臺灣博碩士論文加值系統

本研究目的在於比較延遲診斷與未延遲診斷之乳癌婦女於疑似病兆到確立病理診斷其希望感變化。研究為前瞻性縱貫研究設計，以南部某醫學中心乳房外科門診初次罹患乳癌的婦女為研究對象，採方便性取樣，使用結構式問卷於接受切片檢查（T1）、確立癌症診斷（T2）及手術後之確立病理分期（T3）到三個時間點進行資料收集。本研究共計完成67位個案，延遲診斷組有30位，未延遲診斷組37位，將所得資料以描述性及推論性統計進行分析。結果發現：（1）乳癌婦女的希望感平均得分屬於中上程度，兩組的希望感隨著時間的變化皆達顯著差異，以T3的希望感最高，但兩組間未達顯著差異。（2）兩組的心理社會狀態僅未延遲診斷組憂鬱未能隨著時間的變化而有顯著的組內差異，其餘變項均能隨著時間的變化而有組內差異，在T2的焦慮與憂鬱分數最高，在T3的自我效能與社會支持最高，這些變項中僅焦慮變項有顯著的組間差異。（3）兩組乳癌婦女從T1到T3其希望感與神經質人格特質、焦慮、憂鬱均呈顯著的負相關，而與自我效能、社會支持呈顯著的正相關。（4）兩組乳癌婦女於T1到T3其希望感的預測分析均發現各整體迴歸模式對希望感的解釋力介於60-80％。延遲診斷組乳癌婦女T1和T2的希望感重要預測因子為自我效能，T3的希望感重要預測因子為憂鬱；未延遲診斷組乳癌婦女T1到T3之希望感重要預測因子均為自我效能。應用本研究結果可做為婦女在疑似乳癌與確立診斷過程一個月期間的心理評估參考，未來可發展初診斷乳癌婦女其灌注希望感的介入研究與心理健康促進的參考。

The purpose of this study was to determine the changes of hope over time in women with breast cancer within or between delayed and non-delayed groups. The was used in this current study prospective and longitudinal design. The subjects were recruited from a medical center in Southern Taiwan. A purposive sampling survey was conducted by using structured questionnaires to collect data after biopsy (T1); after breast cancer diagnosis (T2) and after pathological cancer stage (T3). Sixty-seven subjects with diagnosis of breast cancer provided data for descriptive and inferential analysis. Thirty subjects were assigned into delayed group and thirty-seven subjects were into non-delayed group. The major findings of this study are as follows: (1) Women with breast cancer reported incremental level of hope from T1 to T3. Total hope changed significantly over time in both delayed and non-delayed groups with the highest scores at T3. However, no significant difference existed between groups. (2)The anxiety, self-efficacy and social support variables showed significant changes over time in two groups. The significant change of depression over time was found only in delayed group. The highest anxiety and depression scores were found at T2. As to the self-efficacy and social support, the scores at T3 were highest. Only anxiety variable showed significant difference between groups. (3) The neurotic personality trait, anxiety and depression variables were negatively correlated with hope over time, in contrast, the self-efficacy and social support showed positive correlations with hope over time. (4) All the regression models of hope at T1, T2 and T3 were statistically significant in both groups, and the predictive power ranged from 60% to 80%. In delayed group, self-efficacy can be served the predictor of hope at T1 and T2. The depression variable were significant in predicting the hope at T3. In non-delayed group, the self-efficacy variable can predict the hope at any measurement time point.Our findings provided references for nurses to evaluate patients’ psychological changes during a one-month period from suspected breast cancer to confirmed pathological cancer stage. Furthermore, it also provides guidance to study the instill hope intervention for improving subjects’ psychological health in the future.

目錄
第一章 緒論 1
第一節 問題的重要性 1
第二節 研究動機 3
第三節 研究目的與假設 5
第四節 名詞定義 6
第二章 文獻查證 8
第一節 健康心理學概述 8
第二節 希望感之概述 11
第三節 乳癌的診斷與治療 20
第四節 延遲診斷之概述 24
第五節 乳癌婦女身心社會狀態的變化 28
第六節 乳癌婦女希望感之相關研究 32
第三章 研究方法 34
第一節 研究設計 34
第二節 研究架構 35
第三節 研究場所與對象 36
第四節 研究工具 37
第五節 資料收集過程 42
第六節 資料分析 43
第七節 研究對象保護權益 44
第四章 研究結果 45
第一節 乳癌婦女人口學屬性分析 45
第二節 比較延遲與未延遲診斷之乳癌婦女其希望感變化 53
第三節 不同組別乳癌婦女其心理社會狀態的變化及其與希望感的關係 55
第四節 延遲與未延遲診斷之乳癌婦女其希望感的預測因子 64
第五章 討論 68
第一節 乳癌婦女人口學屬性分析 68
第二節 比較延遲與未延遲診斷之乳癌婦女其希望感變化 73
第三節 比較不同組別乳癌婦女其心理社會狀態的變化及 76
其與希望感的關係 76
第四節 延遲與未延遲診斷之乳癌婦女其希望感之預測因子 80
第六章 結論與建議 83
第一節 結論 83
第二節 研究限制 84
第三節 建議 85
參考文獻 88

表目錄
表3-1-1資料收集時間與測量工具 34
表3-6-1乳癌婦女心理社會狀態與希望感之推論性統計分析 43
表4-1-1乳癌婦女人口學與疾病特性 47
表4-1-2不同組別其人口學、疾病特性及人格的差異分析 49
表4-1-3不同人口學屬性對不同時間點之希望感的差異分析 52
表4-2-1不同組別之希望感差異分析 54
表4-3-1不同組別之焦慮、憂鬱差異分析 57
表4-3-2不同組別之自我效能差異分析 59
表4-3-3不同組別之社會支持差異分析 61
表4-3-4不同組別乳癌婦女的心理社會狀態與希望感之關係 63
表4-4-1延遲診斷組乳癌婦女希望感之複迴歸分析 66
表4-4-2未延遲診斷組乳癌婦女希望感之複迴歸分析 67
圖目錄
圖3-2-1延遲診斷與未延遲診診斷乳癌婦女其希望感變化之研究架構 35
圖3-5-1乳癌婦女從疑似罹患乳癌到確立癌症分期之資料收集步驟 42
圖4-2-1不同組別乳癌婦女於接受切片檢查、確診及確立病理分期的希望感變化曲線 53
圖4-3-1不同組別乳癌婦女於接受切片檢查、確診及確立病理分期的焦慮改變曲線 55
圖4-3-2不同組別乳癌婦女於接受切片檢查、確診及確立病理分期的憂鬱改變曲線 55
圖4-3-3不同組別乳癌婦女於接受切片檢查、確診及確立病理分期的自我效能改變曲線 57
圖4-3-4不同組別乳癌婦女於接受切片檢查、確診及確立病理分期的社會支持改變曲線 60
附錄
附錄一 同意臨床試驗證明書 105
附錄二 受試者同意書 106
附錄三 病人資本資料表 107
附錄四 醫院焦慮憂鬱量表 108
附錄五 社會支持量表 110
附錄六 自我效能量表 111
附錄七 希望量表 112
附錄八 人格特質量表 113

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