探討乳癌高危險群婦女之風險認知及心理困擾

Association of risk perception and psychological distress among high risk women of breast cancer

吳雪菁(Hsueh-Ching Wu)

指導教授 ： 陳品玲

臺北醫學大學/護理學院/護理學研究所/碩士(2003年)

摘要

本研究目的在探討乳癌高危險群婦女的風險認知及心理困擾程度，以曾參與陳品玲博士國科會研究案及北市某區域教學醫院確立乳癌診斷患者之一級女性血親為研究對象，採橫斷式調查研究法，以結構式問卷為研究工具，以電話邀請研究對象至門診或家訪方式進行資料收集，共有143人同意參與研究，參與率為50.0﹪。 研究結果顯示（一）乳癌高危險群婦女的相對風險認知情形，仍有四成多覺得和一般婦女相比為「較低或一樣」；絕對風險認知有近八成認為自己未來「有可能」罹患乳癌；而預估自己罹患乳癌機率的絕對風險認知顯示，有一半以上的高危險群婦女高估自己罹患乳癌機率的絕對風險。（二）在一般性心理困擾部分，乳癌高危險群婦女的焦慮狀況介於「有一點」及「頗為」之間；憂鬱狀況顯示有四分之一的乳癌高危險群婦女有憂鬱症狀。癌症特定性困擾部分，顯示有一半以上對乳癌有中等程度以上的特定性困擾，且有三成的高危險群婦女對乳癌有高程度的特定性困擾。（三）年齡在41歲（含）以下者、教育程度為高中職以上、無子女、未停經、及乳癌血親與個案的親屬關係為母親或姊妹者等其風險認知較高。（四）年齡在41歲（含）以下、教育程度為高中以上、單身、無子女、乳癌血親與個案之親屬關係為母親或女兒等其心理困擾程度較高。（五）相對風險認知為「比較高」者其特定性心理困擾較高；絕對風險認知為「有可能」者其焦慮程度有顯著較高。 根據研究結果可瞭解基本資料不同對乳癌高危險群婦女的風險認知及心理困擾程度的差異，以提供社區護理人員篩選出不同風險認知的高危險群婦女及不同心理困擾程度者，並能針對其需求提供適當的衛教、諮商及轉介服務等介入措施，而增加對乳癌的風險認知及減少乳癌高危險群婦女潛在心理疾病的發生。

關鍵字

乳癌高危險群 ； 一級血親 ； 風險認知 ； 心理困擾

並列摘要

The purpose of this study was to determine the association between risk perception and psychological distress among high-risk women of breast cancer. A cross-sectional design was conducted to examine first-degree female relatives of breast cancer patients. With a participation rate of 50%, data of 143 participants were collected via interviews in clinic or at home. Study results were found as follows: (1) There were 44% high-risk female relatives perceived their risk of breast cancer “relatively lower than or as the same as” general population; 79% thought they are very likely to get breast cancer; However, more than 50% over-estimated their possibilities of getting breast cancer. (2) The anxiety among these high-risk female relatives was found in between “a little” and “some”; Around one fourth suffered depression; Over 50% had moderate and above degree of cancer specific distress; Approximately 30% carried high degree of cancer specific distress. (3) Female relatives with the following categories were found to carry higher risk perception: those with ages under 41, those with above high school education, those do not have child and those their menstrual cycles have not ended; Higher risk perception was also found in high-risk female relatives when their mothers or daughters have breast cancer. (4) Single and childless female relatives with ages under 41 and above high school education were found to carry higher psychological distress; Higher distress was also found in high-risk female relatives when their mothers or daughters have breast cancer. (5) Female relatives with “relatively higher” relative risk perception carried higher specific psychological distress; Female relatives with “likely” absolute risk perception were found to have significantly higher anxiety. These findings can be useful in helping community nurses to screen high-risk women with different extents of risk perception and psychological distress. Community nurses can accordingly provide more appropriate health education and consulting, consolation and proper referral.

並列關鍵字

high-risk of breast cancer ； first-degree relatives ； risk perception ； psychological distress

參考文獻

鄭綺、楊小娟、蔡仁貞 (民89)。 輕中度和重度肺功能障礙慢性阻塞性肺疾病患者運動自我效能和運動測試結果比較之探討。 護理研究，8(1)，13-23。

Andrieu, N., Clavel, A., Gairard, B., Piana, L., Bremond, A., Lansac, J., Flamant, R., & Renaud, R. (1993). Variations in the risk of breast cancer associated with a family history of breast cancer according to age at onset and reproductive factors. Journal of Clinical Epidemiology, 46(9), 973-980.

Audrain, J., Rimer, B., Cella, D., Stefanek, M., Garber, J., Pennanen, M., Helzlsouer, K., Vogel, V., Lin, T.H., & Lerman, C. (1999). The impact of a brief coping skills intervention on adherence to breast self-examination among first-degree relatives of newly diagnosisd breast cancer patients. Psycho-Oncology, 8(3), 220-229.

Audrain, J., Schwartz, M. D., Lerman, C., Hughes, C., & Peshkin, B.N. (1997). Psychological distress in women seeking genetic counseling for breast-ovarian cancer risk:the contributions of personality and appraisal. Ann Behavior Medicine, 19(4), 370-377.

Baider, L., Ever-Hadani, P., & De-Nour, A.K. (1999). Psychological distress in healthy women with familial breast cancer : like mother, like daughter? The International Journal of Psychiatry in Medicine, 29(5), 4 11-420.