말기암이 환자가족에게 미치는 사회경제적 영향 및 관련요인 = The Socioeconomic Impact of Terminal Cancer on Patients' Families and Its Associated Factors

다국어 초록 (Multilingual Abstract)

Background: We conducted this study to investigate the financial burden of terminal cancer patient’s family and to identify factors influencing their economic burden.
Methods: We approached 187 family members supporting their famly member with terminal cancer who was enrolled in four hospice and palliative care program. We constructed a questionnaire examining the impact of illness on their family. With multiple logistic analysis, we examined the patients’ and family members’ demographic and the patients’ clinical factors associated with the burden caused by terminal cancer.
Results: The majority of families reported the loss of savings (54%), the need to make major life changes in order to care for the patient (50%), the loss of incomes (34%), the inability to function normally because of the stress of the illness (27%). Many families had to move to a less expensive home (18%), delay medical care for other family members (12%), or change educational plans for other family members (13%). Families that cared for patients who wanted to be cared for at institution (odds ratio: 2.72, 95% confidential interval: 1.19～6.19), patients with liver cancer (3.61, 1.53～8.57), and families who were poor caregivers (2.97, 1.24～7.10), or primary caregiver was a spouse (3.57, 1.47～8.68) were more likely to lose savings. Families that were in ‘new couple’ in family life cycle stages (3.91, 1.04～14.63), ‘birth of the first child' (8.34, 2.74～25.32), and 'the adolescent family or the launching family' (10.56, 4.07～27.33), were more likely to lose savings than 'the empty family or the aging family'.
Conclusion: Many families reported severe caregiving and economic burdens. Social and financial support need to be given to families with predictors of high economic burdens.

국문 초록 (Abstract)

연구배경: 말기질환은 환자뿐 아니라 가족들에게도 사회경제적 측면에서 직접적, 간접적으로 큰 영향을 미친다. 본 연구는 말기 암으로 인한 가족의 사회경제적 영향의 정도를 파악하고, 이런 영향과 관련이 있는 인구사회학적인 요인과 임상적 요인이 무엇인지 밝히고자 하였다.
방법: 2003년 6월부터 12월까지, 5개 호스피스․완화의료 기관에 등록한 말기암환자의 주 간병 가족 187명을 대상으로 수행되었다. 말기암으로 인한 가족의 사회경제적 영향, 환자와 가족의 인구사회학적 요인 및 환자의 임상적 요인을 조사하였으며 말기암환자 가족의 영향에 독립적으로 영향 하는 요인을 규명하기 위하여 다변량회귀분석을 이용하였다.
결과: 대부분의 가족들이, 간병 때문에 직장을 그만두거나 생활에 커다란 변화가 있었으며(50%), 가족이 아프거나 정상기능 할 수 없었다고(27%) 응답하였다. 또한, 저축금의 전부 혹은 대부분 사용(54%), 가족의 주요 수입원이 상실(34%), 더 싼 집으로 이사(18%), 가족의 중요한 치료를 미룸(12%), 가족의 교육 계획 등 계획을 미룬 적이 있다고(13%) 응답하였다. 다변량 회귀분석결과, 환자의 말기에 돌봄을 받고 싶은 장소가 의료기관일 때(OR: 2.72, 95CI: 1.19～6.19), 환자가 간암인 경우(OR: 3.61, 95CI: 1.53～8.57), 가족의 경제상태가 낮은 경우(OR: 2.97, 95%CI: 1.24～7.10), 주 간병인이 배우자인 경우(OR: 3.91, 95CI: 1.04～14.63), ‘중년기’ 또는 '노년기'에 비해 '가족형성기'인 경우(OR: 8.34, 95CI: 2.74～25.32), '출산기 또는 학령기'인 경우(OR: 8.34, 95CI: 2.74～25.32), '청소년기 또는 진수기'인 경우(OR: 10.56, 95%CI: 4.07～27.33) 환자의 질병으로 인한 가족의 저축금 상실이 많은 것으로 나타났다.
결론: 본 연구는 많은 말기암환자 가족들이 심각한 생활의 변화와 경제적 영향을 겪고 있다는 것을 보여 주고 있다. 특히, 말기에 돌봄을 받고 싶은 장소가 의료기관일 때, 간암환자 가족, 저소득층, 주간병인이 배우자인 경우, 가족형성기 및 출산기 또는 학령기인 경우, 청소년기 또는 진수기인 경우의 가족들이 경제적 영향이 더 큰 것으로 나타났다.

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