電話追蹤介入對台灣東部乳癌婦女成效的探討

A Study on Efficacy of Telephone Follow up for the Women with Breast Cancer in Eastern Area of Taiwan

陳品貝(Pin-Pei Chen)

指導教授 ： 熊秉荃

國立臺灣大學/醫學院/護理學研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.10065

摘要

目的：本研究目的為(1)瞭解電話追蹤介入對於台灣東部乳癌婦女的焦慮、鬱結狀態及癌症因應行為的效果，以及(2)乳癌婦女對於電話追蹤介入療效的看法。
方法：本研究採隨機控制試驗(randomized controlled trial)設計。於2009年1月16日至2009年4月20日於花蓮某醫學中心外科及腫瘤科門診及病房收案，以單純隨機方式將收案對象分為實驗組和控制組，最後共有實驗組14人及控制組14人完成研究。實驗組除了接受醫院例行性門診照護外，另有電話追蹤介入，每週一次，共八次，對照組僅接受醫院的例行性門診照護。成效測量以結構式自填量表，於試驗前後測量，量表包括『焦慮狀態量表』、『鬱結量表』、『癌症因應行為量表-簡短版』。實驗組另外於最後一次電話追蹤時，以電話訪談個案，以瞭解個案對於電話追蹤介入療效的看法。
結論：研究結果發現實驗組的『焦慮狀態』和『鬱結』量表後測分數下降，『癌症因應行為』量表後測分數上升；而控制組的『焦慮狀態』、『鬱結』量表後測分數上升，『癌症因應行為』量表分數下降，經Mann-Whitney U test檢定兩組前後測差異，焦慮狀態量表(Z= -.622，p=.534)、鬱結量表(Z= -.621，p=.535) 皆未達統計顯著差異，但在『癌症因應行為』量表中『對於治療引起副作用的因應』次量表(Z= -2.468，p=.014)則達到統計上顯著差異。結果說明經由電話諮詢的介入會增加乳癌病患對於治療引起副作用的因應行為。透過個案主觀對於介入療效的看法，發現經由電話追蹤介入，提供衛教及諮詢，發揮『提供資訊』、『增加對療程的自信心』、『建立人際支持網絡及抒發情緒』、『協助角色調整的適應』、『發展面對癌症、生命的正向觀點』的功能。
結論：對於偏遠地區乳癌婦女提供電話追蹤服務，過程中給予病患疾病及治療的衛教指導和心理社會的支持，以協助發展癌症的正向因應行為，未來可根據此模式擴大研究樣本以檢驗其效果。

關鍵字

乳癌婦女 ； 電話追蹤 ； 焦慮 ； 鬱結 ； 癌症因應行為

並列摘要

Aims：The aims of this study were to examine (1) the effects of telephone follow up intervention on reducing the sense of anxiety, status of stagnation and increasing the cancer coping behavior for women with breast cancer in eastern area of Taiwan, and (2)what aspects of telephone follow up intervention worked to contribute to the therapeutic effects in the views of women with breast cancer.
Methods：This study was a randomized trial design. The subjects were recruited from outpatient and inpatient departments of breast cancer surgery and oncology of medical center in Hualien from January 2009 to April 2009. The subjects were randomly assigned to the experimental or control group by using simple random method. The 14 subjects in the experimental group and the 14 subjects in the control group completed the study. In addition to the physician’s usual care, the subjects in the experimental group received the 8-session telephone follow up intervention. The subjects in the control group only received physician’s usual care. The measurement time included pre and post tests. The outcome measures were State Anxiety Inventory, Stagnation Scale and Cancer Coping Behavior Inventory-Brief. In the last session of telephone follow up, the subjects in the experimental group were invited to express their views on the therapeutic mechanisms of telephone follow up intervention.
Result：The results revealed that at post-test, the scores of State Anxiety Inventory and Stagnation scale decreased and scores of Cancer Coping Behavior Inventory-Brief increased in the experimental group. Differently, in the control group, the scores of State Anxiety Inventory and Stagnation scale increased and scores of Cancer Coping Behavior Inventory-Brief decreased. According to the Mann-Whitney U test, the results indicated that there were no significant differences in the scores of State Anxiety Inventory (Z= -.622，p=.534) and Stagnation Scale (Z= -.621，p=.535) between the experimental group and the control group. However, there was a significant difference in the score of Coping the Side Effect of Treatment Induced Subscale of the Cancer Behavior Inventory-Brief scale. The findings illustrated that the telephone follow up intervention could increased the coping behaviors of coping with side effects caused by treatment in the patients with breast cancer. In the views of women with breast cancer, the therapeutic mechanisms of telephone follow up intervention included “impart information”, “improve confidence about the therapy”, “establish social support network and express emotions”, “assist to adapt the sick roles”, and “develop positive views of suffering from cancer and meanings of life”.
Conclusion：The positive cancer coping behaviors in breast cancer women living in the remote area could be achieved through telephone follow up providing information about disease and treatments and psychosocial support. The future study may enlarge sample size to demonstrate the effects of the telephone follow up intervention.

並列關鍵字

women with breast cancer ； telephone follow up intervention ； anxiety ； stagnation ； cancer coping behavior

參考文獻

曾光毅, & 李福春. (2000). 現階段的乳癌預防與治療 基層醫學, 15(6), 115-119.

郭文宏, & 張金堅. (1999). 乳癌治療的新趨勢. 當代醫學, 26(12), 970-973.

王貴霞, 劉哲銘, & 呂志得. (2005). 乳癌病患的困擾及擔憂問題. 北市醫學雜誌, 2(9), 844-849.

陳純純, 盧美雪, & 許麗珠. (2006). 放射線治療皮膚照護簡介. 腫瘤護理雜誌, 6(2), 11-17.

丁肇鳳、史麗珠 (2006)．乳房切除術後的手臂復健運動方案．腫瘤護理雜誌，6(1)， 19-27。