入6週後將有效的改善照顧者的睡眠狀況，且可縮短睡眠潛伏期幫助入睡，和減少睡眠中斷情形，建議制定個別性照顧指導協助照顧者設計有效率的照顧策略將可減少照顧花費的時間及能量，改善睡眠品質。 Background: Advance cancer patients exhibit symptoms with complexity and diversity, therefore, caregivers always face complicated tasks and challenges, sustaining considerable care loads which makes caregivers liable to mental and physical problems such as the most commonly occurred poor sleep quality. Purpose: Purpose of the study includes 1) intervention with an integrated sleep support program to improve and elevate sleep quality for caregivers of cancer patients; 2) evaluation on predictors affecting sleep quality of caregivers for terminally ill cancer patients. Method: The study uses a prospective, randomized, experimental grouping design. Study subjects are 41 (control group n=20, experimental group n=21) caregivers for cancer patients included from cancer ward of a specific medical center in central area of Taiwan. Inclusion criteria are: 1) primary caregivers for patients with distant organ metastasis declared by physicians or recorded by pathology reports, 2) caregivers granted by patients with care time longer than 6 hours per day, 3) being capable to communicate in both Mandarin and Taiwanese, 4) being willing to wear Actigraph on the non-dominant hand, 5) PSQI (Pittsburgh Sleep Quality Index)≧5, 6) whose residential address is within the greater Taichung area. Patients were randomly grouped into either experimental group or control group. Intervention measures for experimental group were undergone for 11 weeks, including the integrated sleep support program. Study tools include both subjective and objective data collection, subjective data: Chinese version of the Pittsburgh Sleep Quality Index, Chinese version of the Center for Epidemiological Studies Depression Scale, Chinese version of the State-Trait Anxiety Inventory, measurement was conducted once every 2 weeks; objective data: physiologically measured wrist actigraphy recording sleep-related data for participants. The GEE (generalized estimating equations) method was used as the primary statistical approach, with p>.005 as significant difference. Result: After intervention of integrated sleep support program, caregivers in experimental group exhibit significantly lower scores than that of control group caregivers in PSQI average (β=-2.74,p=0.01), sleep disturbance (β=-33.3, p=0.01) and sleep latency (β=-4.88, p=0.01). Nevertheless, there is no any significant difference for total sleep time, sleep efficiency and percentage in each sleep stage. Relevant factors predicting sleep problems used in GEE demonstrate that caregivers with higher depression tendency, offering much assistance in patients’ everyday life and without alcohol addiction exhibit relatively poor sleep quality. Conclusion: 6 weeks of intervention using integrated sleep support program may effectively improve sleep status for caregivers, as well as shorten sleep latency to help falling asleep and reduce sleep disturbance. It is recommended to establish individualized care guidance to assist caregivers in developing efficient care strategies, as which may further minimize time and effort in offering care and consequently improve sleep quality.
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