台灣血液透析患者的個人化生活品質：以SEIQoL-DW為測量工具

Abstract

本研究目的為使用個人化生活品質評量表直接權重版(SEIQoL-DW)，評估國內血液透析患者的個人化生活品質，探討對其特別重要的生活品質向度與相關影響因素，此外，並以Locke(1969, 1976)(引自Wu & Yao,2006b)的「情感間距假設」、Calman(1984)的期望理論與Wu(2009)提出的移轉傾向指標為基礎，探討SEIQoL-DW重要性評估程序的應用價值與潛在臨床應用指標。研究對象以立意取樣，自台北市松山區某私人洗腎中心募集57名血液透析患者、以及台北市文山區一般社區成人60名，研究工具包含SEIQoL-DW、生活滿意度量表、焦慮與憂鬱評量表、自編人口背景/疾病變項問卷，統計方法含描述性統計、卡方檢定、相關分析、平均數差異檢定與迴歸分析。研究結果發現，血液透析患者最常列舉的重要生活向度為健康(77%)，其次依序為家庭(72%)、經濟(65%)、人際關係(53%)、休閒活動(49%)、因應/正向態度(23%)、工作/學業(21%)、心理健康(16%)、生活條件(16%)、靈性/信仰(9%)、角色功能(9%)、其他(9%)，血液透析患者在各向度提名百分比與一般成人組未有顯著差異，但血液透析患者對健康向度的現況評比顯著較低，對健康的現況-期望落差也顯著較高，共病數與血液透析患者個人化生活品質指標有顯著負相關；而SEIQoL-DW項目重要性對項目現況分數與整體滿意度之間的關係不具調節效果，SEIQoL-DW的權重程序未能提升對整體滿意度的解釋力，此外，自項目重要性與現況-想望落差所得移轉傾向指標，和整體生活滿意度、SEIQoL-DW現況平均數亦未有一致的相關性或獨特解釋力。儘管本研究不支持SEIQoL-DW權重程序或衍生指標的助益，但若從個人脈絡來看，向度重要性仍可協助探索個案生活目標重要順序，有其臨床醫療應用價值；最後，SEIQoL-DW個人現況-想望落差分數、現況平均數、以及整體生活滿意度、負向情緒彼此有顯著關聯性與解釋力，在個案生活滿意度、負向情緒評估或介入方案中，具有成為臨床應用指標的潛力。

The primary purpose of this thesis was using the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) to explore hemodialysis patients’ Individual Quality of Life and relative determinants. And further using affect-range hypothesis (Locke, 1969, 1976), expection theory (Calman,1984) and shifting tendency Index(Wu, 2009) as framework to evaluate SEIQoL-DW weighting procedure’s efficiency and potential clinical application variables. 57 hemodialysis patients and 60 counterparts was recruited from Taipei city, IQoL was assessed by SEIQoL-DW, the general life satisfaction and anxiety /depression statement was chosen as criterian variables. In the analysis, twelve quality of life domains were identified. Health(77%), family(72%), finance(65%), relations(53%) and leisure time(49%) were the most prominent quality of life domains of hemodialysis patients, although the domains nominated percentage and importance rating didn’t differ between groups, hemodialysis patients’ health domain status and have-want discrepancy were worse than the counterparts. Among the investgated variables, only the comorbidity had negative correlation with hemodialysis patients’ IQoL. The result didn’t support the SEIQoL-DW’s weighting procedure and shifting tendency Index had significant efficiency, but the weighing information could still be useful in personal profile context. Finally, the personal have-want discrepancy, satus average, general life satisfaction and anxiety/depression statement have significant relations with each other, thus could be the potential clinical application variables in negative emotion or life satisfaction intervention programs.