乳癌婦女的心理社會適應狀態探討：以中年(35至64歲)女性為例

Psychosocial Adjustment of Breast Cancer Women in middle age from 35 to 64

洪久茹(Chiu-Ju Hung)

指導教授 ： 王麗容

國立臺灣大學/社會科學院/社會工作學研究所/碩士(2007年)

https://doi.org/10.6342/NTU.2007.01826

摘要

本研究欲瞭解35歲至64歲之中年期乳癌術後婦女的心理社會適應狀態，藉由乳癌婦女的個人基本屬性變項、疾病特性變項、身體意象量表、身體症狀困擾量表來測量心理社會適應狀態。心理社會適應層面包括健康照顧方面、工作環境適應、家庭環境適應、性關係適應、延展家庭關係、社交環境適應與心理困擾等七個層面的適應狀態。
本研究以乳癌切除手術後的婦女為研究對象，並以臺灣北部某一醫學中心乳房外科門診病患以及參加幾所醫院乳癌病友團體活動之成員為調查對象，有效問卷共計219份，以SPSS 13.0軟體進行資料處理的工具，資料分析方法包括描述統計(平均值、次數分配、百分比)、單因子變異數分析、t檢定、雪費法之事後比較、皮爾森積差相關或斯皮爾曼等第相關，以及多元迴歸分析。
研究發現如下:
一、乳癌婦女平均年齡為50.56歲，已婚、高中職學歷、生病前後均有工作、全家平均月收入介於五萬元至七萬五千元以及七萬五千元以上，經濟獨立、不需要他人提供金錢協助，需要金錢協助之乳癌婦女多由配偶和子女提供，已停經者、與配偶子女同住者的比例最高。
二、受訪之乳癌婦女中最早進行手術者為民國77年10月，距離手術後1至3年者最多，平均距離手術時間為3.53年、乳癌婦女為第二期乳癌、未復發過、接受根除型乳房切除術者、接受化學治療者比例最高。
三、乳癌術後婦女的生理困擾是介於「沒有」至「有時」間，即介於一個月內完全沒有出現到最多症狀出現一星期的情況，顯示整體生理困擾不嚴重，但得分最高的前五項症狀包括睡眠改變、疲倦、虛弱、手術側手臂發麻、手術側手臂活動度受限制，症狀多由於乳癌手術後，婦女對治療的擔心及手臂功能影響有關。經濟狀態不同與生理困擾達統計上的顯著差異，收入較低者有較嚴重的生理困擾。
四、乳癌術後婦女的身體意象感受是介於「一點也不在意」至「稍微在意」之間，亦即大多數的乳癌婦女稍微擔心乳癌或治療對於身體意象的影響，其中最在意的項目包括「會特別注意自己的外表」、「對自己的疤痕外觀不滿意」、「乳癌或治療會降低身體的魅力」。並發現乳癌婦女的年齡在45歲以下、手術後1個月內者、接受乳房切除後重建者均對身體意象的感受較為在意。
五、整體心理社會適應是介於「輕度障礙」至「中度障礙」間，家庭環境適應及心理困擾的適應最好，性關係的適應最差。
六、各適應層面的平均數差異分析與多元迴歸分析的結果為:
(一)、影響心理社會適應的因素為婚姻狀態、工作狀態、經濟狀態、經濟支援、經濟支援的對象、同住對象、罹癌階段、復發情況，與心理社會適應均達統計上的顯著差異，生理困擾、身體意象與心理社會適應呈負相關，在多元迴歸分析中，變項共可解釋45%的總變異量，其中以經濟狀態、工作狀態、罹癌階段、身體意象與生理困擾對於心理社會適應有顯著的預測力。
(二)、健康照顧方面與工作環境適應兩個適應層面均未與任何個人基本屬性、疾病特性變項有達顯著差異，但影響健康照顧方面、工作環境適應方面的因素為生理困擾與身體意象，亦呈顯著負相關，共可解釋健康照顧方面8.4%的總變異量、工作環境適應12.8%的總變異量，研究也發現生理困擾是最具影響健康及工作適應的預測因素。
(三)、影響家庭環境適應的因素為婚姻狀態、工作狀態、經濟狀態、經濟支援、經濟支援的對象、更年期、同住對象、生理困擾與身體意象，共可解釋32.3%的總變異量，其中以身體意象、生理困擾、已停經者、收入愈高以及無工作者對家庭環境適應的影響最為重要。
(四)、影響性關係適應的因素為婚姻狀態、同住對象、身體意象，共可解釋16.2%的總變異量，並以身體意象為最重要的影響因素。
(五)、影響延展家庭關係的因素為經濟狀態、輔助治療方式、生理困擾與身體意象，共可解釋14.9%的總變異量，其中發現收入愈高以及輔助治療進行的種類愈少都有顯著的預測力。
(六)、影響社交環境適應的因素為經濟狀態、更年期、同住對象、距離手術時間、手術形式、復發情況、生理困擾與身體意象，共可解釋22.7%的總變異量，其中以接受何種手術型式、沒有乳癌復發及生理困擾有顯著的預測力。
(七)、影響心理困擾的因素為目前的年齡、距離手術時間、罹癌階段、更年期、生理困擾與身體意象，共可解釋34.8%的總變異量，其中以罹癌階段、身體意象與生理困擾有顯著的預測力。
本研究結果在政策面上的建議，包括：政府應積極宣導乳癌篩檢，並加強對乳癌治療與預後的正確認知、對於性別與健康照顧議題的積極關注、創造一個保障女性經濟安全的環境。在實務面的建議包括：強化乳癌術後婦女社交網絡的參與機會、協助經濟弱勢的乳癌婦女獲得較適切的生活品質、重視乳癌手術後夫妻關係的維護增進等，提供社會工作專業與醫務社會工作者實務工作的參考。

關鍵字

乳癌婦女 ； 中年期 ； 心理社會適應 ； 生理困擾 ； 身體意象

並列摘要

Abstract
Purposes:
The paper is intended to provide a good understanding of the affecting factors and influences of the demographic data, characteristics of the illness, physical distress and body image data on the psychosocial adjustment. The author works in a hospital and is in charge of breast cancer self-help group, wishes to further understand every aspect related to the effect of the surgery on body image, physical distress and psychosocial adjustments.
Participants:
Participants were middle age women and diagnosed breast cancer, accepted mastectomy one side or two sides. The study population includes patients of purposive sampling selected hospital and participants of breast cancer self-help group which consists of breast cancer patients from several hospitals. Total of 219 participants were interviewed.
Methodology:
The ages of the study population range from 35 to 64. The study period was from June 10, 2006 to August 31, 2006. The instruments identified to measure the study variables included demographic variables, characteristics of illness data, body image scale, physical distress scale and psychosocial adjustment to Illness Scale-self report (PAIS-SR). Using SPSS13.0 for Windows to compute quantitative data, and one-way ANOVA to analysis. Using Scheffe’s method to post hoc multiple comparisons group difference and multiple regression analysis were used to determine the amount of variance in psychosocial adjustment.
Data Analysis:
1. Sample characteristics
Samples mean age was 50.56. Most samples were married, live with spouse and children, stage Ⅱin breast cancer, post-surgery time before 1 to 3 years (Mean= 3.53 years), accepted radical mastectomy and chemotherapy. Most of the samples reported haven’t recurrent. Most of senior high school, worked before and after mastectomy, income were NT$50,000-NT$75,000 and above NT$75,000 per month, half of women didn’t need economic-help (financial support), from spouse and children provided financial support.
2. Bivariate analysis and multiple regression analysis
2.1 Psychosocial Adjustment of post-surgery breast cancer women
The degree of psychosocial adjustment in breast cancer women was moderate disturbance to mild. The best adjustment was observed in domestic environment and psychological distress. The worst adjustment was observed in sexual relations. Married, continue working, income above NT$50,000, have enough income or spouse and children provide resource and breast cancer condition was 1 or 2 stage all have better psychosocial adjustment. We use those variables to predict psychosocial adjustment, finding that can predict 45% variance.
Adjustment in Health Care Orientation:
The degree of health care orientation in breast cancer women was mild disturbance to none. There weren’t significant difference between all independent variables on health care orientation. Physical distress, body image and health care orientation have been significant negative correlation. These two variables explain approximately 8.4% of the total variance.
Adjustment in Vocational Environment:
The non working and working women in the study population are 58.8% and 41.2%, respectively. The degree of vocational environment in breast cancer women was mild disturbance to none. In conclusion, only the physical distress and body image play slight significant difference in the vocational environment. The physical distress and body image predict 12.8% of the total variance.
Adjustment in Domestic Environment:
The degree of domestic environment adjustment in breast cancer women was mild disturbance to none. Married, never worked or worked before and after mastectomy, income above NT$50,000, never menopause, have spouse and children provide resource, live with spouse all have better domestic environment adjustment. Physical distress, body image and vocational environment adjustment have been significant negative correlation, so we use all variables predict 32.3% variance.
Adjustment in Sexual Relationship:
The degree of sexual relations in breast cancer women was moderate disturbance to mild. Married, live with spouse and children have better sexual relationship. Body image and sexual relations have been negative correlation, so all affecting variable were predict 16.2% variance.
Adjustment in the Extended Family Relations:
The degree of extended family relations in breast cancer women was mild disturbance to none. Income above NT$75,000 and never accepted any adjuvant therapy have better extend family relationship. All variable have been significant difference to predict 12.5% variance.
Adjustment in Social Environment:
The degree of social environment adjustment in breast cancer women was mild disturbance to none. Income above NT$75,000, have been menopause, live with spouse and children, post-surgery above 1 year and not recurrent have better social environment adjustment.
Adjustment in Psychological Distress:
The degree of psychological distress adjustment in breast cancer women was mild disturbance to none. Age from 45 to 60, have been menopause, post-surgery above 1 year and breast cancer condition at 0 or 2 stage have better psychological adjustment. We use all variable to predict 34.8% variance.
3.1 Physical Distress of the Post-Surgery breast cancer Women
This score indicates that the degree of physical distress is from “never” to “sometimes”, represented patients have not experienced any physical distress in a month or the physical stress persists for a week. The affecting factors to the physical distress are economic status. The worst physical distress is observed among the patients with income between NT$25,000-NT$50,000. Similarly, physical distress and psychosocial adjustment have been significant negative correlation.
4.1 Body image of the Post-Surgery breast cancer Women
All of the samples feel herself body images was from “not at all” to “a little”, so as to concerns both her appearance, physically attractive and dissatisfied with her scar. This score indicates that the post-surgery women do not care or slightly care about the body image. Women with age below 45 years, within a month of the surgery, and accepted breast reconstruction surgery were more negative body image.
Suggestion:
1. Political suggestion:
Provide outreach activities to promote the cancer screening and enhance the proper knowledge of the cancer treatment and care. Focus on the sex equality when provide health care. Create a financial security environment.
2. Implementation suggestion:
Enhance the breast cancer women’s participation and chance in social activities. Assist poor financial condition breast cancer women to achieve a better quality life. Emphasize the maintenance of the wife-husband relationship

並列關鍵字

breast cancer women ； middle age ； psychosocial adjustment ； physical distress ； body image

參考文獻

季瑋珠、黃俊升、張金堅（1997）。台灣的乳癌。中華衛誌，16(1)，62-76。

陳惠美、馬鳳歧、郭英調、石宜銘（1999）。乳癌術後婦女身心社會調適之探討－以羅氏適應模式為基礎。護理研究，7(4), 321-332。

莫藜藜（1998）。醫務社會工作。臺北：桂冠。

鄧盡妹（2004）。癌症病患身體心像及其相關因素之探討。未出版碩士論文。臺北醫學大學護理學研究所，臺北。

王楚君（2003）。乳房手術患者術後兩週內之症狀困擾、身體心像、生活品質之探討。未出版碩士論文。臺北醫學大學護理研究所，臺北。