乳癌患者的生活品質:生物心理情境觀點

The Quality of Life in Persons with Breast Cancer: Biological, Psychological, and Contextual Perspectives

王怡婷(I-Ting Wang)

指導教授 ： 潘璦琬

國立臺灣大學/醫學院/職能治療研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.02458

摘要

前言：職能治療可幫助乳癌患者面對心理社會的挑戰，並協助患者隨疾病歷程調適、回復均衡生活型態、增進生活品質。本研究目的為探討乳癌患者生活品質之變化及預測因子。本研究之預測因子包含五種領域：疾病、社會、物理及社會環境、心理及職能表現形態等五種領域，依變項為世界衛生組織生活品質問卷簡明版之四個範疇及單題（World Health Organization Quality of Life-brief version, WHOQOL-BREF)。
方法：本研究個案來自於北部某醫學中心之乳醫中心，隨機取樣100位乳癌患者。本縱向型研究於基準期後三個月後進行一次追蹤。個案平均年齡為49.6歲；77%已婚；55%為大學畢業程度或以上。本研究使用的量表包括: 職能自我評估、掌控感量表、貝式憂鬱量表、貝式焦慮量表、職能活動問卷、角色量表、日常生活滿意度問卷、社會支持問卷、負向社會互動感受量表、疾病衝擊量表、世界衛生組織生活品質問卷簡明版。所有量表分數由羅序測量模式(Rasch measurement model)轉為等距分數後，進行混合模式分析，找出可預測生活品質之顯著因子。
結果：本研究平均追蹤期約為3.5月，追蹤率76%。流失原因包含失聯、身體不適、沒有時間、無興趣、距離太遠等。研究結果顯示乳癌患者的生活品質與世界衛生組織所建立的健康族群常模相似。社會範疇之原始分數隨時間顯著下降，負向感受及參與休閒活動機會隨時間增加。各預測因子對生活品質的影響如下，憂鬱傾向主要對心理範疇生活品質產生負面影響；職能勝任感可提升社會範疇生活品質，環境支持度有益於環境範疇生活品質，職能表現形態面向因子對整體生活品質影響最劇，日常生活滿意度及心理領域預測因子對生活品質影響最為廣泛。
結論： 根據本研究結果，建議臨床治療師可提供乳癌患者(1)日常生活規劃個別化諮詢，增進職能參與。(2)培養娛樂興趣，增加職能勝任感。(3)情緒調適技巧教導。（4）提供家屬及社區民眾衛教增加環境資源。(5)鼓勵患者參加志工或自助團體，增加社會支持資源。

關鍵字

生活品質 ； 乳癌患者 ； 職能勝任感 ； 職能環境狀況

並列摘要

Background：Occupational therapy can help breast cancer patients to face psychosocial challenges, restore balance lifestyle and improve quality of life. The aims of this study are to examine the change in quality of life and predictors of quality of life in persons with breast cancer from longitudinal perspective. The predictors in this study contain five areas: disease-related, psychological, social, physical & social environment, and contextual areas. The dependent variables are items and domains from World Health Organization Quality of Life-brief version, WHOQOL-BREF)。
Methods：The subjects were 100 outpatients with breast cancer recruited from the chemotherapy treatment room of the medical center in the northern Taiwan. The data collected twice at baseline(T1) and three months later(T2). The mean age of the subjects was 49.6；77% patients were married；55% patients were graduated from colleges。The subjects were tested on the WHOQOL-BREF Taiwan version, occupational self assessment, mastery, Beck Anxiety Inventory , Beck Depression Inventory II, social support and social impact scale, unsupported social interactions, role checklist, occupational questionnaire, and satisfaction with daily occupations. The raw data was transformed for Rasch analysis, then the data were analyzed by mixed effect model using SAS computer program.
Results：The average length of involvement in this study was 3.5 months, and the follow up rate was 76%. The reasons of drop out in this study contain: cannot contact, physical issues, busy, no interests, and far from the hospital. The results showed that the quality of life in persons with breast cancer was similar with healthy populations. The raw score of the social domain decreased from T1to T2. The negative feelings and the opportunities to participate leisure activities increased with time. Depression was the most significant predictors to the psychological domain; occupational competences can improve the social domain of quality of life; environmental affordances have the benefits for environmental domain of quality of life; the predictors in Occupational Patterns domain have the influence on overall quality of life; satisfaction with daily occupations and the predictors of psychological area have the wide influence on quality of life.
Conclusions: According to the study, occupational therapists can provide treatments for persons with breast cancers in the following domains: (1) individual consulting for lifestyle redesign to increase occupational competences (2) providing leisure activities for enhancing occupational competence (3)improving emotional coping skills（4）providing psycho educations for family and communities (5) relocating environmental resources such as attending volunteer works.

並列關鍵字

quality of life ； breast cancer ； occupational competence ； environmental affordance

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