臺灣博碩士論文加值系統

背景：台灣 ｢乳癌｣ 在女性癌症好發率第一名，死亡率第二名 (衛生福利部國民健康署，2022) 。越來越多的乳癌患者接受了手術、放射線及化學治療提高存活率，治療期間因藥物及治療帶來副作用及合併症造成身體諸多不適，進而產生焦慮及疲憊等情緒問題，影響生活品質。諸多研究指出音樂治療在乳癌患者能改善疲憊及生活品質，但成效如何有待商確。目的：本研究主要運用系統文獻回顧與統合分析方式，探討音樂介入治療是否能有效改善乳癌患者治療過程中焦慮、疲憊及生活品質之成效相關性之探討。方法：本研究透過系統回顧與統合分析品質 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA)，文獻檢索流程，運用四個中、英文資料 PubMed、Cochrane Library、Medline、華藝等資料庫，並手動搜尋納入文獻之資料參考，納入研究類型為運用音樂治療對乳癌患者焦慮、疲憊及生活品質成效之隨機分派試驗，使用關鍵字 “Breast cancer patient＂、“music therapy＂、 “Practical Nursing” 、 “anxiety＂、 “fatigue＂ 及 “Quality of Life 之 MeSH term及同義字，搜尋 2011 年至2022 年期間相關 隨機對照試驗及系統性回顧中英文獻，文獻以 2020 CASP (Critical Appraisal Skills Program) 來進行評讀，並利用 RevMan 5.4.1 版軟體進行統合分析。結果：共納入 11篇隨機試驗研究文獻，總計收案人數為 810 例，實驗組有 404例、對照組有406 例，受試者平均年齡介於 26~77 歲。整體評讀結果， 以 牛津大學實證醫學中心證據等級表評估證據等級為 Level II。統合分析結果顯示音樂治療在乳癌患者接受手術、放射線及化學治療中焦慮成效有統計上顯著差異，綜合效應量 SMD= -0.93, 95% CI (-1.54, -0.32) , p < .005，高異質性 I2 =94%，需進一步執行次族群分析，音樂介入分別經訓練音樂治療師提供再由患者自選或者經訓練音樂治療師執行之次族群分析中皆可降低焦慮成效，詳細分析經訓練音樂治療師提供再由患者自選之次族群分析，異質性仍偏高 I 2 = 93%、經訓練音樂治療師執行之次族群分析，異質性明顯降低 I 2 = 0 %，結果顯示音樂選擇類別次族群分析音樂由訓練音樂治療師提供再由患者自選或者單獨由患者自選屬高異質性，表示音樂選擇經由患者自選可能是造成臨床操作高度異質性主要或部分原因。在音樂介入時間次族群分析中：分別持續 20min 、45min 在焦慮成效無差異，分別持續 30min、60min 在焦慮成效有差異，且音樂介入時間持續 30min 比 60min 在焦慮成效更佳。生活質量成效有統計上顯著差異，綜合效果SMD=1.15, 95% CI (0.22, 2.07), p < .01。疲憊成效無統計上顯著差異，綜合效果量 SMD=-1.55, 95% CI (-3.25, 0.15), p > .05。結論：整體而言，音樂治療對乳癌患者綜合效果在焦慮、生活品質有正面影響，但在疲憊成效不如預期，仍希望更多高品質的文獻以強化實證效果證據力。藉由本研究結果可提供醫護人員日後照顧乳癌患者，在治療過程中音樂介入選擇，可藉由專業音樂治療師，依照患者個別性先進行篩選，音樂介入為每次持續 30分鐘，減輕乳癌患者因疾病治療帶來的焦慮，提升其生活品質。

Background: Breast cancer is the first cause of cancer incidence women in Taiwan. Although many breast cancer patients received surgery and radiotherapy to increase survival rate, some of them had different somatic complains, fatigue and emotional distress, such as anxious to have negative impact on quality of life during treatment. Many studies indicated that music therapy could improve fatigue and quality of life, but the efficacy of music therapy still remained unclear. This study was aimed to investigate the relationship between anxiety, fatigue, quality of life and music therapy among breast cancer patients. Purpose: This study was to examine the efficacy of music therapy on anxiety, fatigue and quality of life in breast cancer patients by using systematic literature review. Methods: A systematic literature search and meta-analysis was conducted in the PubMed, Cochrane Library, Medline and CEPS databases from 2011 to 2022, including Chinese and English randomized control trials (RCT) studies by using search terms “breast cancer patient”, “music therapy” "practical nursing", “anxiety”, “fatigue” and “quality of life”. Using 2020 CASP randomized controlled trial standard checklist and RevMan 5.4.1 software to conduct meta-analysis. Results: A total of 11 RCT research articles were included, with a total of 810 participants. There were 404 participants in the experimental group and 406 participants in the control group. The average age of the participants was between 26 and 77 years old. The overall reading rate of evidence evaluated by OCEBM is level II. The meta-analysis results showed that music therapy had a statistically significant difference in the anxiety effects of breast cancer patients undergoing surgery, radiation and chemotherapy, the combined effect size SMD= -0.93, 95% CI (-1.54, -0.32), p < .005, high Heterogeneity I2 = 94%, further sub-group analysis is needed. Music interventions provided by professional music therapists and patients could select any type of music intervention. The music intervention performed by professional music therapists can reduce anxiety in sub-group analysis. Detailed analysis of music is provided by professional music therapists. The therapist provided a subgroup analysis that was selected by the patient and the heterogeneity was still high I2 = 93%. The music intervention was performed by a professional music therapist that there was no heterogeneity I2 = 0%. The music intervention was selected by the patient that there was no statistically significant different in subgroup analysis (p>.05). The sub-group analysis showed that music intervention was performed by professional music therapists provided for patients or selected by patients alone, which may be the main or part of the reason for the high heterogeneity of clinical operations. In the sub-group analysis of music intervention time: there was no difference in anxiety effect between 20min and 45min respectively, and there was a difference in anxiety effect between 30min and 60min respectively, and music intervention time lasting 30min was better than 60min in anxiety effect. There was a statistically significant difference for quality of life outcomes, combined effect size SMD=1.15, 95% CI (0.22, 2.07), p < .01. There was no statistically significant difference in fatigue outcomes, combined effect size SMD=-1.55, 95% CI (-3.25, 0.15), p > .05. Conclusion: Overall, music therapy had a positive effect on anxiety and quality of life in breast cancer patients, but the effect on fatigue is not expected. More high-quality literature is still needed to strengthen the evidence of empirical effect. The results of this study can provide for medical staff caring for breast cancer patients in the future. The music intervention for 30 minutes/each section during the treatment process screened by professional music therapists according to the individuality of the patients can improve their anxiety and quality of life.

中文摘要 i
ABSTRACT iii
致謝 v
目錄 vi
表目錄 viii
圖目錄 ix
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 名詞解釋 3
第二章 文獻查證 7
第一節 乳癌患者之流行病學、致病因素、診斷分期及治療 7
第二節 乳癌患者相關焦慮 10
第三節 乳癌患者相關疲憊 11
第四節 乳癌患者相關生活品質 12
第五節 乳癌患者於治療治療期間焦慮、疲憊及生活品質之評估工具量表 13
第六節 音樂治療的概念與運用 16
第七節 音樂治療對乳癌患者於治療期間焦慮、疲憊及生活品質相關性及臨床應用 18
第八節 系統性文獻回顧與統合分析簡介 21
第九節 研究假設 22
第三章 研究方法 23
第一節 研究架構 23
第二節 系統性文獻搜尋過程 23
第三節 統合分析 28
第四章 研究結果 30
第一節 文獻特性 30
第二節 文獻品質評估 43
第三節 統合分析結果 55
第五章 討論 66
第一節 文獻品質及基本屬性 66
第二節 音樂治療對乳癌患者接受切片、手術、化學治療及放射治療後整體焦慮緩解之成效 67
第三節 音樂治療對乳癌患者接受切片、手術、化學治療及放射治療後整體疲憊緩解之成效 71
第四節 音樂治療對乳癌患者接受切片、手術、化學治療及放射治療後整體生活品質提升之成效 72
第六章 結論與建議 74
第一節 結論 74
第二節 建議 74
第三節 研究限制 76
參考文獻 77
一、 中文部分 77
二、 英文部分 80

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