臺灣博碩士論文加值系統

研究背景與目的：
癌症自民國71年起高居國內十大死因之首，而乳癌位居台灣女性癌症發生率之第一名，亦為女性主要死因之一，隨著政策防癌篩檢之推廣，乳癌個案因早期發現，早期治療，五年整體存活率高達90%。罹患乳癌對婦女來說，是威脅生命的重大壓力事件，尤其在面對癌症確診，代表著健康狀況及生活品質即將面臨挑戰與影響，且面對手術的治療、輔助性治療的副作用和疾病可能復發的不確定性等，讓多數病人處在恐懼及憂鬱中。因此在治療期間面臨的症狀困擾與負面情緒反應、心理壓力，皆會導致生活品質的降低。本研究目的為瞭解乳癌婦女發生睡眠障礙、焦慮、憂鬱症狀之概況；探討乳癌婦女個人基本屬性及疾病特性，睡眠障礙、焦慮、憂鬱症狀及生活品質相關性。
研究方法：
本研究採橫斷性研究設計，以南部某區域教學醫院乳癌病人為抽樣對象，採便利取樣，收案數為145人，有效樣本數為140人，於病人在門診或住院化療中與回門診追蹤時收集資料，研究工具採結構式問卷，問卷包括病人基本屬性問卷、匹茲堡睡眠品質量表、醫院焦慮憂鬱量表及SF-36健康相關生活品質量表等收集資料，資料統計採用個人電腦SPSS 18.0中文版的統計軟體，以描述性統計分析研究對象的基本屬性、睡眠品質、焦慮、憂鬱及生活品質的平均值及標準差，並以推論性統計包括單因子變異分析（ANOVA）、皮爾森積差相關、複迴歸方式，探討各變項間的相關程度及生活品質的預測因子。
研究結果：
睡眠障礙與焦慮、憂鬱呈顯著正相關（r =.389, p＜.001；r =.187, p =.027）；睡眠障礙與生理、心理生活品質呈顯著負相關（r = -.268, p =.001；r = -.311, p＜.001）；亦即睡眠障礙嚴重時，焦慮與憂鬱程度愈嚴重，其生理、心理生活品質愈差。教育程度低及家庭月收入較少之乳癌婦女其憂鬱症狀之發生較高。睡眠障礙主要為焦慮、憂鬱症狀及生活品質之重要預測因子；其次教育程度是憂鬱與生理生活品質之預測因子；確診期間亦是生理生活品質之預測因子。
本研究發現乳癌婦女的睡眠障礙與焦慮、憂鬱及生活品質皆有相關，故建議在臨床上，護理人員若能及早發現病人的睡眠障礙問題，提早做預防與提供需要之醫療照護措施，改善乳癌病人的睡眠障礙問題，將可降地焦慮憂鬱之困擾並提升病人生活品質。

Background and purpose：
Cancer has been among the top ten leading causes of death in the country since 1982, while breast cancer is the first in Taiwan for women, and one of the main causes of death. With the promotion of anti-cancer screening policy, the breast cancer cases are early discovered, early treatment, and five years of overall survival rate of up to 90%. The Breast cancer is a major stressful event for women, especially in the face of cancer diagnosis, which represents the impending challenge and impact of health and quality of life, and patients are in fear and depression in the face of surgical treatment, side effects of adjuvant therapy and uncertainty about the possibility of relapse. Therefore, in the treatment, the symptoms encountered, negative emotional reactions, and psychological pressure, all will lead to lower quality of life. The purpose of this study was to investigate the status of sleep disorder, anxiety and depression in women with breast cancer, and to explore the characteristics of individual and disease, sleep disorder, anxiety, depression and quality of life.
Methods：
The design of the research on the transverse and fault-taking of the patients with breast cancer in a regional teaching hospital in southern region, and convenient sampling the number was 145 patients, which collected data from patients in the clinic or hospitalized chemotherapy and back-clinic tracking. And studied tool was using structured questionnaires, including patient''s basic attribute questionnaire, Pittsburg Sleep Quality Scale, Hospital Anxiety and Depression Scale and SF-36 Health-realted quality of Life Scale, and so on. Data statistics was using the personal computer SPSS 18.0 Chinese version of the statistical software, to describe the basic attributes of statistical analysis of the object, the average and standard deviation of sleep quality, anxiety, depression and quality of life, and the predictive factors of the correlation degree and quality of life of each variable were discussed by the one-wayanalysis of variance（ANOVA）, independent-sample T test,Pearson correlation and multiple regression.
Results:
Sleep disorders were significantly positively correlated with anxiety and depression (r = .389, p <.001；r = .187, p = .027)；sleep disorders were negatively correlated with physical and psychological life quality (r = -.268 , p = .001；r = -.311, p <.001)；That is, severe sleep disorders, the degree of anxiety and depression more serious, the physiological and psychological quality of life worse. The depressive symptoms of breast cancer women with low level of educational and less family monthly income were higher. Sleep disorders are important predictors of anxiety, depression and quality of life. Secondly, education is a predictor of depression and physiological quality of life. The diagnosis period is also a predictor of physiological quality of life. This study found that women with breast cancer sleep disorders and anxiety, depression and quality of life are related, it is suggested that in the face of clinical, nursing staff can early detection of patients with sleep disorders, early prevention and provision of necessary medical care measures to improve the sleep problems of patients with breast cancer will reduce anxiety and depression and improve the quality of life of patients.

謝辭……………………………………………………………………………………i
中文摘要……………………………………………………………………………………ii
英文摘要……………………………………………………………………………iv
目錄…………………………………………………………………………………vi
表目錄……………………………………………………………………………………ⅷ
圖目錄……………………………………………………………………………………ⅸ
第一章　緒論
第一節 研究背景與動機……………………………………………………………1
第二節 問題陳述與研究目的………………………………………………………2
第三節 研究重要性…………………………………………………………………3
第四節 名詞界定 ……………………………………………………………………4
第二章 文獻查證
第一節 乳癌病人之診斷與治療……………………………………………………6
第二節 乳癌婦女之睡眠障礙、焦慮、憂鬱症狀…………………………………7
第三節 生活品質之影響因素探討…………………………………………9
第四節 睡眠障礙與焦慮、憂鬱症狀及生活品質之間的關係………………10
第五節 研究架構……………………………………………………………………12
第六節 研究假設……………………………………………………………………13
第三章　研究方法
第一節　研究設計…………………………………………………………………14
第二節　選樣………………………………………………………………………15
第三節　資料收集…………………………………………………………………16
第四節　研究工具…………………………………………………………………17
第五節　資料分析…………………………………………………………………19
第四章　研究結果
第一節　基本屬性之分佈…………………………………………………………21
第二節　睡眠障礙之情形…………………………………………………………25
第三節 焦慮、憂鬱及生活品質之情形…………………………………………26
第四節 基本屬性、睡眠障礙與焦慮、憂鬱及生活品質之相關性……………27
第五節 焦慮、憂鬱症狀及生活品質的預測因子………………………………37
第五章　討論與建議
第一節　討論………………………………………………………………………41
第二節　研究限制…………………………………………………………………43
第三節　後續研究建議……………………………………………………………44
參考文獻
中文文獻……………………………………………………………………………45
英文文獻……………………………………………………………………………48
附錄
附錄A 人體試驗/研究同意證明書………………………………………………51
附錄B 匹茲堡睡眠品質指標量表中文版授權書………………………………52
附錄C SF-36台灣中文版問卷使用授權書………………………………………53
附錄D 研究問卷……………………………………………………………………54

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