臺灣博碩士論文加值系統

本研究目的主要為探究乳癌婦女於手術及化學治療期間的身心社會功能、貫徹健康行為與生活品質之關係。研究為前瞻式、縱貫研究設計，以南部某醫學中心欲進行乳房切除的乳癌婦女為研究對象，採方便取樣方式，使用結構式問卷於手術前一天、術後第二週、第一個化學治療療程後一週及後三週，進行資料收集。由2007年6月至2007年11月，共計完成25位個案，資料以描述性及推論性統計進行分析。結果發現：（一）在術前一天社會功能為最少；術後二週的心理功能及生活品質為最差；而第一個化學療程後一週以生理功能及貫徹健康行為最差。（二）手術及化學治療期間，生理困擾與心理困擾有顯著正相關，且僅第一個化學療程後三週社會功能與生理困擾有顯著正相關；生、心理困擾於跨時間點與貫徹健康行為、生活品質有不同相關性。（三）術後二週乳癌婦女癌症分期為早期者、活動功能減少者傾向能貫徹執行健康行為，整體模式對貫徹健康行為之解釋力為28.5%。（四）術後二週乳癌婦女為無偶及癌症分期早期者、活動功能減少者傾向能有較好的生活品質，整體模式對生活品質之解釋力為51.8%；而第一個化學療程後一週及三週，不論是否納入人口學特性，情緒狀態一致對生活品質具有統計上顯著的影響，整體模式解釋力介於46.7%至58%。
研究結果能提供醫護人員對乳癌婦女接受手術及化學治療後之身心社會功能、生活品質與貫徹健康行為之關連性有進一步瞭解，做為持續評估患者對疾病及治療過程之適應狀態與健康促進行為參考。且藉由提供相關心理諮商處置，能進而提升乳癌婦女貫徹健康行為與良好的生活品質，及增加腫瘤照護人員之介入能力與實證應用。

The purpose of this study was to explore the relationship of the biopsychosocial function, adherence to health behavior and quality of life in women with breast cancer during mastectomy and chemotherapy. The research was a prospective, longitudinal design. The patients were recruited at a medical center in South Taiwan. A convenience sampling survey was conducted by using structured questionnaires to collect data on 1 day pre operation; 2 weeks post operation, 1 week and 3 weeks after first cycle of chemotherapy. Twenty-five patients were enrolled in the study form June 2007 to November 2007. The data was analyzed through descriptive and inference statistics. The results were as follows: 1) The social function was least at 1 day pre operation, the psychological function and quality of life was worst at 2 weeks post operation, and physical function and adherence to health behavior was worst at 1 week after first cycle of chemotherapy. 2) Psychological distress and physical distress was significantly positive correlation during surgery and chemotherapy, and only social function and physical distress was significantly positive correlation at 3 weeks after first cycle of chemotherapy, there were various correlations cross different time period between the physical and psychological distress as well as adherence to health behavior and quality of life. 3) Women with breast cancer were characteristic with early stage and lower function of activity those who incline to increase the adherence to health behavior at 2 weeks post operation. The predictive power of whole model toward adherence to health behavior was 28.5%. 4) Women with breast cancer those who were in early stage, without spouse and lower function of activity could have better of quality of life at 2 weeks post operation. The significant impact showed with emotional state toward quality of life, no matter the demographic variables were considered or not at 1 week and 3 weeks after first cycle of chemotherapy. The predictive power of whole model toward quality of life crossed from 46.7% to 58%.
The results of this study could be provided to make health professionals understand the relationship of biopsychosocial function, adherence to health behavior and quality of life of women with breast cancer during mastectomy and chemotherapy. The frame of adaptation assessment and health promotion will be proposed through continuous monitories the process of illness and treatment for these patients. The adherence of health behavior and quality of life in women with breast cancer will be improved by the psychological counseling intervention. Moreover, the competence and application of intervention for oncology nurse professionals will be fostered based on these preliminary and empirical research findings.

第一章 緒論 1
第一節 研究背景與重要性 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 研究限制 7
第二章 文獻回顧 8
第一節 生物心理社會模式 8
第二節 乳癌治療與生理困擾 12
第三節 乳癌婦女的心理社會功能 15
第四節 乳癌婦女貫徹健康行為探討 21
第五節 乳癌婦女的生活品質 25
第三章 研究方法與過程 35
第一節 研究設計 35
第二節 名詞定義 36
第三節 研究架構 38
第四節 研究對象與場所 39
第五節 研究工具 40
第六節 資料收集過程 45
第七節 資料分析 48
第八節 倫理考量 51
第四章 研究結果 52
第五章 討論 77
第六章 結論與建議 93
參考資料. ................................................................................................................... 97



表目錄
表2-5-1 國內外乳癌婦女生活品質研究...................................................................27
表3-1-1 罹患乳癌婦女於手術及化學治療期間之研究資料收集時間與工具.......35
表3-7-1 乳癌婦女人口學特性及手術與化學治療期間之各變項分佈與統計.......49
表3-7-2 乳癌婦女身心社會功能、貫徹健康行為與生活品質推論性統計分析...50
表4-1-1 乳癌婦女人口學特性...................................................................................53
表4-1-2 手術及化學治療期貫徹健康行為與生活品質得分之常態性檢定...........54
表4-1-3 人口學特性於貫徹健康行為之差異...........................................................55
表4-1-4 人口學特性於生活品質之差異...................................................................56
表4-2-1 乳癌婦女於手術及化學治療期間生理功能的重複測量變異數分析.......58
表4-2-2 乳癌婦女於手術及化學治療期間心理功能的重複測量變異數分析.......60
表4-2-3 乳癌婦女於手術及化學治療期間社會功能的重複測量變異數分析.......62
表4-3-1 乳癌婦女手術及化學治療期間貫徹健康行為重複測量變異數分析.......64
表4-4-1 乳癌婦女於手術及化學治療期間生活品質的重複測量變異數分析.......65
表4-5-1 乳癌婦女身心社會功能的Pearson相關係數……………………………...67
表4-5-2 乳癌婦女身心社會功能與貫徹健康行為、生活品質Pearson相關係數...69
表4-6-1 乳癌婦女於手術及化學治療期間貫徹健康行為階層複迴歸分析...........72
表4-7-1 乳癌婦女於手術及化學治療期間生活品質之階層迴歸分析...................75

圖目錄
圖2-1-1 健康與疾病的生物心理社會模式...............................................................9
圖3-1-1 乳癌婦女身心社會功能、貫徹健康行為與生活品質探討之研究架構...38
圖3-6-1 研究進行流程.............................................................................................45
圖4-2-1 乳癌婦女於手術及化學治療期間的身體症狀分數改變曲線.................59
圖4-2-2 乳癌婦女於手術及化學治療期間的活動功能分數改變曲線.................59
圖4-2-3 乳癌婦女於手術及化學治療期間的自覺病況分數改變曲線.................61
圖4-2-4 乳癌婦女於手術及化學治療期間的身體心像分數改變曲線.................61
圖4-2-5 乳癌婦女於手術及化學治療期間的情緒狀態分數改變曲線.................61
圖4-2-6 乳癌婦女於手術及化學治療期間的社會支持總分改變曲線.................63
圖4-2-7 乳癌婦女於手術及化學治療期間的社會支持網絡改變曲線.................63
圖4-3-1 乳癌婦女於手術及化學治療期間的貫徹健康行為分數改變曲線.........64
圖4-4-1 乳癌婦女於手術及化學治療期間的生活品質總分改變曲線.................66
圖4-4-2 乳癌婦女於手術及化學治療期間的生活品質各範疇改變曲線.............66


附錄
附錄一 同意臨床試驗證明書..............................................................................112
附錄二 症狀困擾量表使用同意書......................................................................113
附錄三 身體心像量表使用同意書......................................................................114
附錄四 情緒狀態量表使用同意書......................................................................115
附錄五 社會支持量表使用同意書......................................................................116
附錄六 臺灣版世界衛生組織生活品質問卷使用授權......................................117
附錄五 受試者同意書..........................................................................................118
附錄六 研究量表..................................................................................................119

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