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系統識別號 U0026-0408201016050400
論文名稱(中文) 探討老年癌末病人住院後至死亡小於或等於14日的預測因子
論文名稱(英文) Prognostic Factors in Predicting Death within 14 days after Hospice Admission in Elderly Terminally ill Cancer Patients
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 98
學期 2
出版年 99
研究生(中文) 高以信
研究生(英文) Yee-Hsin Kao
學號 tc697108
學位類別 碩士
語文別 中文
論文頁數 121頁
口試委員 口試委員-趙可式
口試委員-張家銘
指導教授-盧豐華
中文關鍵字 預測因子  老年  癌末  安寧療護 
英文關鍵字 prognostic factors  elderly  terminally ill cancer  hospice care 
學科別分類
中文摘要 前言︰癌末病人的存活期是病人、家屬及安寧團隊所關心的議題,若能事先預知,病人才可有較適宜的末期生涯規劃及較合理的對治療考量;家屬則對未來事物有較適宜的規劃;醫護人員則可讓安寧療護發揮最大作用,能明智使用醫療及避免病人在臨終時的不必要治療。
目的︰本研究的目的在探討癌末住院老年病人之人口學、臨床特徵、症狀、徵候及檢查結果的盛行率、比較住院後至死亡小於或等於14日及大於14日兩組間上述變項之差異、及分析老年癌末病人住院後至死亡小於或等於14日的預測因子。
方法︰本研究計畫藉由病歷回顧法,收集2004年11月至2007年5月間,因癌末住至安寧病房之老年病人作為研究對象,登錄該些病人第一次入住安寧病房之病歷內所記載病人住院後24小時內的基本人口學資料、臨床特徵、症狀、徵候、實驗室檢驗值、及病人的死亡日期等資料。使用SPSS 12.0版統計軟體進行統計分析,對於連續變項以t檢定;對於類別變項以卡方檢定來比較。最後以多因子邏輯斯迴歸分析法,建立迴歸模型以分析病人住院後至死亡小於等於14日之預測因子。
結果︰本研究共有433位老年癌末病人納入分析,其中住院後至死亡時間小於或等於14日者有187位(43.2%),大於14日者有246位(56.8%)。病人的平均年齡為74.7±6.3歲,存活中位日數為17日,此次住院的中位日數為10日。病人來源以由病房轉入為主、癌症原發部位以肺癌為最多,肝癌其次、有35.3%的病人住院前未曾接受過任何的治療、癌症轉移之器官數目則以一個器官為最多(44.1%)、另有61.2%的病人身上並未使用任何的管路治療。臨床症狀以疲倦/衰弱為最多(94.5%),其次為食慾降低(82.4%);徵候則以體重減輕為最多(91.2%)。在兩組間比較方面,存活小於或等於14日組罹患肝癌較多、有較差的身體功能、較少的便秘與失眠、心搏次數較多、呼吸次數較快、較常有下肢水腫、意識不清、腹水及黃疸、較高的WBC、BUN、Creatinine、SGOT、Bilirubin(T)、K+、corrected Ca++,及較低的lymphocyte比例與albumin。在住院後至死亡小於或等於14日之顯著正相關的預測因子包括︰男性(p< 0.001)、癌症原發部位是肝癌(p = 0.004)、癌症轉移器官之總數(p = 0.020)、身體功能差者(p < 0.001)、心搏次數(p = 0.004)、黃疸(p = 0.036)、腹水(p = 0.040)、WBC(p = 0.010)及BUN(p<0.001),負相關的預測因子為癌症原發部位為胃癌者(β = -1.045,p = 0.025)。
結論︰藉由研究所發現的性別、胃癌、肝癌、癌症轉移器官之總數、身體功能狀態、心搏次數、腹水、黃疸、WBC及BUN等預測因子,將可增進醫護人員對癌末病人存活期的預測能力,進而提升老年癌末病人的安寧照護品質。
英文摘要 Abstract

Background: The issue about the survival time of the terminally ill cancer patients is always a major concern of patients, families, and the hospice-care team. If the information about patient’s prognostication are more accurate, patient can benefit from appropriate planning about his (her) end-of-life, and proper decisions about his (her) future treatment can be made. Patient’s family can benefit from appropriate planning about his (her) daily work. Hospice physicians and coworkers may benefit from optimizing the use of hospice care, making judicious use of medical treatment, and avoiding futile treatment near the patient’s dying stage.
Objectives: To study the prevalence of demographic, clinical characteristics, symptoms, signs, and laboratory test, in the elderly terminally ill cancer patients after hospice admission; compare the above variables in two groups of patients died within or more than 14 days. To analyze the prognostic factors in predicting death within 14 days after hospice admission in elderly terminally ill cancer patients is the purpose of this study.
Methods: This is a retrospective study on elderly patients, who were admitted to the hospital-based hospice ward, from November 2004 to May 2007. Data are collected from chart review, including demographic data, clinical characteristics, symptoms, signs, and laboratory tests recorded within 24 hours after admission, and the date of death. The SPSS 12.0 statistics software package is used in statistical analysis. Comparability between the 2 groups is tested using t test for continuous variables and Chi-square test for categorical variables. Logistic regression analysis is performed to analyze the odds ratio of significant factors associated with patients who died within 14 days after hospice admission.
Results: Of the 433 patients, who are enrolled in the study, 187 patients (43.2%) died within 14 days after hospice admission and 246 patients (56.8%) died after an interval of more than 14 days. The mean age of the subjects is 74.7±6.3 years, the median survival day is 17days, and the median admission day is 10 days. The major source of patients is from other wards in the same hospital, lung cancer is the most common primary cancer and 35.3% patients have not been treated before admission. Majority of patients (44.1%) has metastasis in one organ and the percentage of patients having no tube in their body is 61.2%. The most common symptoms are fatigue/weakness (94.5%), and body weight loss (91.2%). When compared between the 2 groups, we found that some factors are significant in the group of death within 14days after admission. Those factors includes primary cancer in the liver, the worse performance status, less constipation and insomnia in the patient’s symptom, more rapid heart rate and respiratory rate, more frequent lower leg edema, conscious disturbance, ascites and jaundice in the patient’s signs. There are higher values in the WBC, BUN, Creatinine, SGOT, total Bilirubin, potassium, and corrected Ca, and lower values in the lymphocyte percentage, and albumin in the patient’s laboratory test. In the logistic regression analysis, the positive significant factors are male (p < 0.001), primary cancer site as liver (p = 0.004), the number of metastasis (p = 0.020), heart rate (p = 0.004), the worse performance status (p < 0.001), jaundice (p = 0.036), ascites (p = 0.040), WBC (p = 0.010), and BUN (p < 0.001). The negative significant factor is primary cancer in the stomach (β = -1.045, p = 0.025)
Conclusion: We develop models of predicting death within 14 days after hospice admission, so that physicians can more accurately predict death in the elderly terminally ill cancer patients, by cognition of their clinical symptoms, signs and laboratory factors. Hence, we can deliver more appropriate and compassionate care to these patients, and their families.
論文目次 目 錄
口試合格證明 II
中文摘要 III
Abstract V
致謝 VII
目 錄 VIII
表目錄 X
圖目錄 XI
第一章 緒論 1
第一節 研究背景及動機 1
第二節 研究目的 13
第三節 研究問題 13
第二章 文獻查證 14
第一節 有關癌末病人存活期之預測 14
第二節 有關癌末病人存活期的預測因子 18
第三節 有關老年癌末病人存活期的預測因子 55
第四節 文獻回顧小結 55
第三章 研究方法 58
第一節 研究設計 58
第二節 研究地點及對象 58
第三節 研究工具 58
第四節 資料收集與倫理考量 58
第五節 統計分析 63
第四章 研究結果 64
第一節 老年癌末病人的基本資料、臨床特徵、症狀、徵候及實驗室檢查結果 64
第二節 住院後至死亡小於或等於14日與大於14日兩組的病人在基本資料、臨床特徵、症狀、徵候及實驗室檢查之比較 77
第三節 老年癌末病人住院後至死亡小於或等於14日的預測因子 80
第四節 登錄者自身與登錄者間信度 86
第五章 討論 87
第一節 老年癌末病人症狀與徵候之盛行率 87
第二節 老年癌末病人住院後14日內死亡的預測因子 89
第六章 結論與建議 96
第一節 結論 96
第二節 研究限制 96
第三節 建議 98
參考文獻 (Reference) 100
一、英文部分 100
二、中文部分 108
附錄 109
附錄一、人體試驗委員會同意證明書 109
附錄二、研究問卷 111
附錄三、研究問卷譯碼表 113
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