癌症患者照料者护理负担、生命质量与抑郁的关系研究
|
摘要
前言
20世纪中叶以来,无论是在发达国家还是发展中国家,癌症在疾病谱和死因谱中的位置逐年上升,近年来都出现了以恶性肿瘤占据最主要位置的趋势。中国自2005年以来,癌症已成为位居首位的健康杀手。癌症是一种病程较长、病死率较高的全身消耗性疾病。患者长时间承受着肉体和精神的折磨,其照料者在长期繁重的护理环境中会倍感紧张和疲惫,幸福感降低以及生命质量下降,甚至身心健康受到损害。
中国已进入老龄化社会,随着我国独生子女家庭进入成年期和居民平均寿命的提高,传统家庭的养老功能正在逐渐弱化,老年人口和癌症等慢性病患者的家庭护理问题正成为日益凸显的社会问题,实现护理工作社会化和建立护理保险制度将成为我国未来社会发展必须面对的重大社会问题。目前我国尚无相关的护理保障政策和护理保险制度,护理责任主要由家庭承担,而在欧美国家、日本、台湾及香港地区都有相应的护理保险,其护理负担部分由社会保障体系承担,相应地缓解了患者及家属的经济和护理负担。近些年,国内学者对癌症患者的心理压力与生活质量开展了大量的调查研究,但很少有学者从社会政策的视角对癌症患者照料者的护理负担问题进行研究,政策滞后将影响社会发展。
因此,本研究旨在通过对癌症患者照料者的护理负担、照料者反应、社会支持、心理一致感、生活质量和抑郁倾向等变量关联关系的系统研究,详细阐明诸多自变量、因变量、中介变量和调节变量之间的关系,建构护理负担理论模型,为促进我国护理工作的社会化提供理论依据,为开展其他病种护理负担研究提供研究思路,为改善癌症患者护理现状提供有效的干预路径。
对象与方法
本研究采用横断面设计,在中国医科大学盛京医院,以方便抽样的方法,选取400位癌症患者照料者为研究对象。以面对面访谈和问卷调查的方式进行调查。研究工具使用结构性问卷,包括照料者的人口统计学资料、护理负担、生活质量、抑郁、照料者反应评估和心理一致感、社会支持。应用照料者负担量表(ZBI)、患者家属生命质量量表(QOL)及流调用抑郁自评量表(CES-D)测量癌症照料者护理负担情况、生命质量及抑郁倾向。采用Epidata3.0进行数据的统一录入,SPSS13.0对收集到的数据进行整理和分析,应用结构方程模型以探究癌症患者照料者护理负担、生命质量与抑郁的主要影响因素,探讨照料者反应的中介效应,及心理一致感和社会支持对护理负担的调节作用。
结果
结构方程模型分析结果显示,护理负担对抑郁有显著的主效应,护理负担程度越高,照料者抑郁倾向的发生率越高,生命质量越低。照料者反应作为护理负担导致抑郁的中介变量,而心理一致感对于抑郁倾向有着显著的调节作用,可降低家属的抑郁的发生。护理工作量对护理负担有显著性的影响,照料者的帮助方式与护理负担呈显著的正相关关系,人口统计学变量对护理负担并无显著性影响。高护理负担可导致照料者抑郁倾向的发生。
结论
护理工作量过大会增加患者家属照料者的护理负担的发生,应建立照料者的轮流护理的补偿机制,以减低照料者的护理负担程度。护理负担是导致抑郁的直接因素,照料者反应是护理负担导致照料者抑郁的中介变量、心理一致感作为调节变量,可降低相应的护理负担和抑郁发生率。因此应开展患者家属照料者反应能力及心理一致感的相关辅导,以增加其应对护理负担的能力,进而提高其生命质量。创造有利于缓解压力的支持性的环境以减低护理患者所导致的压力与抑郁和生命质量下降,如提高医院医疗水平与服务水平,改善患者的治疗环境、建立合理的医患关系、争取义工支持和社会救助。
Introduction
Since the middle of the century, the rank of cancer in the disease spectrum and death spectrum increased dramaticly year by year no matter in developed or developing country. In recent years, malignant tumor has tended to be the most primary cause of death. Cancer has become the first health killer since the year 2005 in China. Cancer is a disease with high mortality and also is a systemic wasting disease. Patients suffer from both physical torture and the destruction of spirit in a relative long period. Cancer is not only a major life event to patients themselves but also has a great affect on their caregivers, often resulting in tension and pressure, declining of well-being and quality of life in caregivers. Meanwhile caregivers have to bear the burden and pressure in a long period of time because of the long-term and heavy caring work, thus their physical and mental health are seriously affected.
Cancer patients and their families have to face not only cancer diagnosis and treatment process but also the impact of their family system. Especially core-type family type is the major type of current China's family type, that family members'life must be affected when there is a cancer patient in their family. In addition, China has entered the aging society which has a great number of older population. Under such circumstance, caregivers usually have heavy family burden to family members including supporting the elderly, raising children and taking care of cancer patients.
Due to aging and the one child policy, the caregiving problem has become prominent in China. Since long-term care has not established in China, as well as the shortage of official nurses and caregivers, family members usually take the responsibility of taking care of patients and older people, their quality of life should not be underestimated.
In recent years, domestic scholars have carried out a large number of researches on the psychological stress and quality of life of cancer patients, but few scholars care for the burden of caregivers of cancer patients. Therefore, we carry out this survey in order to evaluate the burden of care and quality of life of caregivers of cancer patients and to study the related factor. In this study, we provide the evidence through the evaluation of caregivers of cancer patients about the burden of care, quality of life and depression levels to explore effective predictor to improve the coping capacity of caregivers of cancer patients, to reduce their stress and to improve their health status, as well as to further improve the quality of life and life satisfaction of cancer patients.
This study aims to assess caregiver burden, quality of life and depression among the cancer patients, and explore the relatinship of caregiver burden, quality of life and depression and to find out predictors of caregiver burden on depression. Finally, establish theoretical model of caregiver burden, provide evidence and new ideas about long-term care for the government, and give effective interventions in order to improve the care situations
Method
A cross-sectional study was conducted through the convince sampling, composed of 400 caregivers of cancer patients from 3 departments in the Second Affiliated Hospital of China Medical University. A face-to-face interview was explored to assess caregivers' burden, depression, and quality of life.
The questionnaire consisted of question on demographic variables, the Chinese edition of Zarit caregiver burden interview (ZBI), quality of life (QOL), Center for Epidemiologic Studies Depression Scale (CES-D), Caregiver reaction assessment (CRA), Sence of coherence scale (SOC). Multivariate linear regression analyses were performed to study the factors related to cargiver burden and depression. Statistical analysis was performed using Statistical Package for the Social Sciences Version,11.5 (SPSS Inc.,Chicago,IL,USA),and apply structural equation (SEM) AMOS6.0 to
Result
Structural equation model analysis showed that cargiver burden had a significantly main effect on depression, the heavier cargiver burden is, the prevalence of depression is higher, and the QOL is lower. Caregiver reaction was the mediator of burden on depression. Sence of coherence was the moderator, which could moderate depression. Additionally Caring workload has a remarkable effect on cargiver burden, and the help mode has a positive correlation with caregiver burden, while demographic variables has not notable influence on caregiver burden.
Conclusion
Caring workload results in the prevalence of caregiver burden, it is necessary to establish compensation mechanism for alternating nursing care,in order to decrease caregivers burden. Caregiver reaction was the mediator of burden on depression. Sence of coherence was the moderator, which could moderate depression.
Therefore, guidance training should be provided in order to enhance the levels of coping capacity and psychological control, so as to improve the ability to deal with nursing burden, and improve their quality of life. Supportive environment should be created which contributes to releasing pressure, including improve medical level and service level of hospitals, optimize patients'therapeutic environment, establish rational doctor-patient relationship, strive volunteers'support and social helping.
20世纪中叶以来,无论是在发达国家还是发展中国家,癌症在疾病谱和死因谱中的位置逐年上升,近年来都出现了以恶性肿瘤占据最主要位置的趋势。中国自2005年以来,癌症已成为位居首位的健康杀手。癌症是一种病程较长、病死率较高的全身消耗性疾病。患者长时间承受着肉体和精神的折磨,其照料者在长期繁重的护理环境中会倍感紧张和疲惫,幸福感降低以及生命质量下降,甚至身心健康受到损害。
中国已进入老龄化社会,随着我国独生子女家庭进入成年期和居民平均寿命的提高,传统家庭的养老功能正在逐渐弱化,老年人口和癌症等慢性病患者的家庭护理问题正成为日益凸显的社会问题,实现护理工作社会化和建立护理保险制度将成为我国未来社会发展必须面对的重大社会问题。目前我国尚无相关的护理保障政策和护理保险制度,护理责任主要由家庭承担,而在欧美国家、日本、台湾及香港地区都有相应的护理保险,其护理负担部分由社会保障体系承担,相应地缓解了患者及家属的经济和护理负担。近些年,国内学者对癌症患者的心理压力与生活质量开展了大量的调查研究,但很少有学者从社会政策的视角对癌症患者照料者的护理负担问题进行研究,政策滞后将影响社会发展。
因此,本研究旨在通过对癌症患者照料者的护理负担、照料者反应、社会支持、心理一致感、生活质量和抑郁倾向等变量关联关系的系统研究,详细阐明诸多自变量、因变量、中介变量和调节变量之间的关系,建构护理负担理论模型,为促进我国护理工作的社会化提供理论依据,为开展其他病种护理负担研究提供研究思路,为改善癌症患者护理现状提供有效的干预路径。
对象与方法
本研究采用横断面设计,在中国医科大学盛京医院,以方便抽样的方法,选取400位癌症患者照料者为研究对象。以面对面访谈和问卷调查的方式进行调查。研究工具使用结构性问卷,包括照料者的人口统计学资料、护理负担、生活质量、抑郁、照料者反应评估和心理一致感、社会支持。应用照料者负担量表(ZBI)、患者家属生命质量量表(QOL)及流调用抑郁自评量表(CES-D)测量癌症照料者护理负担情况、生命质量及抑郁倾向。采用Epidata3.0进行数据的统一录入,SPSS13.0对收集到的数据进行整理和分析,应用结构方程模型以探究癌症患者照料者护理负担、生命质量与抑郁的主要影响因素,探讨照料者反应的中介效应,及心理一致感和社会支持对护理负担的调节作用。
结果
结构方程模型分析结果显示,护理负担对抑郁有显著的主效应,护理负担程度越高,照料者抑郁倾向的发生率越高,生命质量越低。照料者反应作为护理负担导致抑郁的中介变量,而心理一致感对于抑郁倾向有着显著的调节作用,可降低家属的抑郁的发生。护理工作量对护理负担有显著性的影响,照料者的帮助方式与护理负担呈显著的正相关关系,人口统计学变量对护理负担并无显著性影响。高护理负担可导致照料者抑郁倾向的发生。
结论
护理工作量过大会增加患者家属照料者的护理负担的发生,应建立照料者的轮流护理的补偿机制,以减低照料者的护理负担程度。护理负担是导致抑郁的直接因素,照料者反应是护理负担导致照料者抑郁的中介变量、心理一致感作为调节变量,可降低相应的护理负担和抑郁发生率。因此应开展患者家属照料者反应能力及心理一致感的相关辅导,以增加其应对护理负担的能力,进而提高其生命质量。创造有利于缓解压力的支持性的环境以减低护理患者所导致的压力与抑郁和生命质量下降,如提高医院医疗水平与服务水平,改善患者的治疗环境、建立合理的医患关系、争取义工支持和社会救助。
Introduction
Since the middle of the century, the rank of cancer in the disease spectrum and death spectrum increased dramaticly year by year no matter in developed or developing country. In recent years, malignant tumor has tended to be the most primary cause of death. Cancer has become the first health killer since the year 2005 in China. Cancer is a disease with high mortality and also is a systemic wasting disease. Patients suffer from both physical torture and the destruction of spirit in a relative long period. Cancer is not only a major life event to patients themselves but also has a great affect on their caregivers, often resulting in tension and pressure, declining of well-being and quality of life in caregivers. Meanwhile caregivers have to bear the burden and pressure in a long period of time because of the long-term and heavy caring work, thus their physical and mental health are seriously affected.
Cancer patients and their families have to face not only cancer diagnosis and treatment process but also the impact of their family system. Especially core-type family type is the major type of current China's family type, that family members'life must be affected when there is a cancer patient in their family. In addition, China has entered the aging society which has a great number of older population. Under such circumstance, caregivers usually have heavy family burden to family members including supporting the elderly, raising children and taking care of cancer patients.
Due to aging and the one child policy, the caregiving problem has become prominent in China. Since long-term care has not established in China, as well as the shortage of official nurses and caregivers, family members usually take the responsibility of taking care of patients and older people, their quality of life should not be underestimated.
In recent years, domestic scholars have carried out a large number of researches on the psychological stress and quality of life of cancer patients, but few scholars care for the burden of caregivers of cancer patients. Therefore, we carry out this survey in order to evaluate the burden of care and quality of life of caregivers of cancer patients and to study the related factor. In this study, we provide the evidence through the evaluation of caregivers of cancer patients about the burden of care, quality of life and depression levels to explore effective predictor to improve the coping capacity of caregivers of cancer patients, to reduce their stress and to improve their health status, as well as to further improve the quality of life and life satisfaction of cancer patients.
This study aims to assess caregiver burden, quality of life and depression among the cancer patients, and explore the relatinship of caregiver burden, quality of life and depression and to find out predictors of caregiver burden on depression. Finally, establish theoretical model of caregiver burden, provide evidence and new ideas about long-term care for the government, and give effective interventions in order to improve the care situations
Method
A cross-sectional study was conducted through the convince sampling, composed of 400 caregivers of cancer patients from 3 departments in the Second Affiliated Hospital of China Medical University. A face-to-face interview was explored to assess caregivers' burden, depression, and quality of life.
The questionnaire consisted of question on demographic variables, the Chinese edition of Zarit caregiver burden interview (ZBI), quality of life (QOL), Center for Epidemiologic Studies Depression Scale (CES-D), Caregiver reaction assessment (CRA), Sence of coherence scale (SOC). Multivariate linear regression analyses were performed to study the factors related to cargiver burden and depression. Statistical analysis was performed using Statistical Package for the Social Sciences Version,11.5 (SPSS Inc.,Chicago,IL,USA),and apply structural equation (SEM) AMOS6.0 to
Result
Structural equation model analysis showed that cargiver burden had a significantly main effect on depression, the heavier cargiver burden is, the prevalence of depression is higher, and the QOL is lower. Caregiver reaction was the mediator of burden on depression. Sence of coherence was the moderator, which could moderate depression. Additionally Caring workload has a remarkable effect on cargiver burden, and the help mode has a positive correlation with caregiver burden, while demographic variables has not notable influence on caregiver burden.
Conclusion
Caring workload results in the prevalence of caregiver burden, it is necessary to establish compensation mechanism for alternating nursing care,in order to decrease caregivers burden. Caregiver reaction was the mediator of burden on depression. Sence of coherence was the moderator, which could moderate depression.
Therefore, guidance training should be provided in order to enhance the levels of coping capacity and psychological control, so as to improve the ability to deal with nursing burden, and improve their quality of life. Supportive environment should be created which contributes to releasing pressure, including improve medical level and service level of hospitals, optimize patients'therapeutic environment, establish rational doctor-patient relationship, strive volunteers'support and social helping.
引文
1 张秀霞.癌症患者家属心理健康状况及护理干预的研究现状.中国护理管理.2007；7(10)：30-31.
2 马军.饮用水源污染威胁公共健康.科学对社会的影响.2009；2.
3 胡月娟.濒死病人与其家属需更多的关怀.护理杂志.1992；39(2)：133-138.
4 Dumont S, Turgeon J, Allard P, Charbonneau G, Vezina L. Caring for a loved one with advanced cancer:determinants of psychological distress in family caregivers. Journal of Palliative Medicine.2006; 9(4):912-921.
5 Redinbaugh EM, Banm A, Tarbell S,Arnold R. End-of caregiving:What helps family caregiver cope. Journal of Palliative Medicine.2003; 6(6):901-909.
6 胡幼慧,王孝先,郭淑珍.家人照护失能老人之困境.一项质化与量化整合的研究.公共卫生.1995；2(2)：99-113.
7 高淑芳,盧孳艳,葉淑惠,劉雪娥.家庭功能、社会支持与小区残病老人照顾者负荷之关系.护理研究.1999；7(2)：172-182.
8 Zheng XY, Chen LX. Features of China's population ageing and its policies. Chin. Gen. Pract.2006; 9:1919-1923.
9 Chou K R. Caregiver burden:A concept analysis. Journal of Pediatric Nursing.2000; 15(6):398-407.
10 Zarit SH, Femia EE, Kim K, Whitlatch CJ. The structure of risk factors and outcomes for family caregivers:implications for assessment and treatment. Aging Ment Health. 2010; 14(2):220-31.
11 Hoenig J, Hamilton M. The schizophrenic patient and his effect on the household. International Journal of Social Psychiatry.1966; 12:165-176.
12 马先芝.照顾负荷之概念分析.护理杂志.2003；50(2)：82-85.
13吴琼满.居家照顾者的负荷.美和专校学报.1999；17：1-14。
14 Novak M, Guest C. Application of a multidimensional caregiver burden inventory. The Gerontologist.1989; 29(6):799-803.
15 Hunt CK. Concepts in caregiver research. Journal of Nursing Scholarship.2003; 35: 27-32.
16赖鹏城.家庭照料者就业状况与其照料负荷的关系.2003,台北：国立台湾大学卫生政策与管理研究硕士论文.
17 Kahana E, Biegel D.E, Wykle M. Family caregiving:A lifespanperspective. Family Caregiver Applications Series, Volume 4. Newbury Park, CA:Sage Publications.1994
18 Holmes T, Rahe R. Holmes-Rahe Social Readjustment Rating Scale. Journal of
Psychosomatic Research.1967;2.
19 Haan MN, Kaplan GA, Syme SL. Socioeconomic status and health:Caregiver burden and health promotion. Int J Nurs Stud.2000; 37:37-43.
20 Kahana E, Kahana B, Johnson J.R, Hammond R. J, Kercher K. Developmental challenges and family caregiving. Family caregiving across the lifespan. Thousand Oaks, CA:Sage.1994; 3-41.
21 沈若仪.居家服务使用与家庭照顾者负荷之关系探讨.台北：台湾大学公共卫生学院卫生政策与管理研究所硕士論文.2004.
22 Given B, Wyatt G, Given C, Sherwood P, Gift A, DeVoss D, et al. Burden and depression among caregiver of patients with cancer at the end of life. Oncology Nursing Forum.2004; 31(6):1105-1117.
23 Grunfeld E, Coyle D, Whelan T, Clinch J, Reyno L, Earle C C. Family caregiver burden: Results of a longitudinal study of breast cancer patient and their principal caregivers. Canadian Medical Association Journal.2004; 170(12):1795-1801.
24 Nijboer C, Triemstra M, Tempelaar R, et al. Determinants of caregiving experiences and mental health of partners of cancer parients. Cancer.1999; 86(4):577-588.
25 Huang X, Butow PN, Meiser B, et al. Attitudes and information needs of Chinese migrant cancer patients and their relatives. Aust NZ J Med.1999; 29:207-213.
26 于玲,李惠兰,林乐辉.癌症患者家属焦虑、抑郁状况调查分析与对策.现代医院.2007；7(6)：151-152.
27 Wagner CD, Bigatti SM, Storniolo AM. Quality of life of husbands of women with breast cancer.Psycho-oncology.2005; 15(2):109-120.
28 Deeken JF, Taylor KL, Mangan P, et al. Care for the caregivers:a review of self-report instruments developed to measure the burden, needs, and quality of life of informal caregivers [J]. Journal of Pain and Symptom Management.2003; 26(4):922-953.
29 Hinds C. The needs of families of who care for patients with cancer at home:Are we meeting them [J]. Adv Nurs.1985; (10):575-581.
30 Lazarus R, Folkman S.Stress, appraisal, and coping. NewYork:Springer Publishing Company.1984.
31 Folkman S, Lazarus R, Gruen R. DeLong is A Appraisal, coping, health status, and psychological symptoms. Journal of Personality and Social Psychology.1986; 48: 571-579.
32 Rosenbaum M. Learned Resourcefulness:On Coping Skills, Self-Control and Adaptive Behavior. New York:Springer.1990.
33 Hills J, Paice J A, Cameron J R, Shott S. Spirituality Medicine.2005; 8(4):782-788.
34 Sharpe L, Butow P, Mcconnell D, Clarke. The relationship between available support,
unmet needs and caregiver burden in patients with advanced cancer and their carers. Psycho-Oncology.2005; 14(2):102-114.
35 林维君,黄文聪,廖纯真等.安寧病房中家属照顾者的信息需求.安寧療护杂志.8(2)：161-174。
36杨嘉玲,孙惠玲.照顾者负荷概念分析.马偕学报.2003；5(1)：15-27.
37 Siegel K, Aeis VH, Houts P, et al. Caregiver burden and unmet needs. Cancer.1991; 68: 11-40.
38 Faison K J, Faria SH, Frank D. Caregivers of chronically ill elderly:perceived burden. Journal of Community Health Nursing.1999; 16(4):243-253.
39 郑良成,田辉荣,谢培增主编.医学生存质量评估.军事医学科学出版社.2005：96-100.
40 Meyers JL, Gray LN. The relationships between family primary caregiver characteristics and satisfaction with hospice care, quality of life, and burden. Oncology Nursing Fortum. 2001; 20(1):73-82.
41 李淑霞,吴淑琼.家庭照顾者负荷与抑郁之影响因素.护理研究.1998；6(1)：57-67.
42 Ukpong DI. Demographic factors and clinical correlations of burden and distress in relatives of service users experiencing schizophrenia:A study from south-western Nigeria. International Journal of Mental Health Nursing,2006; 15:54-59.
43 Goldstein NE, Concato J, Fried TR, et al. Factors associated with Caregiver burden among caregivers of terminally ill patients with cancer[J].Journal of Palliative Care Health & Medical Complete.2004; 20(1):38-43.
44 Yang C, Kirschling JM. Exploration of factors related to direct care and outcomes of caregiving. Caregivers of terminally ill older persons. Cancer Nursing.1992; 15(3): 173-181.
45许淑敏,吴琼满.主要照顾者负荷、压力与因应之国内研究文献回顾.医护科技学科.2002；4(4)：273-279.
46林敬程.失智老人家庭照顾者之负荷与支持性服务需求之探讨,高雄：高雄医学大学行为科学研究所硕士論文.2000.
47林信男.罹病严重度、自觉健康、社会支持与台湾地区老人抑郁之关系,台南：国立成功大学行为医学研究所硕士输文.2003.
48陈昱名.社会福利资源与需求的落差：以老年失智症病患照顾者之照顾负荷、需求与困难为例.台北：台北医学大学医学研究所硕士論文.2004.
49 Zanetti O, Frisoni GB, Bianchetti A, Thamanza G, Cigoli V, Trabucchi M. Depressive symptoms of Alzheimer caregivers are mainly due to personal rather than patient factors.
International Journal of Geriatric Psychiatry.1997; 13(6):358-367.
50 Song LY, Biegel DE, Milligan SE. Predictors of depressive symptomatology among lower social class caregivers of persons with chronic mental illness. Community Mental Health Journal.1997; 33:269-286.
51 Dunkin JJ, Anderson-Hanley C. Dementia caregiver burden:a review of the literature and guidelines for assessment and intervention. Neurology.1998; 51(Suppl 1):S53-S60.
52 Hileman JW, Lackey NB, HMaanein RS. Identifying the of home caregivers of patients with cancer [J]. Oncol Nurs Forum.1992; 19(5):771-777.
53 周跃萍,马剑红,李韬.心理一致感及其影响因素研究.心理科学.2004； (4)1134-1135.
54 Anyonvosky A.Unraveling the Mystery of Health:How People Manage Stress and Stay Well. San Francisco:Jossey-Bass.1987.
55 Bowlby J. Attachment and loss:Loss. New York:Basic Books.1980; Vol 3.
56何怡儒.病患家属照顾经验中压力之探讨.嘉义：南华大生.2002.
57 Grunfeld E, Whelan TJ, Zitzelsberger L. Death anxiety, and social support in hospice and critical care nurses. Eur J Cancer Care (Engl).2002; 11:188-192.
58 Predicting caregiver burden and depression in Alzheimer's disease. Journal of Gerontology:Social Sciences.2000; 55(1):S2-S13.
59王春葉,林佑桦,李忆农,陈靖博,林耀信.血液透析病患主要照顾者的负荷及其相关因素之探讨.台湾肾脏护理学会研究.2002；1(1)：31-45.
60 Grov EK, Fossa SD, Sorebo O, Dahl AA. Primary caregivers of cancer patients in the palliative phase:path analysis of variables influencing their burden. Social Science& Medicine.2006; 63(9):2429-2439.
61 Arai Y, Ikegami N. Health care systems in transition:an overviewof Japanese health care [J].Journal of Public Health Medicine.1998; 20 (1):29-33.
62 Ferrell BR, Wisdom C, Wenzl C, Schneider C. Quality of Life as an Outcome Variable in Pain. Cancer.1989; 63:2321-2327.
63张明园.正常人群中的抑郁症状的调查CES-D的应用.中华神经精神科杂志.1987；20：67-71.
64 Given CW, Given B, Stommel M, Collins C, King S, Franklin S. The caregiver reaction assessment (CRA) for caregivers to persons with chronic physical and mental impairment. Research in Nursing and Health.1992; 15:271-283.
65 England M, Roberts BL. Theoretical and psychometric analysis of caregiver strain. Research in Nursing.1996; 19(6):499-510.
66 Anyonvosky A.The structure and properties of the sense of coherence scale. Soc Sci Med.
1993; 36(6):725-733.
67 Siew Tzuh Tang, Chung-Yi Li. The important role of coherence of relation to depressive symptoms for Taiwanese family caregivers of cancer patients at the end of life. Journal of psychosomatic Research.2008; 64:195-203.
68 Sarason IG, Levine HM, Basham, Sarason B.R. Assessing Social Support:The Social Support Questionnaire. Journal of personality and Social Psychology.1983; 44:127-39.
69 Lynn MR. Determination and quantification of content validity. Nursing Research.1986; 35(6):382-385.
70史麗珠、李绛桃、徐亚瑛、高淑芬、徐麓华、陈美伶.护理研究法：高级统计方法.台北： 桂冠.1999
71 温忠霖,张雷,侯杰泰.中介效应检验程序及其应用[J].心理学报.2004；26(5)：614-620.
72 Gaston-Johansson F, Lachica EM, Fall-Dickson JM, Kennedy MJ. Psychological distress, fatigue, burden of care, and quality of life in primary caregivers of patients with breast cancer undergoing autologous bone marrow transplantation. Oncology Nursing Forum.2004;31(6):1161-1169.
73 Andrews SC. Caregiver burden and symptom distress in people with cancer receiving hospice care. Oncology Nursing Fortum.2001; 28(9):1469-1474.
74 Tang ST. Predictors of the extent of agreement for quality of life assessments between terminally ill cancer patients and their primary family caregivers in Taiwan. Quality of Life Research.2006; 15(3):391-404.
75 Newton M, Bell D, Lambert S, Fearing A. Concerns of Hospice Patient Caregivers. The ABNF Journal.2002; 13(6):140-144.
76 Foxall MJ, Gaston-Johansson F. Burden and health outcomes of family caregivers of hospitalized bone marrow transplant patients. Journal of Advanced Nursing.1996; 24(6): 915-923.
77 Tilden VP, Tolle SW, Drach LL, Perrin NA. Out-of-Hospital Death:Advance Care Planning, Decedent Symptom, and Caregiver Burden. American Geriatrics Society.2004; 52(4):532-539.
78 Payne S, Smith P, Dean S. Identifying the concerns of informal carers in palliative care. Palliative Medicine.1999; 13(1):37-44.
79刘春年,李孟智,胡月娟.住院中风病人主要照顾者负荷及其相关影响因素之探讨.公共卫生.1998；25(3)：197-209.
80 马吉男.居家脊髓损伤病患主要照顾者负荷及需求之探讨.台北：台北医学院医学研究所硕士論文.2001.
81 McCorkle R, Yost LS, Jepson C, et al. A cancer experience:relationship of patient psychosocial responses to care-giver burden over time. Psycho-Oncology.1993; 2: 21-32.
82 McCorkle R,Yost L S, Jepson C, Malone D, Baird S Lusk E. A cancer experience: relationship of patient psychosocial responses to caregiver burden overtime. Psycho-Oncology.1993; 2:21-32.
83释宗惇,释法成,陈庆余,释会焜,释天琳.信仰认知对癌末病人与其照顾者之影响.安寧療护杂志.2004；9(2)：124-131.
84林梅香,顾乃平,劉仲冬,陈政友,林麗婵.肝癌患者家属主要照顾者的压力、因应行为、健康状况及其相关因素之探讨.护理研究.1996；4(2)：171-184.
85王淑贞,王英伟.癌末病患病危出院对丧亲家属之冲击.安寧療护杂志.2002；7(3)：185-195.
86侯淑英精神分裂病患者生活质量及主要照顾者负荷之探讨,高雄：高雄医学院护理研究所硕士論文.2004.
87 Diwan S, Hougham GW, Sachs GA. Strain experienced by caregivers of dementia patients receiving palliative care:findings from the palliative excellence in Alzheimer care efforts program. Journal of Palliative Medicine.2004; 7(6):797-807.
88 Lori L, Bernard, and Charles A. Guarnaccia.Two Models of Caregiver Strain and Bereavement Adjustment:A Comparison of Husband and Daughter Caregivers of Breast Cancer Hospice Patients.Oxford Journals of the Gerontologist.2002;43(6):808-816.
89 Gallant M P. Connell C M. Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses. Journal of Aging and Health.1997; 9:373-395.
90 Burton L C, Newsom J T, Schulz R, Hirsch C H, German P S. Preventive health behaviors among spousal caregivers. Preventive medicine.1997;26(2):162-169.
1 张秀霞.癌症患者家属心理健康状况及护理干预的研究现状.中国护理管理.2007；7(10)：30-31.
2 马军.饮用水源污染威胁公共健康.科学对社会的影响.2009；2.
3 Nijboer C,Triemstra M,Tempelaar R, et al. Determinants of caregiving experiences and mental health of partners of cancer parients. Cance,1999;86(4):577-588.
4 Huang X, Butow P N, Meiser B,et al. Attitudes and information needs of Chinese migrant cancer patients and their relatives. Aust NZ J Med.1999;(29):207-213.
5 于玲,李惠兰,林乐辉.癌症患者家属焦虑、抑郁状况调查分析与对策.现代医院.2007；7(6)：151-152.
6 Wagner CD, Bigatti S M, Storniolo A M.Quality of life of husbands of women with breast cancer.Psychooncology,2005; 15(2):109-120.
7. Deeken J F,Taylor KL,Mangan P,et al.Care for the caregivers:a review of self-report instruments developed to measure the burden, needs,and quality of life of informal caregivers [J]. Journal of Pain and Symptom Management.2003;26(4):922-953.
8 Hinds C.The needs of families of who care for patients with cancer at home:Are we meeting them [J].Adv Nurs.1985;(10):575-581.
9 Chou K R.Caregiver burden:A concept analysis. Journal of Pediatric Nursing.2000; 15(6): 398-407.
10 Zarit S H, Femia E E, Kim K, Whitlatch CJ. The structure of risk factors and outcomes for family caregivers:implications for assessment and treatment. Aging Ment Health.2010; 14(2): 220-31.
11 李淑霞,吴淑琼.家庭照顾者负荷与忧郁之影响因素.护理研究,1998；6(1)：57-67.
12 吴琼满。居家照顾者的负荷.美和专校学报.1999；17：1-14.
13 林维君,黄文聪,廖纯真等.安寧病房中家属照顾者的信息需求.安寧療护杂志.2003；8(2)：161-174.
14 Faison K J, Faria S H, Frank D. Caregivers of chronically ill elderly:perceived burden. Journal of Community Health Nursing.1999; 16(4):243-253.
15郑秀容.居家失智老人家属照顾者照顾负荷及照顾需求.台中中山医学大学医学院护理研究所硕士論输文.2005.
16 刘春年,李孟智,胡月娟.住院中风病人主要照顾者负荷及其相关影响因素之探讨,公共卫生.1998；25(3)：197-209.
17高淑芳,虞孳艳,葉淑惠等.探讨家庭功能、社会支持与小区残病老人照顾者负荷之关 系.护理研究.1999；7(2)：172-182.
18 Meyers J L,Gray L N. The relationships between family primary caregiver characteristics and satisfaction with hospice care, quality of life, and burden. Oncology Nursing Fortum. 2001;20(1):73-82.
19 Pong D I. Demographic factors and clinical correlations of burden and distress in relatives of service users experiencing schizophrenia:A study from south-western Nigeria. InternationalJournal of Mental Health Nursing.2006;15:54-59.
20 Goldstein N E, Concato J, Fried T R, Kasl S V, Johnson-Hurzeler R, Bradley E H. Factors associated with caregiver burden among caregivers of terminally ill patients with cancer. Journal of palliative care.2004;20(1):38-43.
22林维君,黄文聪,廖纯真等.安寧病房中家属照顾者的信息需求.安寧療护杂志.2003；8(2)：16]-174.
23邱启润,许淑敏,吴琼满.主要照顾者负荷、压力与因应之国内研究文献回顾.医护科技学科.2002.4：273-279.
24林敬程.失智老人家庭照顾者之负荷与支持性服务需求之探讨。高雄医学大学行为科学研究所硕士論文.2000.
25 陈昱名.社会福利资源与需求的落差：以老年失智症病患照顾着之照顾负荷、需求与困难为例.台北医学大学医学研究所说是论文.2004.
26 Zanetti O, Frisoni G B, Bianchetti A, Thamanza G, Cigoli V, Trabucchi M. Depressive symptoms of Alzheimer caregivers are mainly due to personal rather than patient factors. International Journal of Geriatric Psychiatry.1997;13(6):358-367.
27 Song, LY, Biegel, D E, Milligan S E. Predictors of depressive symptomatology among lower social class caregivers of persons with chronic mental illness. Community Mental HealthJournal.1997; 33:269-286.
28 Given B, Wyatt G, Given C, Sherwood P, Gift A, DeVoss D. Rahbar M.Burden and depression among caregiver of patients with cancer at the end of life. Oncology Nursing Forum.2004;31(6):1105-1117.
29 Dunkin J J, Anderson-Hanley C. Dementia caregiver burden:a review of the literature and guidelines for assessment and intervention. Neurology.1998; 51(1 Suppl 1):53-60.
30 Barbara G, Gwen W, Charles G,et al. Burden and depression among caregivers of patients with cancer at the end-of-life [J]. Oncol Nurs Forum.2005; 31(6):1105-1117.
31 Smeenk F W, DewitteL P, Vanhaastregt J C,et al.Transmural care of terminal cancer patients: effects on the quality of life of direct caregivers[J]. Nurs Res.1998; 47(3):129-136.
32 Burton L C, Newsom J T, Schulz R, Hirsch C H, German P S. Preventive health behaviors among spousal caregivers. Preventive medicine.1997;26(2):162-169.
33 Klemm P, Wheele E. Cancer caregivers online [J].CIN:Computers,Informatics,Nursing.2005; 23(1):38-45.
34 Monnier J,Laken M, Carter C,et al. Patient and caregiver interest in internet-based cancer services[J].Cancer Pract.2002; 10(6):305-310.
35 Lieberman M A, Golant M, Giese-Davis J, et al. Electronic support groups for breast carcinoma:a clinical trial of effectiveness [J]. Cancer.2003;97(4):920-925.
36 McMillan S.Quality of life of primary caregivers of hospice patients with cancer.Cancer Prac.1996;4:191-198.
37 冯素文,来军.袁芳等.影响妇科癌症患者家属生活质量的相关因素研究.中华护理杂志.2006；41(5)：402-404.
38 Gill P, Kaur J S, Rumanna T, et al.The hospice patient's primary caregiver. What is their quality of life. Journal of Psychosomatic Research.2003;55(5):445-451.
39 Tuinman M A, Fleer J, Hoekstra H J, et al.Quality of life and stress response symptoms in long-term and recent spouses of testicular cancer survivors.European Journal of Cancer.2004; 40(11):1696-1703.
40 Le T, Leis A, Pahwa P, et al.Quality of life evaluations of caregivers of ovarian cancer patients during chemotherapy treatment. Gynecologic Oncology.2004;92(3):839-844.
41 Kornblith A B.Quality of life of patients with prostate cancer and their spouses.The value of a data base in clinical care. Cancer.1994;73:2791-2802.
42 Patricia A,Carter P h D,R N Betty L.Sleep and Depression in Cancer Caregivers.Cancer Nursing,2000;23(6):410-415.
43 林小莺.阿尔兹海默氏症患者的家属照顾者(隐形的病患).健康状况探讨.心理科学,2006；29(2)：457-459.
44 Schulz R,Beach SR.Caregiving as a risk factor for mortality:the Caregiver Health Effects Study.JAMA.1999;282:2215-2219.
45 Jepson C, McCorkle R, Adler D, et al. Effects of home caregivers'psychosocial status. ImageJNurs.Schol.1999; 31:115-120.
46 Axelsson B.Quality of life of cancer patients and their spouses in palliative home care. Palliative Medicine.1998; 12:29-39.
47 张孟喜,李艳群.癌症病人家属焦虑状态调查分析及对策.护理学杂志.2004；19(11)：53-54.
48 Baider L,Perez T,Kaplan De-Nour A.Gender and adjustment to chronic.disease:a study of couples with colon cancer.Gen Hosp Psychiatry.1989; 11:1-8.
49 Baider L, Koch U, Esacson R.Prospective study of cancer patients and their spouses:the weakness of marital strength. Psycho-Oncology.1998; 7:49-56.
50 Borneman T. Concerns of family caregivers of patients with cancer facing palliative surgery for advanced malignancies. Oncology Nursing Forum..2003; 30:997-1005.
51 Mc Corkle R,Yost L S. Jepson C, et al. A cancer experience:relationship of patient psychosocial responses to care-giver burden over time. Psycho-Oncology.1993; 2:21-32.
52 Siegel K, Raveis V H, Houts P,et al.Caregiver burden and unmetneeds.Cancer.1991;68:11-40.
2 马军.饮用水源污染威胁公共健康.科学对社会的影响.2009；2.
3 胡月娟.濒死病人与其家属需更多的关怀.护理杂志.1992；39(2)：133-138.
4 Dumont S, Turgeon J, Allard P, Charbonneau G, Vezina L. Caring for a loved one with advanced cancer:determinants of psychological distress in family caregivers. Journal of Palliative Medicine.2006; 9(4):912-921.
5 Redinbaugh EM, Banm A, Tarbell S,Arnold R. End-of caregiving:What helps family caregiver cope. Journal of Palliative Medicine.2003; 6(6):901-909.
6 胡幼慧,王孝先,郭淑珍.家人照护失能老人之困境.一项质化与量化整合的研究.公共卫生.1995；2(2)：99-113.
7 高淑芳,盧孳艳,葉淑惠,劉雪娥.家庭功能、社会支持与小区残病老人照顾者负荷之关系.护理研究.1999；7(2)：172-182.
8 Zheng XY, Chen LX. Features of China's population ageing and its policies. Chin. Gen. Pract.2006; 9:1919-1923.
9 Chou K R. Caregiver burden:A concept analysis. Journal of Pediatric Nursing.2000; 15(6):398-407.
10 Zarit SH, Femia EE, Kim K, Whitlatch CJ. The structure of risk factors and outcomes for family caregivers:implications for assessment and treatment. Aging Ment Health. 2010; 14(2):220-31.
11 Hoenig J, Hamilton M. The schizophrenic patient and his effect on the household. International Journal of Social Psychiatry.1966; 12:165-176.
12 马先芝.照顾负荷之概念分析.护理杂志.2003；50(2)：82-85.
13吴琼满.居家照顾者的负荷.美和专校学报.1999；17：1-14。
14 Novak M, Guest C. Application of a multidimensional caregiver burden inventory. The Gerontologist.1989; 29(6):799-803.
15 Hunt CK. Concepts in caregiver research. Journal of Nursing Scholarship.2003; 35: 27-32.
16赖鹏城.家庭照料者就业状况与其照料负荷的关系.2003,台北：国立台湾大学卫生政策与管理研究硕士论文.
17 Kahana E, Biegel D.E, Wykle M. Family caregiving:A lifespanperspective. Family Caregiver Applications Series, Volume 4. Newbury Park, CA:Sage Publications.1994
18 Holmes T, Rahe R. Holmes-Rahe Social Readjustment Rating Scale. Journal of
Psychosomatic Research.1967;2.
19 Haan MN, Kaplan GA, Syme SL. Socioeconomic status and health:Caregiver burden and health promotion. Int J Nurs Stud.2000; 37:37-43.
20 Kahana E, Kahana B, Johnson J.R, Hammond R. J, Kercher K. Developmental challenges and family caregiving. Family caregiving across the lifespan. Thousand Oaks, CA:Sage.1994; 3-41.
21 沈若仪.居家服务使用与家庭照顾者负荷之关系探讨.台北：台湾大学公共卫生学院卫生政策与管理研究所硕士論文.2004.
22 Given B, Wyatt G, Given C, Sherwood P, Gift A, DeVoss D, et al. Burden and depression among caregiver of patients with cancer at the end of life. Oncology Nursing Forum.2004; 31(6):1105-1117.
23 Grunfeld E, Coyle D, Whelan T, Clinch J, Reyno L, Earle C C. Family caregiver burden: Results of a longitudinal study of breast cancer patient and their principal caregivers. Canadian Medical Association Journal.2004; 170(12):1795-1801.
24 Nijboer C, Triemstra M, Tempelaar R, et al. Determinants of caregiving experiences and mental health of partners of cancer parients. Cancer.1999; 86(4):577-588.
25 Huang X, Butow PN, Meiser B, et al. Attitudes and information needs of Chinese migrant cancer patients and their relatives. Aust NZ J Med.1999; 29:207-213.
26 于玲,李惠兰,林乐辉.癌症患者家属焦虑、抑郁状况调查分析与对策.现代医院.2007；7(6)：151-152.
27 Wagner CD, Bigatti SM, Storniolo AM. Quality of life of husbands of women with breast cancer.Psycho-oncology.2005; 15(2):109-120.
28 Deeken JF, Taylor KL, Mangan P, et al. Care for the caregivers:a review of self-report instruments developed to measure the burden, needs, and quality of life of informal caregivers [J]. Journal of Pain and Symptom Management.2003; 26(4):922-953.
29 Hinds C. The needs of families of who care for patients with cancer at home:Are we meeting them [J]. Adv Nurs.1985; (10):575-581.
30 Lazarus R, Folkman S.Stress, appraisal, and coping. NewYork:Springer Publishing Company.1984.
31 Folkman S, Lazarus R, Gruen R. DeLong is A Appraisal, coping, health status, and psychological symptoms. Journal of Personality and Social Psychology.1986; 48: 571-579.
32 Rosenbaum M. Learned Resourcefulness:On Coping Skills, Self-Control and Adaptive Behavior. New York:Springer.1990.
33 Hills J, Paice J A, Cameron J R, Shott S. Spirituality Medicine.2005; 8(4):782-788.
34 Sharpe L, Butow P, Mcconnell D, Clarke. The relationship between available support,
unmet needs and caregiver burden in patients with advanced cancer and their carers. Psycho-Oncology.2005; 14(2):102-114.
35 林维君,黄文聪,廖纯真等.安寧病房中家属照顾者的信息需求.安寧療护杂志.8(2)：161-174。
36杨嘉玲,孙惠玲.照顾者负荷概念分析.马偕学报.2003；5(1)：15-27.
37 Siegel K, Aeis VH, Houts P, et al. Caregiver burden and unmet needs. Cancer.1991; 68: 11-40.
38 Faison K J, Faria SH, Frank D. Caregivers of chronically ill elderly:perceived burden. Journal of Community Health Nursing.1999; 16(4):243-253.
39 郑良成,田辉荣,谢培增主编.医学生存质量评估.军事医学科学出版社.2005：96-100.
40 Meyers JL, Gray LN. The relationships between family primary caregiver characteristics and satisfaction with hospice care, quality of life, and burden. Oncology Nursing Fortum. 2001; 20(1):73-82.
41 李淑霞,吴淑琼.家庭照顾者负荷与抑郁之影响因素.护理研究.1998；6(1)：57-67.
42 Ukpong DI. Demographic factors and clinical correlations of burden and distress in relatives of service users experiencing schizophrenia:A study from south-western Nigeria. International Journal of Mental Health Nursing,2006; 15:54-59.
43 Goldstein NE, Concato J, Fried TR, et al. Factors associated with Caregiver burden among caregivers of terminally ill patients with cancer[J].Journal of Palliative Care Health & Medical Complete.2004; 20(1):38-43.
44 Yang C, Kirschling JM. Exploration of factors related to direct care and outcomes of caregiving. Caregivers of terminally ill older persons. Cancer Nursing.1992; 15(3): 173-181.
45许淑敏,吴琼满.主要照顾者负荷、压力与因应之国内研究文献回顾.医护科技学科.2002；4(4)：273-279.
46林敬程.失智老人家庭照顾者之负荷与支持性服务需求之探讨,高雄：高雄医学大学行为科学研究所硕士論文.2000.
47林信男.罹病严重度、自觉健康、社会支持与台湾地区老人抑郁之关系,台南：国立成功大学行为医学研究所硕士输文.2003.
48陈昱名.社会福利资源与需求的落差：以老年失智症病患照顾者之照顾负荷、需求与困难为例.台北：台北医学大学医学研究所硕士論文.2004.
49 Zanetti O, Frisoni GB, Bianchetti A, Thamanza G, Cigoli V, Trabucchi M. Depressive symptoms of Alzheimer caregivers are mainly due to personal rather than patient factors.
International Journal of Geriatric Psychiatry.1997; 13(6):358-367.
50 Song LY, Biegel DE, Milligan SE. Predictors of depressive symptomatology among lower social class caregivers of persons with chronic mental illness. Community Mental Health Journal.1997; 33:269-286.
51 Dunkin JJ, Anderson-Hanley C. Dementia caregiver burden:a review of the literature and guidelines for assessment and intervention. Neurology.1998; 51(Suppl 1):S53-S60.
52 Hileman JW, Lackey NB, HMaanein RS. Identifying the of home caregivers of patients with cancer [J]. Oncol Nurs Forum.1992; 19(5):771-777.
53 周跃萍,马剑红,李韬.心理一致感及其影响因素研究.心理科学.2004； (4)1134-1135.
54 Anyonvosky A.Unraveling the Mystery of Health:How People Manage Stress and Stay Well. San Francisco:Jossey-Bass.1987.
55 Bowlby J. Attachment and loss:Loss. New York:Basic Books.1980; Vol 3.
56何怡儒.病患家属照顾经验中压力之探讨.嘉义：南华大生.2002.
57 Grunfeld E, Whelan TJ, Zitzelsberger L. Death anxiety, and social support in hospice and critical care nurses. Eur J Cancer Care (Engl).2002; 11:188-192.
58 Predicting caregiver burden and depression in Alzheimer's disease. Journal of Gerontology:Social Sciences.2000; 55(1):S2-S13.
59王春葉,林佑桦,李忆农,陈靖博,林耀信.血液透析病患主要照顾者的负荷及其相关因素之探讨.台湾肾脏护理学会研究.2002；1(1)：31-45.
60 Grov EK, Fossa SD, Sorebo O, Dahl AA. Primary caregivers of cancer patients in the palliative phase:path analysis of variables influencing their burden. Social Science& Medicine.2006; 63(9):2429-2439.
61 Arai Y, Ikegami N. Health care systems in transition:an overviewof Japanese health care [J].Journal of Public Health Medicine.1998; 20 (1):29-33.
62 Ferrell BR, Wisdom C, Wenzl C, Schneider C. Quality of Life as an Outcome Variable in Pain. Cancer.1989; 63:2321-2327.
63张明园.正常人群中的抑郁症状的调查CES-D的应用.中华神经精神科杂志.1987；20：67-71.
64 Given CW, Given B, Stommel M, Collins C, King S, Franklin S. The caregiver reaction assessment (CRA) for caregivers to persons with chronic physical and mental impairment. Research in Nursing and Health.1992; 15:271-283.
65 England M, Roberts BL. Theoretical and psychometric analysis of caregiver strain. Research in Nursing.1996; 19(6):499-510.
66 Anyonvosky A.The structure and properties of the sense of coherence scale. Soc Sci Med.
1993; 36(6):725-733.
67 Siew Tzuh Tang, Chung-Yi Li. The important role of coherence of relation to depressive symptoms for Taiwanese family caregivers of cancer patients at the end of life. Journal of psychosomatic Research.2008; 64:195-203.
68 Sarason IG, Levine HM, Basham, Sarason B.R. Assessing Social Support:The Social Support Questionnaire. Journal of personality and Social Psychology.1983; 44:127-39.
69 Lynn MR. Determination and quantification of content validity. Nursing Research.1986; 35(6):382-385.
70史麗珠、李绛桃、徐亚瑛、高淑芬、徐麓华、陈美伶.护理研究法：高级统计方法.台北： 桂冠.1999
71 温忠霖,张雷,侯杰泰.中介效应检验程序及其应用[J].心理学报.2004；26(5)：614-620.
72 Gaston-Johansson F, Lachica EM, Fall-Dickson JM, Kennedy MJ. Psychological distress, fatigue, burden of care, and quality of life in primary caregivers of patients with breast cancer undergoing autologous bone marrow transplantation. Oncology Nursing Forum.2004;31(6):1161-1169.
73 Andrews SC. Caregiver burden and symptom distress in people with cancer receiving hospice care. Oncology Nursing Fortum.2001; 28(9):1469-1474.
74 Tang ST. Predictors of the extent of agreement for quality of life assessments between terminally ill cancer patients and their primary family caregivers in Taiwan. Quality of Life Research.2006; 15(3):391-404.
75 Newton M, Bell D, Lambert S, Fearing A. Concerns of Hospice Patient Caregivers. The ABNF Journal.2002; 13(6):140-144.
76 Foxall MJ, Gaston-Johansson F. Burden and health outcomes of family caregivers of hospitalized bone marrow transplant patients. Journal of Advanced Nursing.1996; 24(6): 915-923.
77 Tilden VP, Tolle SW, Drach LL, Perrin NA. Out-of-Hospital Death:Advance Care Planning, Decedent Symptom, and Caregiver Burden. American Geriatrics Society.2004; 52(4):532-539.
78 Payne S, Smith P, Dean S. Identifying the concerns of informal carers in palliative care. Palliative Medicine.1999; 13(1):37-44.
79刘春年,李孟智,胡月娟.住院中风病人主要照顾者负荷及其相关影响因素之探讨.公共卫生.1998；25(3)：197-209.
80 马吉男.居家脊髓损伤病患主要照顾者负荷及需求之探讨.台北：台北医学院医学研究所硕士論文.2001.
81 McCorkle R, Yost LS, Jepson C, et al. A cancer experience:relationship of patient psychosocial responses to care-giver burden over time. Psycho-Oncology.1993; 2: 21-32.
82 McCorkle R,Yost L S, Jepson C, Malone D, Baird S Lusk E. A cancer experience: relationship of patient psychosocial responses to caregiver burden overtime. Psycho-Oncology.1993; 2:21-32.
83释宗惇,释法成,陈庆余,释会焜,释天琳.信仰认知对癌末病人与其照顾者之影响.安寧療护杂志.2004；9(2)：124-131.
84林梅香,顾乃平,劉仲冬,陈政友,林麗婵.肝癌患者家属主要照顾者的压力、因应行为、健康状况及其相关因素之探讨.护理研究.1996；4(2)：171-184.
85王淑贞,王英伟.癌末病患病危出院对丧亲家属之冲击.安寧療护杂志.2002；7(3)：185-195.
86侯淑英精神分裂病患者生活质量及主要照顾者负荷之探讨,高雄：高雄医学院护理研究所硕士論文.2004.
87 Diwan S, Hougham GW, Sachs GA. Strain experienced by caregivers of dementia patients receiving palliative care:findings from the palliative excellence in Alzheimer care efforts program. Journal of Palliative Medicine.2004; 7(6):797-807.
88 Lori L, Bernard, and Charles A. Guarnaccia.Two Models of Caregiver Strain and Bereavement Adjustment:A Comparison of Husband and Daughter Caregivers of Breast Cancer Hospice Patients.Oxford Journals of the Gerontologist.2002;43(6):808-816.
89 Gallant M P. Connell C M. Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses. Journal of Aging and Health.1997; 9:373-395.
90 Burton L C, Newsom J T, Schulz R, Hirsch C H, German P S. Preventive health behaviors among spousal caregivers. Preventive medicine.1997;26(2):162-169.
1 张秀霞.癌症患者家属心理健康状况及护理干预的研究现状.中国护理管理.2007；7(10)：30-31.
2 马军.饮用水源污染威胁公共健康.科学对社会的影响.2009；2.
3 Nijboer C,Triemstra M,Tempelaar R, et al. Determinants of caregiving experiences and mental health of partners of cancer parients. Cance,1999;86(4):577-588.
4 Huang X, Butow P N, Meiser B,et al. Attitudes and information needs of Chinese migrant cancer patients and their relatives. Aust NZ J Med.1999;(29):207-213.
5 于玲,李惠兰,林乐辉.癌症患者家属焦虑、抑郁状况调查分析与对策.现代医院.2007；7(6)：151-152.
6 Wagner CD, Bigatti S M, Storniolo A M.Quality of life of husbands of women with breast cancer.Psychooncology,2005; 15(2):109-120.
7. Deeken J F,Taylor KL,Mangan P,et al.Care for the caregivers:a review of self-report instruments developed to measure the burden, needs,and quality of life of informal caregivers [J]. Journal of Pain and Symptom Management.2003;26(4):922-953.
8 Hinds C.The needs of families of who care for patients with cancer at home:Are we meeting them [J].Adv Nurs.1985;(10):575-581.
9 Chou K R.Caregiver burden:A concept analysis. Journal of Pediatric Nursing.2000; 15(6): 398-407.
10 Zarit S H, Femia E E, Kim K, Whitlatch CJ. The structure of risk factors and outcomes for family caregivers:implications for assessment and treatment. Aging Ment Health.2010; 14(2): 220-31.
11 李淑霞,吴淑琼.家庭照顾者负荷与忧郁之影响因素.护理研究,1998；6(1)：57-67.
12 吴琼满。居家照顾者的负荷.美和专校学报.1999；17：1-14.
13 林维君,黄文聪,廖纯真等.安寧病房中家属照顾者的信息需求.安寧療护杂志.2003；8(2)：161-174.
14 Faison K J, Faria S H, Frank D. Caregivers of chronically ill elderly:perceived burden. Journal of Community Health Nursing.1999; 16(4):243-253.
15郑秀容.居家失智老人家属照顾者照顾负荷及照顾需求.台中中山医学大学医学院护理研究所硕士論输文.2005.
16 刘春年,李孟智,胡月娟.住院中风病人主要照顾者负荷及其相关影响因素之探讨,公共卫生.1998；25(3)：197-209.
17高淑芳,虞孳艳,葉淑惠等.探讨家庭功能、社会支持与小区残病老人照顾者负荷之关 系.护理研究.1999；7(2)：172-182.
18 Meyers J L,Gray L N. The relationships between family primary caregiver characteristics and satisfaction with hospice care, quality of life, and burden. Oncology Nursing Fortum. 2001;20(1):73-82.
19 Pong D I. Demographic factors and clinical correlations of burden and distress in relatives of service users experiencing schizophrenia:A study from south-western Nigeria. InternationalJournal of Mental Health Nursing.2006;15:54-59.
20 Goldstein N E, Concato J, Fried T R, Kasl S V, Johnson-Hurzeler R, Bradley E H. Factors associated with caregiver burden among caregivers of terminally ill patients with cancer. Journal of palliative care.2004;20(1):38-43.
22林维君,黄文聪,廖纯真等.安寧病房中家属照顾者的信息需求.安寧療护杂志.2003；8(2)：16]-174.
23邱启润,许淑敏,吴琼满.主要照顾者负荷、压力与因应之国内研究文献回顾.医护科技学科.2002.4：273-279.
24林敬程.失智老人家庭照顾者之负荷与支持性服务需求之探讨。高雄医学大学行为科学研究所硕士論文.2000.
25 陈昱名.社会福利资源与需求的落差：以老年失智症病患照顾着之照顾负荷、需求与困难为例.台北医学大学医学研究所说是论文.2004.
26 Zanetti O, Frisoni G B, Bianchetti A, Thamanza G, Cigoli V, Trabucchi M. Depressive symptoms of Alzheimer caregivers are mainly due to personal rather than patient factors. International Journal of Geriatric Psychiatry.1997;13(6):358-367.
27 Song, LY, Biegel, D E, Milligan S E. Predictors of depressive symptomatology among lower social class caregivers of persons with chronic mental illness. Community Mental HealthJournal.1997; 33:269-286.
28 Given B, Wyatt G, Given C, Sherwood P, Gift A, DeVoss D. Rahbar M.Burden and depression among caregiver of patients with cancer at the end of life. Oncology Nursing Forum.2004;31(6):1105-1117.
29 Dunkin J J, Anderson-Hanley C. Dementia caregiver burden:a review of the literature and guidelines for assessment and intervention. Neurology.1998; 51(1 Suppl 1):53-60.
30 Barbara G, Gwen W, Charles G,et al. Burden and depression among caregivers of patients with cancer at the end-of-life [J]. Oncol Nurs Forum.2005; 31(6):1105-1117.
31 Smeenk F W, DewitteL P, Vanhaastregt J C,et al.Transmural care of terminal cancer patients: effects on the quality of life of direct caregivers[J]. Nurs Res.1998; 47(3):129-136.
32 Burton L C, Newsom J T, Schulz R, Hirsch C H, German P S. Preventive health behaviors among spousal caregivers. Preventive medicine.1997;26(2):162-169.
33 Klemm P, Wheele E. Cancer caregivers online [J].CIN:Computers,Informatics,Nursing.2005; 23(1):38-45.
34 Monnier J,Laken M, Carter C,et al. Patient and caregiver interest in internet-based cancer services[J].Cancer Pract.2002; 10(6):305-310.
35 Lieberman M A, Golant M, Giese-Davis J, et al. Electronic support groups for breast carcinoma:a clinical trial of effectiveness [J]. Cancer.2003;97(4):920-925.
36 McMillan S.Quality of life of primary caregivers of hospice patients with cancer.Cancer Prac.1996;4:191-198.
37 冯素文,来军.袁芳等.影响妇科癌症患者家属生活质量的相关因素研究.中华护理杂志.2006；41(5)：402-404.
38 Gill P, Kaur J S, Rumanna T, et al.The hospice patient's primary caregiver. What is their quality of life. Journal of Psychosomatic Research.2003;55(5):445-451.
39 Tuinman M A, Fleer J, Hoekstra H J, et al.Quality of life and stress response symptoms in long-term and recent spouses of testicular cancer survivors.European Journal of Cancer.2004; 40(11):1696-1703.
40 Le T, Leis A, Pahwa P, et al.Quality of life evaluations of caregivers of ovarian cancer patients during chemotherapy treatment. Gynecologic Oncology.2004;92(3):839-844.
41 Kornblith A B.Quality of life of patients with prostate cancer and their spouses.The value of a data base in clinical care. Cancer.1994;73:2791-2802.
42 Patricia A,Carter P h D,R N Betty L.Sleep and Depression in Cancer Caregivers.Cancer Nursing,2000;23(6):410-415.
43 林小莺.阿尔兹海默氏症患者的家属照顾者(隐形的病患).健康状况探讨.心理科学,2006；29(2)：457-459.
44 Schulz R,Beach SR.Caregiving as a risk factor for mortality:the Caregiver Health Effects Study.JAMA.1999;282:2215-2219.
45 Jepson C, McCorkle R, Adler D, et al. Effects of home caregivers'psychosocial status. ImageJNurs.Schol.1999; 31:115-120.
46 Axelsson B.Quality of life of cancer patients and their spouses in palliative home care. Palliative Medicine.1998; 12:29-39.
47 张孟喜,李艳群.癌症病人家属焦虑状态调查分析及对策.护理学杂志.2004；19(11)：53-54.
48 Baider L,Perez T,Kaplan De-Nour A.Gender and adjustment to chronic.disease:a study of couples with colon cancer.Gen Hosp Psychiatry.1989; 11:1-8.
49 Baider L, Koch U, Esacson R.Prospective study of cancer patients and their spouses:the weakness of marital strength. Psycho-Oncology.1998; 7:49-56.
50 Borneman T. Concerns of family caregivers of patients with cancer facing palliative surgery for advanced malignancies. Oncology Nursing Forum..2003; 30:997-1005.
51 Mc Corkle R,Yost L S. Jepson C, et al. A cancer experience:relationship of patient psychosocial responses to care-giver burden over time. Psycho-Oncology.1993; 2:21-32.
52 Siegel K, Raveis V H, Houts P,et al.Caregiver burden and unmetneeds.Cancer.1991;68:11-40.