以正念為基礎治療於乳癌病人的生心理及生活品質效益之研究

研究背景乳癌是台灣女性十大癌症發生率第一順位，多數女性病人接受治療後，產生生心理及生活品質上的變化，因此醫療專業人員應當了解乳癌病人治療後的問題及運用有效的輔助治療以協助病人盡快回歸到正常的生活。研究目的探討以正念介入措施對乳癌病人更年期症狀、女性性功能、焦慮憂鬱壓力、生活品質、唾液皮質醇和自律神經系統之成效及正念介入措施過程中的經驗。研究方法本研究為類實驗研究設計，研究對象共51名乳癌病人，將其分為實驗組26名及對照組25名，實驗組接受連續6週正念介入措施，對照組未接受正念介入措施，僅按照日常生活方式。研究工具為人口學基本資料、更年期症狀量表、女性性功能指數量表、焦慮憂鬱壓力量表、健康生活品質測量問卷；生理指標為唾液皮質醇及心率變異度。統計方法採用多元迴歸分析(Multiple regression analysis)、威爾卡森符號檢定(Wilcoxon signed rank test)和曼惠特尼U檢定(Mann-Whitney U Test)。質性研究採用深度訪談法，以理解乳癌病人接受正念介入措施後的經驗。研究結果研究結果顯示量性研究部分，乳癌病人參與六週正念介入措施後，其更年期熱潮紅症狀、女性性功能(性關係滿意、整體性生活滿意、性慾望、性渴望和陰道濕潤)、焦慮、壓力程度、SDNN和HF，均達統計上顯著差異。使用多元迴歸分析，自變項「治療方式」和「宗教信仰」對依變項「憂鬱」、自變項「治療方式」對依變項「焦慮」及自變項「治療方式」和「年齡」對依變項「生活品質」的影響均達統計顯著意義。然而在憂鬱、健康生活品質及唾液皮質醇均未達統計上顯著差異；質性研究部分，透過深度訪談，共歸納出五個主題：「剛開始執行正念練習的困難處」、「正念，覺察日常和不完美的身體」、「正念，覺察並安撫躁鬱之心」、「困難、擔憂及如何面對」和「自覺最有幫助的正念練習項目。」結論正念介入措施可改善更年期熱潮紅症狀、提升女性性功能(性關係滿意、整體性生活滿意、性慾望、性興奮和陰道濕潤)、降低焦慮、壓力程度、提升SDNN和HF。正念為一種經濟、方便且實用之介入措施，未來醫療人員可以將其納入臨床衛教，期待乳癌病人面對未來的生活能更積極、更正向。

關鍵字

正念；乳癌；生心理效益；皮質醇；心率變異度

並列摘要

Background Breast cancer is the first rank cancer among women in Taiwan. Most women suffer from psychological and physical problems after receiving treatments. Therefore, medical professionals should understand the experience of patients with breast cancer after treatment and use effective complementary alternative medicine to help patients return to normal life as soon as possible. Purposes To explore the effects of mindfulness intervention on menopausal symptoms, female sexual function, anxiety and depression, quality of life, salivary cortisol and autonomic nervous system in patients with breast cancer, and the experience of mindfulness intervention. Method This study was designed as a quasi-experimental study. Fifty-one women with breast cancer were allocated into an experimental group (n=26) or a control group (n=25). The experimental group received mindfulness interventions for 6 consecutive weeks, and the control group received only routine care without mindfulness intervetions. The research tools were basic demographic questionnaire, Female Sexual Function Index (FSFI), Greene Climacteric Scale (GCS), Depression Anxiety Stress Scales-21 (DASS-21), EuroQol instrument (EQ-5D)；physiological measures of stress including salivary cortisol levels and heart rate variability (HRV) were collected and measures. Data were analyzed by multiple regression analysis, Wilcoxon signed rank test and Mann-Whitney U Test. The Qualitative part was conducted in-depth interviews to explore women with breast cancer experience after receiving mindfulness interventions. Result The results of the study showed that in the quantitative study part, the indicators of menopausal symptoms, female sexual function (satisfaction with sexual relationship, satisfaction with overall sexuality, sexual desire, arousal and lubrication), anxiety, stress level, standard deviation of all normal to normal intervals (SDNN) and high frequency power (HF) of patients with breast cancer after participating in six-week mindfulness intervention were statistically significant. Multiple regression analysis showed that the influence of the independent variable "treatments" and "religious belief" versus the dependent variable "depression", the independent variable "age" versus the dependent variable "anxiety" and the independent variable "treatments" and "age" versus the dependent variable "quality of life" all reached statistical significance. However, the indicators of depression, healthy quality of life and salivary cortisol are not statistically significant. In the qualitative research part, through in-depth interviews, five themes emerged："Difficulties in the implementation of mindfulness practice at the beginning", "Mindfulness, awareness of daily and imperfect bodies", "Mindfulness, awareness and appeasement of restless heart", "Difficulties, Worries and how to face them" and "the most helpful mindfulness practice project for self-consciousness." Conclusion Mindfulness intervention can improve menopausal symptoms, anxiety and stress in patients with breast cancer. Mindfulness interventions are economical, convenient and practical. In the future, medical staffs can incorporate it into clinical health education. We look forward to patients with breast cancer in the future will be more active and positive life.