女性乳癌復發治療心理復原力歷程的心理諮商需求之研究

A study for women who received metastatic breast cancer treatment in a need of psychological counseling during the resilient process

蔡明儒(Ming-Ju Tsai)

指導教授 ： 宋鴻燕

淡江大學/教育學院/教育心理與諮商研究所碩士班/碩士(2021年)

https://doi.org/10.6846/TKU.2021.00510

摘要

緒論：癌症一直是個復發率極高的疾病，存有再次罹癌的不確定性，會讓癌症病人長期面對疾病是『聞癌色變』。特別針對女性乳癌病人，因為根據2016年台灣癌症登記報告，國內每年仍約有五千名女性乳癌病人身陷晚期與復發轉移癌症之苦，也就是說在歷經乳房切除手術及將近十年的侵入性輔助治療後，若是又診斷出現癌症復發轉移時，或許其心理衝擊與調適的議題更應該被重視。但是在目前台灣的健保制度下，針對癌症復發已有一套標準化治療的給付建議，因此臨床上醫師面對女性乳癌復發者，在告知病人癌症復發後隨即就會開始後續治療；此時病人經歷乳癌復發的轉變，或許內心正充滿疑問與不安，也就更遑論是否能及時做好再次罹癌的心情調適。故本研究的目的，是以深入訪談三位女性乳癌復發者，探討接受治療前後的心理復原力(resilience)歷程變化，與研究參與者對於心理諮商期待的心態，以了解心理諮商的協助與強化心理復原力的影響。
研究方法：本研究採以質性研究訪談法，並採取現象學為主要取向來收集資料。研究對象選取是以目的抽樣之獨特樣本(unique sample)抽樣法，三位研究參與者為已接受第一線復發乳癌治療中的女性，且癌症未有再惡化與轉移者進行回溯性訪談。資料整理分析是採「內容分析法(content analysis)」。
研究結果：針對研究問題由訪談資料歸納發現，(1)女性乳癌復發者於被確診到決定治療的歷程：共同相似的經歷都是先否認癌症復發的事實，且最後會聽醫師的建議來選擇治療，而不同的心情或情緒調適之經歷，會是受家庭關係影響或由自我照顧意識提升而決定治療；(2)影響女性乳癌復發者面對治療歷程的心理復原力與心理因素：由結果發現當面對治療時有「知足及感恩好運」的心理復原力，就較能協助消除再次罹癌的心理衝擊；(3)面對治療女性乳癌復發者對於心理諮商的需求：研究受訪者是肯定心理諮商師所賦予的專業能力並期待心理諮商的助益。
結論與建議：當女性乳癌復發者被告知再次罹癌時，或許及時接受心理諮商的協助，可以降低面對疾病變化與後續長期治療時心理的負面情緒衝擊。後續研究可以再收集已接受過心理諮商的女性乳癌復發者相關經驗，或收集心理諮商協助女性乳癌復發者自我效能變化的客觀量化資料，以延伸探討。

關鍵字

女性乳癌復發治療 ； 心理復原力 ； 心理諮商

並列摘要

Introduction：Cancer has always played a role with the very high recurrence rate that leaves cancer patients with long-term uncertainty belief about recurrence of cancer. Especially for female breast cancer patients, according to the 2016 Taiwan Cancer Registry Report, there are still about 5,000 female breast cancer patients suffering from recurrence and metastasis malignant illness each year in Taiwan. It means that after mastectomy and nearly ten years of invasive adjuvant treatment, if the recurrence and metastasis of breast cancer was diagnosed, perhaps the issue of psychological impact and adjustment should be paid more attention. However, under the current health insurance system in Taiwan, there is already a set of standardized treatment and recommended payment according to the health and insurance policies payment for metastatic breast cancer treatment. Therefore, the clinicians will start follow-up treatment immediately after informing female breast cancer patient about the recurrence status. At this time, the patients are suddenly faced with the transformation of breast cancer recurrence, and perhaps suffer from full of doubts and anxiety, let alone whether they can adjust the mood for recurring cancer in time. The purpose of this study was to conduct in-depth interviews with women who were diagnosed metastatic breast cancer, and to explore the changes of resilience during the process in the treatment, with the expectations for psychological counseling. To understand the assistance of psychological counseling whether has an impact on strengthening the resilience during the malignant illness.
Method：This current study adopted a qualitative method, used the phenomenology as the main orientation to collect data. The selection of this research participants are based on the unique sample sampling method for purposeful sampling. We invited 3 participants who were females in the first line metastatic breast cancer treatment without any malignant illness or relapse, and they were asked to respond to the interview by retrospective thinking. Data collections and analyses were based on "Content Analysis".
Results：The findings were inducted from the interview data base on the research questions, (1)The process during the diagnosis and decision of treatment for women with metastatic breast cancer: Their common experience was to deny the fact of metastatic breast cancer first, and received the doctor’s advice to decide the treatment finally. The different experience is a process of mood or emotional adjustment that depends on the treatment which may be determined by the influence of family ties or the increase in self-care awareness. (2) The influences of the resilience and psychological factors for women with metastatic breast cancer in the treatment process: The findings were that the resilience of "contentment and gratitude for good luck" in the face of treatment was better able to help eliminate the psychological impact of the malignant illness. (3)The needs of psychological counseling during the metastatic breast cancer treatment for women: The research participants affirmed the professional ability conferred by the psychological counselor and looked forward to the acquire benefits of psychological counseling.
Conclusion and Suggestion：If women who have metastatic breast cancer were told the state of an illness, they will receive the assistance of psychological counseling in time and it might be reduced the negative emotional impact during the malignant disease process or the long-term treatment. It is possible to collect the experience feedback or the objective quantitative data of women who have metastatic breast cancer when they have received the assistance of psychological counseling for the further research.

並列關鍵字

metastatic breast cancer treatment for women ； resilience ； psychological counseling

參考文獻

李維倫、賴憶嫻（2009）。現象學方法論：存在行動的投入。中華輔導與諮商學報，25，275-321。

林金定、嚴嘉楓、陳美花（2005）。質性研究方法：訪談模式與實施步驟分析。身心障礙研究，3(2)，122-136。

陳秉華、蔡秀玲、鄭玉英（2011）。心理諮商中上帝意象的使用。中華輔導與諮商學報，31，127-157。

王智弘、劉淑慧、孫頌賢、夏允中（2017）。文化脈絡中的危機、轉機與復原力：本土諮商心理學研究的方向、目標與策略。中華輔導與諮商學報，50，1-28。

方俊凱、陳虹汶、賴允亮（2006）。癌症病人的自殺學。安寧療護雜誌，11(3)，163-172。