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Journal of the Korean Academy of Family Medicine 1995;16(2):142-156.
Published online February 1, 1995.
Factors Correlated with the Score of FamUy Coplng and Reaction Phase to Chronic lllness.
Hye Ree Lee, Yoo Sun Moon, Tae Soo Kim, Dae Gon Kang, Seong Il Jeong
만성 질병에 처한 가족의 대응도 및 반응 단계에 관련된 요인
이혜리, 문유선, 김태수, 강대곤, 정성일
고려대학교의과대학 가정의학교실
Abstract
Background
: The experience of chronic illness affects families in profound ways and how well the family adapts to chronic illness can influence the course of the illness. The purpose of this study is to analyze the factors correlated with the family's coping and the reaction phase to chronic illness, and then to suggest the basis of model for the family-oriented family medicine.

Methods : Total 211 patients and their family was reviewed to investigate the correlating factors between the family's coping, the reaction phase and the chronic illness by the questionnares on which the followings were included : the score of a family's coping with chronic illness, family APGAR, family stress(by Holmes's SRRS), the reaction phase, the duration of chief complaints, demographic factors, etc. The results were analyzed by the descriptive, comparative and multiple regression statistics with DBSTAT and SPSS/PC+4.0 computer program.

Results : The completed subjects was 203 cases of which the mean age was 47.6±15.8 years old. The mean of the duration of chief complaints was 4.3±2.7 years. The mean score of family's coping was 11.3±2.9 points, and the above 11 points was 67.0%, 5 to 10 points was 28.6%, the below 4 points was 4.4%. The distribution of families on the each reaction phase to chronic illness was followings : 1) Denial phase : 3.5%, 2) Fear phase : 17.7%, 3) Guilty phase : 7.9%, 4) Anger phase : 9.3%, 5) Depression phase : 22.7%, 6) Acceptance phase : 38.9%. The factors correlated with the score of family's coping to chronic illness was family APGAR and family stress(r=0.26). Other associated factors was followings : religion, education, economy, reaction phase, the family's coping experience of past ilness(P<0.05). The factors correlated with the family's reaction phase to chronic illness was patient'sage and the duration of chief complaints (r=0.15). And the other associated factors was the number of admission, the score of family's coping and stress, the family's experience to past illness(P<0.05). For only all of the 1st admission patients, their families on denial and fear phase was 80.0%, 83.4% within 2 years. Depression phase was 76.9% within 5 years. Acceptance phase was 75.0% within 7 years(P<0.05)

Conclusion : The score of family's coping with chronic illness was correlated with the family's APGAR and family's stress. The family's reaction phase to chronic illness was correlated with the pamily's stress. The family's reaction phase to chronic illness was correlated with the patient's age and the duration of chief complaints. Further study of the factors and reaching times of family's reaction phase to chronic illness were needed.
초록
연구배경 : 만성 질병은 가족에 심각한 영향을 미치며 그 가족이 만성 질병에 어떻게 잘 대응하느냐가 질병의 경과(course of illness)에 영향을 미친다고 했다. 본 논문은 만성 질병 환자에 대처하는 가족의 대응과 반응 단계에 관련된 요인들을 분석하여 보다 나은 가족-지향의 가정의학(Family-Oriented Family Medicine)을 추구하는데 기본적 자료와 이해를 위해 연구되었다.

방법 : 서울과 지방의 대학 및 종합병원에 만성 질병으로 입원한 211명을 대상으로 가족대응지수(The score for family coping with chronic illness), 가족기능지수(Family APGAR), 가족의 Sress 지수(Holme's SRRS), 반응 단계, 이환 기간, 그리고 사회 인구학적 요인들을 설문지를 토행 조사하여 DBSTAT과 SPSS/PC를 이용하여 기술, 비교 및 다중 회귀분석 통계처리로 결과를 분석하였다.

결과 : 완성된 설문지 환자는 총 203명이었고, 연령은 평균이 47.6±15.8세였고, 만성질병의 평균 이환기간은 4.3±2.7년이었다. 가족 대응도는 평균이 11.3±2.9점이었고, 11점이상이 67.0%, 5-10점이 28.6%, 4점 이하가 4.4%였다. 가족 반응 단계 분포는 1) 부정(Denial)단계가 3.5%, 2) 공포(Fear)단계가 17.7%, 3) 죄의식(Guilty)단계가 7.9%, 4) 분노(Anger)단계가 9.3%, 5) 우울(Depression)단계가 22.7%, 6) 수용(Acceptance)단계가 38.9%를 보였다. 대응도에 상관관계가 있는 요인으로는 가족기능지수와 가족의 Stress 지수가 의의 있었고(r=0.26), 그밖에 종교, 교육, 경제력, 가족반응단계, 가족의 과거 질병경험 요인들이 관련있다(P<0.05). 가족의 반응단계와 상관관계가 있는 요인들로는 이환기 간과 환자연령이 의의 있었고(r=0.15), 그밖에 입원 횟수, 가족의 대응도와 Stress, 가족의 과거 질병경험 요인들이 관련있었다(P<0.05). 처음 입원한 환자 중 가족의 반응단계별 질병 이환기간에 따른 환자 가족의 빈도는 부정, 공포 단계에 있는 가족의 각각 80%, 91.0%가 발병 1년 미만에, 우울 단계는 76.9%가 5년 미만에, 수용 단계의 가족들은 75.0%가 7년 미만에 걸쳐 분포하였다(P<0.05).

결론 : 만성 질병에 처한 가족의 대응은 가족의 기능과 가족의 Stress와 상관성이 있고, 그 반응단계는 질병의 이환기간과 환자의 연령이 상관성이 있으며 반응단계 별 도달기간과 요인에 관해서는 향후 더 많은 연구가 필요하다.


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