2005-2006 > Academic research: refereed > Publication in refereed journalVersion of RecordPublishe

Chan, KS

Chan, MF

Chan, YL

Chung, PM

Lau, KS

Leung, MK

Leung, WK

Pang, MC

PolyU Institutional Repository

????????????????????????????彭美慈　钟佩雯　梁颖琴　陈健生　刘锦城　梁万福　陈裕丽　陈满辉【??】　??　比较晚期慢性阻塞性肺疾病(COPD)患者及晚期癌症患者的生存质量(Quality o f life , QOL), 探讨 COPD患者对临终关怀的需求。 ??　访问 COPD 患者 108 例及癌症患者 50 例。采用晚期病患者生存质量量表(Quality-o f-LifeConcerns in the End-of-Life Que stionnaire , QOLC-E)作评估。通过统计分析 ,比较两组的 QOL分数。??　COPD 患者的基本活动程度及操作活动程度均明显低于癌症患者(t=-6.2 , -4.7 , P 均<0.01)。而在 QOLC-E 的 8 个分类中 , COPD患者在“身体不适” 、“负面情绪”及“存在困扰”得分均比癌症患者低 , 但是“生活价值”一类却较高 , 差异均有显著性(P<0.05)。??　研究结果显示晚期 COPD患者及晚期癌症患者有相近的生存质量关注 , 但关注面各有不同。 一方面意味临终关怀应扩展至晚期 COPD患者 ,另一方面也显示 COPD 患者的诉求与晚期癌症患者不尽相同 , 故在发展有关服务的同时 , 要考虑COPD 患者的独特性。【???】　肿瘤;　比较研究;　肺疾病 ,慢性阻塞性;　生活质量;　临终医护A comparative study of the quality of life of patients with advanced chronic obstructive pulmonary disease and terminal cancer /PENG Mei-ci , CHUNG Pui-wan , LIANG Ying-qin, et al// Chinese Journal of Nursing ,-2006 , 41(3):202.【Abstract】　Objective　Compare the quality-of-life concerns o f patients w ith advanced chronic obstructive pulmonary disease(COPD)and terminal cancer , and explo re the palliativ e ca re needs of advanced COPD patients.Methods　108 advanced COPDpa tient s and 50 te rminal cance r pa tients wer e interv iewed using the Quality-of-Life Concerns in the End-of-Life Questionnaire(QOLC-E).QOLC-E comprise s four po sitiv e and four negativ e subscale s.The po sitiv e subscales are suppo rt , value o f life ,food-related concerns and healthcare conce rns;the negative subscales a re phy sical discomfo rt , nega tive emo tions , a sense o f al-ienation and existential distress.The overall QOL , eight QOLC-E subscale sco res , and se lf-maintenance and instrumental ac-tivities of daily living(P-ADL and I-ADL)sco res of the tw o patient g roups w ere compared using independent t te sts.Results　The advanced COPD patients were mo re dependent in activities o f daily living than the terminal cance r patients (t =-6.2 ,-4.7 , P<0.01).They had a low er ove rall QOL evaluation than cance r patients(t =-2.1 , P<0.05).No significant diffe r-ence was found in the mean QOLC-E sco re be tw een COPD and cancer patients (t =-1.6 , P >0.05).The COPD patientssco red low er in thr ee out of the four negative subscales , w hile the cance r pa tients scored low er in the value of life subscale(P<0.05)among the four po sitive subscale s.Conclusions　The results showed that bo th advanced COPD and terminal cancerpa tient s bor e simila r quality-o f-life concerns.However , the advanced COPD patients a ssessed their quality o f life w o rse thantha t of the terminal cancer patients.The results highly suggest that palliativ e medicine and ho spice care should be ex tended topa tient s w ith advanced COPD , taking into account the unique characteristics of COPD patients.【Key words】　Neoplasms;　Terminal cancer;　Compara tive study;　Pulmonaly disease , chronic obstructiv e;　Qua lity o f life;　Terminal care【Author's address】　Schoo l o f Nursing , The Hong Kong Po ly technic Unive rsity ,H ung Hom ,HKSAR , China????:??????????(??? , ??? , ??? ,??? ,???);????????????(???);?????????(???);???????????(???)??? :? ,???? ,????????????????????(Poly U7257/ 00H)??2005-07-22??　　???????? (chronic obst ructive pul-monary disease , COPD)????????? ,?????????? ,????????????? ,???????????????[ 1-3] ,????????? 。?????? COPD ????????????? ,?????????? ,??????????[ 4 , 5] 。?? ,???????????(palliative medicine)????? (ho spice care)?????????? ,? COPD ??????????????????[ 1-6] 。WHO?“????”??? ,?????????????????? ,????????????????????????????? ,???????????。?????????????(quali ty of life , QOL)???????[ 5 , 7-9] 。?? QOL ????????? ,?????·202· ?????? 2006? 3?? 41?? 3???? QOL ??????????????? ,?????? 、???? 、?????????????? 。??? COPD ??????????????? 、?????? 、?????????4?[ 10-13] ,????????????????????。??????????????????[ 4 , 5] ,???? COPD ?????????????? ,?? COPD?????????? 。1　?????1.1　??108? COPD ???????? , FEV 1??1L/min , ?????????3???? ,?“?????? 100m ?????? , ???????” [ 14] ,???? 1 ?????? 3 ???? 。?50?????????????? ,?????????? 。????????????? COPD???? 。???????? ,?????? 。???????? ,?? COPD??????????(34.3%),????????????(17.6%)?????(44.4%)?? (P ??<0.01)。??COPD??? P-ADL ? I-ADL ???????????(P ?<0.01)。?? 1。1.2　??1.2.1　?????????? 2??:????????????????????????;????????????? 。??????????(Self-maintenance Ac-tivi ties of Daily Living , P-ADL and Inst rumentalActivi ties o f Daily Living , I-ADL):???????? P-ADL ? I-ADL ??。P-ADL ??????????? ,????????????;I-ADL???????????? 。???? 8??? ,???? ADL ?? , ????????????[ 15] 。??????????? (Quality-o f-LifeConcerns in the End-of-Life Quest ionnaire , QOLC-E)[ 16] :???????? QOLC-E?? 。QOLC-E ??? 4????? (????2?;?? 2 ?;???? 6?;???? 4?),? 4?????(???? 4?;???? 4?;??? 3?;???? 3?)??。?? 28????? 1??? QO L? 1　?? COPD??????????????????　　　　 ??(n=158)????COPD(n=108)　　　　??(n=50)t ? χ2 ? P???(?) 73.49±10.49 74.69±9.43 70.90±12.17 1.95 0.06?? ,(n , %)　? 100(63.3) 72(66.7) 28(56.0) 1.67 0.20　? 58(36.7) 36(33.3) 22(44.0)????(n , %)　?? 17(10.8) 9(8.3) 8(16.0)　?? 102(64.6) 75(69.5) 27(54.0) 4.04 0.26　????? 7(4.4) 4(3.7) 3(6.0)　?? 32(20.3) 20(18.5) 12(24.0)????(n , %)　?? 28(17.7) 15(13.9) 13(26.0)　????? 88(55.7) 54(50.0) 34(68.0) 16.52 <0.01　??? 40(25.3) 37(34.3) 3(6.0)　?? 2(1.3) 2(1.9) 0????(n , %)　?? 16(10.1) 9(8.3) 7(14.0)　???? 42(26.6) 26(24.1) 16(32.0)　??? 23(14.6) 19(17.6) 4(8.0) 14.11 <0.01　???? 61(38.6) 48(44.4) 13(26.0)　?? 16(10.1) 6(5.6) 10(20.0)????　??????(P-ADL) 17.86 ± 4.92 16.25 ± 4.48 21.11 ± 4.12 -6.23 <0.01　??????(I-ADL) 14.44 ± 4.83 13.12 ± 4.15 17.11 ± 5.04 -4.70 <0.01·203·?????? 2006? 3?? 41?? 3??? ,??? 29???。???????????0 ～ 10? ,?????? QOL ???? 。QOLC-E ????????????? ,????????????[ 16] 。?????? 28???????????????? 62.8%。????????????????? ,???????(Cronbach′sα)0.57 ～ 0.83。QO LC-E????????????? ,? 0.87 。1.2.2　????????? 3????????????????????????????。???????? ,??? 2002? 8?? 2004? 10? 3???????? COPD ????????? 。????? COPD????????????? ,??????????????????? 。?????????? 。?????????????? ,???????????? ,?????? 。???????????????????????/????????。????????????? ,??????????????? 。?????????? ,?????????????????? 。?? ,??????????????????? ,?????????????????????。???? ,?????? ,??? 20min ,???????????? ,?????????????。1.2.3　??????? SPSS 11.1????? ,????????????? ,???????? t??。2　?　??“?? QOL”??? ,?? COPD ????(5.6±2.6),??????? (6.5 ±2.2)? ,???????? (t =-2.1 , P <0.05),????COPD???????????????????。? QOLC-E? 8???? ,?? COPD???????????(4.8±2.4),?????????????????(5.1±2.7)。???QO LC-E?? 4 ???????。?????? , ??COPD?????????????????? 。??????? ,?? COPD ????????? ,?????? 、?????????。???QOLC-E????????? ,?? COPD???6.5±1.3 ,??????? 6.8±1.4(t =-1.6 , P>0.05)。?????? ,????????????? ,??? COPD??????。?? 2。3　?　????? COPD?????????? QOL???????? QOL ?? ,?? COPD ???????? ,? QOLC-E ??????????。?? 8???? , 4??????????。3.1　??????? COPD??????????????????? ,????????????????。??? COPD??????????? ,???????? 、??????????????????????(?? 1),????????????????? 。??????? COPD ??????????????? 。????????????????????????? ,????????????。?? COPD???????????????? 。???????? 、????????? ,??????????????? ,??????????????。????????? , ??COPD????????????? ,??????????????????????。?QOLC-E?????? , P-ADL ? I-ADL ????????????????(r ? 0.18 ～ 0.28 ,P ?<0.05)[ 11] 。??????????????????? COPD??????????????? 。?? ,???????????? 、????????? ,??????????????。?? ,????????????? ,??????????。?? ,?? COPD ????? QOL ?????????? 。3.2　??????? COPD?????????????????? ,???????? 。?????? 6??? ,???? 4?????? ,??:??????? 、??????? 、?????????????。????????????????????。?? Bolmsjo[ 17] ????????? ,?????????????????????:?? 、?? 、?? 、?? 、???? 、??。???????????????????????? COPD ???? ,?????????????????? ,?·204· ?????? 2006? 3?? 41?? 3????????????? ,?????????????? ,????????????????????????? 。??????????? ,????????????? ,??????? 。?? ,??????????????????COPD??? ,??? QOLC-E 8????????????。3.3　????????? COPD?????????? QOL ???????? 4? ,???????;?????????? 、???????。????????????????? ,?????????????????????? ,??????? ,?????? 、?????????。　　?? 2???? QO LC-E ???? , 2???????? ,????????? COPD ???????????? ,?????????? ,???? 2　?? COPD??????????????????(? ,  x±s)????　　　　　　　　　　　 ??(n=158)????COPD(n=108)　　　　　??(n=50)t? P?　?? QOL 5.86±2.49 5.58±2.57 6.46±2.22 -2.09 0.04???? 5.30±2.44 4.82±2.35 6.33±2.33 -3.76 <0.01　?????? 3.42±2.84 2.72±2.64 4.92±2.71 -4.83 <0.01　??????? 5.72±3.43 5.26±3.38 6.72±3.34 -2.54 0.01　??????? 7.84±3.28 7.67±3.36 8.21±3.09 -0.99 0.32　??????? 4.11±2.86 3.49±2.62 5.41±2.93 -4.06 <0.01???? 5.76±2.37 5.56±2.53 6.19±1.94 -1.70 0.09　?? 5.37±3.04 5.03±3.20 6.12±2.54 -2.07 0.04　???????? 6.05±2.53 5.98±2.46 6.22±2.70 -0.55 0.58???? 7.67±2.42 7.35±2.45 8.38±2.23 -2.49 0.01　???? 7.44±2.98 7.06±3.01 8.29±2.77 -2.39 0.02　?? 7.99±2.66 7.70±2.65 8.63±2.59 -2.01 0.05　?? 7.33±3.04 7.02±3.03 8.00±2.99 -1.88 0.06　???? 8.43±2.56 8.16±2.70 9.03±2.10 -2.17 0.03??? 7.57±2.34 7.48±2.34 7.77±2.35 -0.72 0.47　?? 7.75±3.04 7.39±3.22 8.55±2.42 -2.47 0.02　????????? 8.11±2.89 7.96±2.84 8.47±3.02 -0.96 0.34　????????? 6.95±3.52 7.28±3.34 6.16±3.82 1.69 0.10?? 7.23±2.01 7.15±2.09 7.40±1.81 -0.72 0.47　?????????? 7.05±2.17 7.11±2.17 6.94±2.18 0.44 0.66　??????? 7.44±2.46 7.25±2.60 7.84±2.12 -1.40 0.16???? 6.01±2.34 6.42±2.07 5.08±2.65 3.07 <0.01　??????? 4.11±4.01 4.79±4.05 3.11±3.78 1.97 0.05　????????? 6.32±3.15 6.78±2.75 5.16±3.77 2.47 0.02　????????? 6.72±2.74 7.14±2.25 5.68±3.49 2.46 0.02　?????????? 7.02±2.39 7.04±2.39 6.95±2.42 0.21 0.84　??????? 6.11±2.61 6.60±2.43 4.90±3.00 3.48 <0.01　???????? 5.63±3.11 5.69±3.09 5.46±3.21 0.39 0.70???? 5.61±3.16 5.20±2.95 6.54±3.44 -2.44 0.02　?? 6.46±3.61 6.45±3.43 6.47±4.03 -0.02 0.98　???? 4.82±3.67 4.25±3.44 6.09±3.88 -2.72 0.01　?? 5.35±3.71 4.81±3.64 6.62±3.61 -2.73 0.01???? 7.68±1.68 7.77±1.65 7.48±1.73 0.10 0.32　????????? 5.97±3.25 6.05±3.23 5.80±3.33 0.43 0.67　??????????? 8.44±1.90 8.58±1.71 8.11±2.27 1.43 0.16　????????? 7.64±2.20 7.78±2.08 7.35±2.43 1.14 0.26　??????????? 8.62±1.47 8.65±1.56 8.53±1.26 0.48 0.63QO LC-E??? 6.59±1.35 6.47±1.32 6.84±1.40 -1.61 0.11?:?? 0～ 10? ,???? ,?? 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A comparative study of the quality of life of patients with advanced chronic obstructive pulmonary disease and terminal cancer

A comparative study of the quality of life of patients with advanced chronic obstructive pulmonary disease and terminal cancer

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