前列腺癌術後患者身心適應問題及心理衛生教育改善憂鬱成效之初探

背景：憂鬱在癌症病患相當常見的，其中也包括前列腺癌。除了疾病本身外，前列腺根除術病患術後容易出現情緒障礙，導因於手術許多的併發症，包括解尿、性功能及腸道的異常。目前並沒有相關的標準照護程序，而心理衛生教育對這個族群的成效仍未有定論。本研究的目的為瞭解病患在接受前列腺根除術後遭遇的身心適應問題及評量心理衛生教育介入對改善前列腺癌根除術後病患的憂鬱之成效。方法：第一階段共收集34名剛接受根除性前列腺手術後一週的病患並收集病患的背景及癌症相關的資料。而憂鬱情緒則採用憂鬱量表（流行病學研究中心憂鬱症量表；CES-D）評估。第二階段針對調查中有憂鬱（CES-D≥16分）的18名病患給予8次，持續八週的心理衛生教育。介入的措施包含：「前列腺根除手術後衛生教育」指導及「支持性心理教育」照護。主要教導病患瞭解疾病及應付無論是短期或中長期的生理併發症，並引導病患發現及表達身心的不適，協助舒緩憂鬱的情緒。此外，利用介入期間，經護病互動收集術後兩個月期間病患常見的身心適應問題。結果：病患的平均年齡為65.26 ± 7.36歲，其中一半的病患合併其他的慢性疾病。腫瘤病理分期(Gleason Score) 平均分數為6.79 ± 1.12，其中61.8％接受腹腔鏡根除性前列腺手術。前列腺根除術後平均CES-D分數為17.32 ± 10.96。憂鬱盛行率為52.9％（95% C.I., 42.2%-62.7%），且有經濟壓力者顯著地憂鬱得分較高。並從其常見的主訴整理出十項前列腺術後術後的身心適應問題。最後，18位憂鬱（CES-D≥16分）個案接受心理衛生教育，所有的個案憂鬱情況獲得改善（CES-D皆<16分）。結論：憂鬱在前列腺癌術後是相當普遍的，因此需被醫護人員關注及重視。而心理衛生教育介入能改善病患術後的憂鬱情緒。

關鍵字

前列腺癌；根除性前列腺手術；心理衛生教育；身心適應問題；憂鬱

並列摘要

Background: Depression is common among patients with a variety of cancers, including prostate cancer. Apart from the illness, patients undergone radical prostatectomy usually experience emotional problems caused by urinary, sexual and bowel disturbance. Until now, there is no standard nursing protocol for it and the effectiveness of psychoeducation is yet to be established. The present study aimed to investigate the adjustment problems of theses patients and to evaluate the effectiveness of psychoeducation on depression. Methods: Purposive sampling was used in this study. At the first stage, 34 patients after radical prostatectomy were recruited into this study. Their demographic data and cancer related parameters were collected. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure their depressive emotions. At the second stage, 18 patients with depression (CES-D ≥ 16) were provided with psychoeducation intervention for 8 times within 2 months. The interventions included providing disease related information and supportive psychoeducation. The patients were led to express their discomforts and were helped to cope with them. Results: The mean age of the patients were 65.26 ± 7.36 year-old. Half of the subjects have other comorbidities. The mean Gleason Score was 6.79 ± 1.12 and 61.8％ of the patients received laparoscopic operation. After the surgery, the mean CES-D score was 17.32 ± 10.96 and the prevalence rate of depression was 52.9% (95% C.I., 42.2%-62.7%). Patients with financial stress were more likely to have depression (p < 0.05). Ten common adjustment problems were identified. After psychoeducation intervention, depressive emotions were significantly improved and none of them has depression (CES-D ≥ 16). Conclusion: High prevalence rate of depression was found in patients after radical prostatectomy and health care-giver should pay more attention on it. Psychoeducation was an effective strategy on improving depression in this population.