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研究生: 龐傳慧
Pang, Chuan-Huei
論文名稱: 乳癌病人之社會支持、決策衝突對重建術後憂鬱、焦慮及生活品質相關因素探討
Exploring the Factors that Impact Quality of Life After Reconstruction:Social Support,Decision Conflicts, Depression and Anxiety in Breast Cancer Patients
指導教授: 劉潔心
Liu, Chieh-Hsing
學位類別: 碩士
Master
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2019
畢業學年度: 107
語文別: 中文
論文頁數: 208
中文關鍵詞: 乳癌重建社會支持決策衝突憂鬱焦慮生活品質
英文關鍵詞: breast cancer reconstruction, social support, decision-making conflicts, depression, anxiety, quality of life
DOI URL: http://doi.org/10.6345/THE.NTNU.DHPHE.019.2019.F02
論文種類: 學術論文
相關次數: 點閱:359下載:44
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  • 目的:本研究目的為乳癌重建病人術前社會支持、決策衝突及術後生活品質、憂鬱及焦慮相關影響因素之探討,藉此了解乳癌重建病人術前社會支持及決策衝突,是否影響術後憂鬱、焦慮、生活品質之變化及其重要構面。方法:採行回溯性研究 (retrospective study)立意取樣,蒐集台北市某醫學中心自105年4月1日起至107年5月31日止,乳癌切除後立即乳房重建者為研究對象,藉由半結構開放式問卷訪談及問卷填答個人基本資料、決策衝突、社會支持、憂鬱、焦慮、生活品質等量表調查。結果:個人背景因素中的婚姻狀態、家族病史、決定前閱讀重建資料、有無接受醫美重建會談、疾病治療資訊衝突等與術前社會支持及決策衝突有達顯著相關;乳癌外科手術方式、乳房重建距今時間、人身保險、家族病史、家庭總收入、疾病治療資訊衝突等與術後憂鬱、焦慮、生活品質有達顯著相關。各量表中相關性可知社會支持與決策衝突、焦慮、憂鬱與生活品質無顯著相關;決策衝突與焦慮達顯著相關;憂鬱與決策衝突、社會支持無顯著相關;生活品質與憂鬱、焦慮、決策衝突有達顯著相關。結論和建議:接受乳房重建婦女獲得較高的社會支持時,術後憂鬱、焦慮、生活品質狀態也較佳;而減少決策衝突和遺憾,建議醫療人員應先瞭解病人文化水準、教育背景、使用資源能力及其支持系統等背景因素,並提供病友協會及癌症腫瘤心理諮商師主動介入評估等立即性情感性支持,能降低重建術後的憂鬱與焦慮造成生活品質下降的衝擊。也建議政府將乳癌重建納入全民健保給付範圍,避免因自費無法重建,恐導致衍生更多心理層面問題進而浪費更多醫療成本。

    Purpose This study investigates how pre-operative social support impacts post-operative quality of life for breast cancer patients who have undergone reconstruction surgery. Methods A retrospective study was conducted to collect data from a medical center in Taipei City from April 1, 2016 to May 31, 2018. Patients who had breast reconstruction surgery immediately after mastectomy were surveyed using open-ended interviews and questionnaires to gather demographic information and factors related to the patients’ decision-making process, social support structure, and quality of life, including feelings of depression or anxiety. Results Information such as marital status, family medical history, pre-operative knowledge of reconstruction survey, and pre-consultation with a plastic surgeon were significantly associated with pre-operative social support. Breast cancer surgery methods, health insurance, family medical history, family income, pre-operative knowledge of reconstruction surgery are significantly associated with post-operative rates of depression and anxiety in patients. Conclusions and recommendations When women with breast reconstruction receive more social support, post-operative quality of life is better with fewer incidences of depression and anxiety. To help reduce decision-making conflicts for patients, medical professionals should first understand the patient’s social support structure and educational background. If patients do not have pre-operative knowledge of the process or social support, medical professionals should refer the patient to the Association of Patients and Cancer Oncology Counselors for an intervention assessment that can reduce the likelihood of depression and anxiety after reconstruction. It is also recommended that the government include breast cancer reconstruction into the scope of universal health insurance payments. Funding breast reconstruction will lead to fewer long-term psychological problems, which would cost more to treat in the long run.

    第一章 緒論 第一節 研究動機與重要性 1 第二節 研究目的 4 第三節 研究問題 5 第四節 研究假設 6 第五節 名詞界定 7 第六節 研究範圍與限制 11 第二章 文獻探討 第一節 乳癌流行病學及分期定義 12 第二節 乳癌重建手術及重建手術之種類 14 第三節 乳癌症狀經驗 17 第四節 社會支持的理論基礎與相關研究 20 第五節 決策衝突理論基礎與相關研究 30 第六節 憂鬱概念及研究 37 第七節 焦慮概念及研究 41 第八節 健康相關生活品質概念及研究 45 第三章 研究方法 第一節 研究架構 54 第二節 研究對象 55 第三節 研究設計及研究工具 57 第四節 研究步驟 64 第五節 資料處理與分析 66 第四章 研究結果 第一節 研究對象個人背景因素、社會支持、決策衝突、憂鬱、焦慮及生活品質之現況分析 67 第二節 研究對象個人背景因素與術前社會支持、決策衝突的關係 85 第三節 研究對象個人背景因素與術後憂鬱、焦慮及生活品質的關係 96 第四節 研究對象社會支持、決策衝突、生活品質、憂鬱及焦慮之關係 109 第五章 討論 第一節 研究對象個人背景因素、社會支持、決策衝突、憂鬱、焦慮、生活品質分佈情形 115 第二節 研究對象個人背景因素與術前社會支持、決策衝突關係探討 127 第三節 研究對象個人背景因素與術後憂鬱、焦慮及生活品質關係探討 132 第四節 研究對象術前社會支持、決策衝突、術後生活品質、憂鬱及焦慮之關係探討 138 第六章 結論、建議與研究限制 第一節 結論 142 第二節 建議 144 第三節 研究限制 147 參考文獻 149 附錄 附錄一 研究量表 181 附錄二 社會支持半結構開放式訪談大綱 196 附錄三 同意臨床研究證明書 197 附錄四 臨床研究受訪者同意書 198 附錄五 問卷授權使用證明 206

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