自我效能對乳癌病人生活品質的影響 ─ 術前心理健康衛教團體之追蹤研究

研究背景：乳癌病人的照護一直是十分值得關注的重要議題。過去已有許多研究指出，自我效能在乳癌病人的身心適應歷程中扮演著相當關鍵的角色，且透過臨床心理的介入，乳癌病人的癌症因應自我效能可獲得有效的提升，其生活品質亦能有所進步。然而，台灣目前仍然缺乏相關臨床研究。故本研究嘗試將自我效能的概念落實於台灣乳癌病人的臨床心理照護，藉由追蹤研究，探討以自我效能理論為基礎之心理介入是否能提升台灣乳癌病人的癌症因應自我效能，並藉此改善其生活品質。研究方法：本研究以北部某醫學中心之158位乳癌病人為研究對象，首先翻譯、編制量測癌症因應自我效能的短版癌症行為量表（Cancer Behavior Inventory, CBI-B）為台灣中文版，並建立其信度與效度。心理介入部份為則於手術前一日為乳癌病人提供單次的術前心理健康衛教團體，並評估其團體前後的癌症因應自我效能與術後1、3、6個月的生活品質。以相依樣本t檢定檢驗病人癌症因應自我效能在心理衛教團體前後的變化，並以路徑分析檢驗心理衛教團體前後之癌症因應自我效能與術後1、3、6個月之生活品質間的關係。研究結果：(1) 中文版短版癌症行為量共包含「個人效能」與「社會效能」兩個因素，具有良好的信度、建構效度與同時效標關聯效度。(2) 乳癌病人的癌症因應自我效能在術前心理健康衛教團體後有顯著的提升。(3) 對於51歲以上或心理衛教團體前情緒壓力小於7分之乳癌病人而言，「團體後的個人 / 社會效能」多能完全中介「團體前個人 / 社會效能」與「術後1個月生活品質」間的關係，但在「團體前個人 / 社會效能」與「術後3 / 6個月生活品質」的關係間多無顯著的中介效果。而對於50歲以下或心理衛教團體前情緒壓力達7分以上之乳癌病人而言，「團體後的個人 / 社會效能」在「團體前個人 / 社會效能」與「術後1 / 3 / 6個月生活品質」的關係間多無顯著的中介效果。結論與討論：(1) 中文版短版癌症行為量表是評估乳癌病人癌症因應自我效能的良好工具，可應用於相關研究及臨床服務。(2) 以自我效能理論為基礎的心理衛教團體可於有限的時間內有效提升乳癌病人的癌症因應自我效能，在步調急促的醫療環境下，是快速、有效的臨床介入模式。(3) 本研究中的心理衛教團體可能藉由提升癌症因應自我效能，改善年紀較長或情緒壓力較低之乳癌病人的短期生活品質，但其效果隨時間遞減；對較年輕或高情緒壓力病人之生活品質帶來的助益則較不顯著。若希望能更有效、更長期提升乳癌病人的生活品質，後續應需要更多癌症臨床心理介入模式之相關研究。

關鍵字

自我效能；生活品質；乳癌；追蹤研究；術前心理衛教

並列摘要

Background: Psychological care for breast cancer patients has been an issue that deserves attention. Previous studies have pointed out that self-efficacy is critical to patients' adjustment to breast cancer, and psychological interventions can improve patients' self-efficacy for coping with cancer and, in turn, promote their quality of life. However, there is limited research on the effect of psychological interventions on self-efficacy for coping with cancer and the relationship between self-efficacy and quality of life in Taiwan. Therefore, the present longitudinal study aims to investigate if a psychological intervention based on self-efficacy theory can improve breast cancer patients' self-efficacy for coping with cancer and quality of life. Method: A total of one hundred and fifty-eight breast cancer patients were recruited from a medical center in northern Taiwan. The Cancer Behavior Inventory (CBI-B) was translated into Traditional Chinese (Taiwan) for measuring the self-efficacy for coping with cancer and evaluated in terms of reliability and validity. All participants were invited to a preoperational psychoeducation group a day before surgery. Cancer self-efficacy was measured pre-and-post group, and quality of life(QoL) was measured at 1, 3, and 6 months post-surgery. Paired sample t-tests were used to examine the change of cancer self-efficacy pre-and-post the psychoeducation group. Path analysis was used to explore the relationship between participants' self-efficacy for coping with cancer and QoL. Results: (1) The Taiwan version CBI-B, containing two factors, "personal self-efficacy" and "social self-efficacy," is a reliable and valid measure of self-efficacy for coping with cancer. (2) Breast cancer patients' cancer self-efficacy improved significantly after the preoperational psychoeducation group. (3) For patients "aged 51 years and older" or "with emotional distress (DT) score lower than 7", the post-group personal/social self-efficacy can fully mediate the relationship between pre-group personal/social self-efficacy and most domains of the QoL at 1-month post-surgery. However, the post-group personal/social self-efficacy did not mediate the relationship between pre-group personal/social self-efficacy and most QoL domains at 3- or 6-month post-surgery. Furthermore, for patients "aged 50 years and younger" or "with DT score 7 or higher", post-group cancer self-efficacy did not mediate the relationship between pre-group personal/social self-efficacy and most domains of the QoL at 1-, 3- and 6-month post-surgery. Discussion: (1) The Taiwan version CBI-B has proper psychometric properties and is suitable for research and clinical use. (2) The psychoeducation group based on self-efficacy theory can effectively improve breast cancer patients' cancer self-efficacy within a short time (30-60 mins). In fast-paced clinical settings, it is a practical and feasible psychological intervention program. (3) The psychoeducation group can promote the QoL at 1-month post-surgery for those older or less distressed breast cancer patients by improving their cancer self-efficacy, but its effect decreases with time. However, the effects of the psychoeducation on the QoL were insignificant for those younger or more distressed breast cancer patients. More researches on psychological interventions for cancer patients are needed to improve and prolong the effect on breast cancer patients' QoL.