臺灣博碩士論文加值系統

本研究主要探討心理衛教諮詢介入於乳癌病人化學治療期間焦慮憂鬱、疾病照護知識、生活品質滿意度、自我效能及復原力之成效，採實驗性設計，取樣於南部某區域教學醫院，收案對象為20歲以上之40位乳癌病人(實驗組20人；對照組20人)，隨機分派至實驗組與對照組。實驗組進行6次心理衛教諮詢介入方案，內容包含：1.強化支持力量、情緒支持；2.強化疾病照護技巧；3.促進情緒表達；4.教導活動與心情的監測；5.運用家庭作業配合治療活動的進行；6.另類療法的使用。對照組則維持一般常規護理。研究工具為個人基本屬性問卷、醫院焦慮憂鬱量表、化學治療知識量表、癌症病人特定疾病生活品質量表、自我效能量表及復原力量表，兩組個案皆於化學治療前、第三次化療、第五次化療、化學治療結束後2週進行結構性問卷調查。研究結果顯示，實驗組病人在接受6次心理衛教諮詢介入方案後，其焦慮與憂鬱程度較對照組低，且在化療結束後2週，兩組的焦慮與憂鬱下降程度呈現顯著差異。疾病照護知識分數方面，實驗組較對照組高，且兩組於第三次化療與化療結束後2週達顯著差異。在化療結束後2週兩組的整體健康生活品質滿意度方面皆有提升，且兩組有呈現顯著差異。兩組在第三次化療的自我效能提升未達顯著差異，但在第五次化療與化療結束後2週的自我效能皆有提升，且兩組有呈現顯著差異。復原力方面，兩組在化療結束後2週的復原力提升呈現顯著差異。綜合研究結果發現，心理衛教諮詢介入方案可有效改善乳癌病人的焦慮憂鬱、疾病照護知識、生活品質滿意度、自我效能及復原力情形，臨床護理人員可運用心理衛教諮詢介入模式於乳癌病人化學治療期間之照護，以增加病人之安適感，進而提升癌症護理品質。

This research investigated the effect of the psycho-education counseling program on anxiety, depression, disease-specific knowledge, quality of life, self-efficacy and resilience among breast cancer patients during the chemotherapy period. A total of 40 patients over 20 years old with a diagnosis of breast cancer were recruited from a medical teaching hospital in the southern Taiwan. The psycho-education counseling program and educational manual were used as intervention programmes in this study. The purpose of the educational manual was to describe important health issues associated with cancer management and self-care and to provide a user-friendly guide. The contents of the educational information and materials consisted of six themes, namely provision of social and emotional support and disease-specific knowledge, promotion of emotional expression, education messages, case analysis, related scenarios, self-monitoring, essays and and evaluation, and use of complementary and alternative medicine. Participants in the experimental group (n = 20) received six sessions of psycho-education counseling program and the educational manual. Participants in the control group (n= 20) were exposed only to the traditional education approach (consultation from psychiatrists and information sheets). The research instruments included basic characteristics of participants and scales of hospital anxiety and depression, chemotherapeutic knowledge, quality of life for cancer patients, self-efficacy and the resilience. Data were collected just before the chemotherapy (T1), the 3rd (T2) and 5th chemotherapy (T3), and 2 weeks after the final session of chemotherapy (T4).
The results revealed that the levels of both anxiety and depression of the experimental group were lower than the control group, and showed significant differences at T4. Disease-specific knowledge scores increased in the experimental group, compared with the control group, and also had significant differences at T2 and T4. Quality of life at T4 was significantly improved between groups. Self-efficacy at T2 showed no significant differences in both groups; however, it was significantly improved at T3 and T4 between groups. Resilience was improved significantly between groups at T4. The results indicated that the psycho-education counseling program improved breast cancer patient’s anxiety, depression, disease-specific knowledge, quality of life, self-efficacy and resilience. Nurses can apply this intervention in breast cancer patients undergoing chemotherapy to promote their quality of life, and improve the quality of oncology nursing care.

第一章 緒論1
第一節 研究背景與動機1
第二節 研究重要性2
第三節 問題陳述與研究目的3
第二章 文獻探討5
第一節 乳癌的化學治療5
第二節 心理衛教諮詢方案之介紹與相關研究6
第三節 乳癌病人的焦慮、憂鬱與心理衛教諮詢方案之相關研究10
第四節 疾病照護知識與心理衛教諮詢方案之相關研究14
第五節 生活品質與心理衛教諮詢方案之相關研究15
第六節 自我效能與心理衛教諮詢方案之相關研究17
第七節 復原力與心理衛教諮詢方案之相關研究19
第八節 研究架構21
第三章 研究方法22
第一節 研究設計22
第二節 研究對象與場所22
第三節 研究工具23
第四節 心理衛教諮詢方案之介紹25
第五節 資料收集過程26
第六節 研究倫理考量27
第七節 統計分析28
第四章 結果29
第一節 描述性統計29
第二節 心理衛教諮詢介入之成效34
第五章 討論50
第一節 研究討論50
第二節 研究限制53
第六章 結論與建議55
第一節 結論55
第二節 後續研究建議55
參考文獻57
中文部分57
英文部分59
附錄69
附錄A 基本資料表69
附錄B 醫院焦慮憂鬱量表70
附錄C 化學治療知識量表74
附錄D 癌症病人特定疾病生活品質量表75
附錄E 良好生活品質的自我效能量表79
附錄F 復原力量表80
附錄G 同意臨床試驗證明書82
表次
表1 問卷資料收集時間一覽表27
表2 實驗組與對照組之人口學特性變項比較29
表3 實驗組與對照組之疾病相關特性變項比較31
表4 心理衛教諮詢介入措施於實驗組與對照組各量表前後測比較之差異34
表5 心理衛教諮詢介入措施於實驗組與對照組措施介入前與化學治療結束後2週之差異39
表6 實驗組與對照組焦慮程度二因子混合設計變異數分析摘要表42
表7 實驗組與對照組憂鬱程度二因子混合設計變異數分析摘要表43
表8 實驗組與對照組化學治療知識二因子混合設計變異數分析摘要表45
表9 實驗組與對照組自我效能二因子混合設計變異數分析摘要表46
表10 實驗組與對照組復原力二因子混合設計變異數分析摘要表47
表11 心理衛教諮詢介入措施於實驗組與對照組的各量表相關分析48
圖次
圖1 研究架構圖21
圖2 研究流程圖26
圖3 實驗組與對照組在三次不同測量時間點之焦慮情形43
圖4 實驗組與對照組在三次不同測量時間點之憂鬱情形44
圖5 實驗組與對照組在三次不同測量時間點之化學治療知識得分情形45
圖6 實驗組與對照組在四次不同測量時間點之自我效能情形46
圖7 實驗組與對照組在二次不同測量時間點之復原力情形47

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