| Summary: | 碩士 === 國立成功大學 === 護理學系碩博士班 === 98 === Background: Advanced chronic obstructive pulmonary disease (COPD) patients experience significantly more bio-psycho-social stress than patients with lung cancer. Palliative care can improve the quality of life of end stage COPD patients. Predicting the life expectancy is crucial to initiate the palliative care. While current studies of prognostic indexes for life expectancy are mainly based on European and American population, there is few study addressed the same issue among Asian population. Furthermore, the predicative power and clinical applicability of the prognostic indexes for one-year survival rate have not been evaluated for COPD patients in Taiwan.
Objectives: Purposes of this study were: (1) to identify the most important predicting factors of one-year survival rate, and (2) to construct a prognosis index of one-year survival rate for Taiwan COPD patients.
Methods: A descriptive and correlational research design. Data was collected from “COPD case management” program started in 2006 in a medical center in southern Taiwan. A total of 294 patients with moderate to very severe COPD who had been followed up for one-year were selected in this study. Descriptive statistics, t test, χ2 test, survival analysis and ROC curve analysis were performed by SPSS 17.0 for Windows.
Results: Three currently developed indexes, CPI, ADO and BODEx, were more appropriate to predict one-year survival rate of this study subjects with the predictive power about 75-76%. Co-morbidities (measured by Charlson Index), arterial oxygen saturation (SaO2) and the quality of life were three significant predictors for one-year survival rate in this study. Using the point system in the Cox proportional hazards regression model, a new prognostic index, COQ, was developed for predicting one-year survival rate among moderate to very severe COPD patients. Its predictive power was 94%.
Conclusions: The newly constructed prognostic index COQ predicts one-year survival rate accurately. It could help health care professionals identify palliative care needs earlier among patients with moderate to very severe COPD in order to alleviate symptoms and increase quality of life.
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