臺灣博碩士論文加值系統

研究背景:根據世界衛生組織統計，每八名女性就有一名婦女罹患乳癌，在台灣，乳癌從2003年起持續為女性發生率最高的癌症，且約有30-40%的乳癌婦女需要進行乳房全切除手術，在乳房全切除手術後，婦女即面臨是否要進行乳房重建的艱難選擇，若婦女在資訊不充足、知識缺乏、未予醫療團隊溝通的情況之下進行乳房重建之決策，容易會產生決策困境，因而產生憂鬱及焦慮之心理問題。電腦化決策輔助工具結合手機平板的產生，不僅較個人化，亦能夠與時俱進，提供手術資訊、進行價值觀的澄清以及幫助乳癌婦女進行手術決策。
研究目的:本篇研究發展行動平板應用程式作為電腦化決策輔助工具，並探究此輔助措施對婦女決策衝突、決策後悔、焦慮及憂鬱與手術後外觀滿意度之成效 。
研究方法: 本研究之行動平板應用程式(application，app)設計依據渥太華決策輔助架構(Ottawa Decision Support Framework)，涵蓋衛教影片及價值觀澄清活動兩大功能。研究為前瞻性隨機控制試驗，採取塊狀隨機分派方式，將納入研究之婦女隨機分派為實驗組及控制組，實驗組婦女接受app之介入措施，控制組婦女則給予常規衛教手冊，兩組婦女皆在介入後一週、以及手術後一個月完成追蹤後測。
研究結果:本研究共納入60位乳癌婦女(實驗組/控制組: 30/30位)，個案的整體年齡介於25~68歲，平均年齡為48.68(為介於、以及歲，實驗組的乳癌婦女較控制組乳癌婦女年輕。在兩組疾病屬性方面，以O期及I期的乳癌婦女佔最為多數（63.0%），腫瘤大小以1~3公分佔最多數（54.3%），兩組之間無顯著差異。研究結果顯示使用app) 可以顯著提升乳癌婦女手術後之身體外觀滿意度，然而無法顯著降低初診斷乳癌婦女之決策衝突、焦慮、憂鬱、及決策後悔。實驗組婦女對於使用app給予正向回饋，部分女性希望能夠改善頁面之觸控敏感度、並在app內容增加術後注意事項；超過八成之個案希望能夠將此app盡快上架。
結論與臨床建議:根據本研究結果，使用app作為決策輔助工具可顯著提升乳癌婦女手術後之身體外觀滿意度，然而在決策衝突、決策後悔、焦慮及憂鬱之成效尚未顯著，未來研究亦建議可納入更多乳癌婦女並針對乳癌婦女心理層面之相關成效進行長期之追蹤與分析。

The incidence of breast cancer had become the most common female cancer in Taiwan since 2003. It is estimated that 30-40 % women need to receive a mastectomy yet it is difficult for them to decide whether undergo breast reconstruction or not after mastectomy. Most of them are not well prepared to make this decision. Recent studies have revealed that women with treatment decision-making difficulties experience chronic psychological distress. Using decision aids that provide information and facilitate value clarification during the process of treatment decision making can improve decision-related outcomes. As a result, we designed an application (app) as a computer-based decision aid to help breast cancer women make breast reconstruciton decision and we conducted a randomized control trial to test its effect including decisional conflict, decisional regret, anxiety, depression and body appearance satisfaction. Sixty women were recruited. The results showed that women in our intervention group didn’t have statistically decreasing score in decisional conflict, decisional regret, anxiety and depression. However, women who received the app reported more satisfied with their body appearance post one-month surgery. This study demonstrated that using an app as a decision aid may benefit Taiwanese breast cancer women by enhancing body appearance satisfaction. Also, most of the participants consider the app not only helpful but also user-friendly. In future direction, we still need more participants and long-term follow-up to test the effect of the app.

中文摘要 I
英文摘要 III
致謝 VI
目錄 VIII
表目錄 X
圖目錄 XI
附件目錄 XIII
第壹章 緒論 1
第一節 背景與重要性 1
第二節 研究目的 4
第三節 研究假設 4
第貳章 文獻探討 5
第一節 乳癌婦女乳房全切除及乳房重建手術 5
一、乳癌全切除手術 5
二、乳房重建手術之種類及方法 6
三、影響乳癌婦女選擇乳房重建之因素 9
第二節 醫病共享決策之概念 11
一、醫病共享決策的概念發展 11
二、台灣醫病共享決策的發展 12
第三節 決策輔助工具協助病患做治療決策之成效 13
第四節 電腦化決策輔助工具在協助乳癌婦女做手術決策之實證結果 15
第參章 研究方法 17
第一節 研究架構 17
第二節 研究設計 18
一、 研究對象及場所 20
二、 研究樣本數 20
三、 研究工具 21
四、 實驗組之介入措施 23
五、 研究步驟 30
六、 資料處理分析方法 31
七、 倫理考量 32
第肆章 研究結果 33
第一節 人口學屬性與疾病相關資料 35
第二節 運用行動平板應用程式協助初診斷乳癌婦女進行乳房重建決策之決策衝突、決策後悔、焦慮及憂鬱之成效 40
第三節 運用行動平板應用程式協助初診斷乳癌婦女進行乳房重建決策之身體外觀滿意度成效 56
第四節 行動平板應用程式之使用滿意度及使用者建議質性資料 60
第伍章 討論 63
第一節 研究個案基本屬性與疾病特性 63
第二節 行動平板應用程式協助初診斷乳癌婦女進行乳房重建決策之決策衝突、決策後悔、焦慮、憂鬱、身體外觀滿意度之影響 65
第三節 行動平板應用程式之使用滿意度及使用者建議質性資料 73
第四節 研究個案最終乳房手術決策 75
第陸章 結論、研究限制與建議 76
第一節 結論 76
第二節 研究限制 77
第三節 未來研究方向 77
參考文獻 79

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