乳癌術後存活病患心理介入方案之心理健康結果評估

目的：探討壓力抒解與情緒管理暨理性情緒行為諮商的心理介入方案，對乳癌術後存活病患的心理健康狀態（憂鬱、焦慮、乳癌困擾以及情緒表達）改善之成效。方法：以高雄醫學大學附設醫院及高雄市立聯合醫院一般外科乳癌特別門診的術後存活病患為主要對象，利用病患等候門診的時間進行心理社會因子的問卷施測，問卷內容包含了基本資料表、貝克憂鬱量表、貝克焦慮量表、癌症特定性困擾量表以及情緒表達量表，採類實驗設計依個案意願決定是否參與心理介入方案。方案介入組將接受每週ㄧ回合，每回合2小時，為期二個月共計八回合的心理介入課程；而比較組將會收到預防乳癌復發的相關資料。統計方法使用重複量數雙因子變異數分析瞭解心理介入方案對健康狀態的影響。結果：本研究的研究對象共60人，其中介入組為21人，比較組為39人，分別以獨立樣本t檢定及卡方檢定進行兩組別的人口學屬性之比較，除教育年數在兩組間達統計學上顯著差異外，其餘變項均顯示未達統計學上顯著差異。採用重複量數雙因子變異數分析，在控制教育年數之後，評估心理介入方案對乳癌術後存活病患的心理健康狀態改善之成效，在憂鬱、焦慮及乳癌困擾症狀方面，介入組前後測的改變量均顯著高於比較組（三者交互作用分別為F=4.52,P=.038;F=7.08,P=.010;F=4.40,P=.040）。結論：經由介入方案的實施後，介入組的乳癌存活病患前後心理健康狀態改善的程度顯著的優於比較組，並且能有效抒解憂鬱症狀、焦慮症狀及乳癌困擾。因此，本研究積極建議在必要的治療過後實施心理介入方案將有助於乳癌復發的預防。

關鍵字

乳癌存活者；類實驗設計；心理介入方案；重複量數變異數分析

並列摘要

Objective: The main purpose of the study is to evaluate the effectiveness of the mental health outcomes of psychological intervention program for the breast cancer survivals after treatment. Methods: A quasi-experimental study was designed and psychological intervention program was developed based on stress management, rational-emotive counseling. Patients were allocated in each group voluntarily. All of the data and records concerned with biological factors, genetic factors, and socio-demographic characteristics have been collected from the questionnaires. In addition, four scales for measuring the psychosocial factors in Chinese version have been administered to each breast cancer survivors in hospital outpatient department. Patients in the intervention group had been administered the psychological intervention program for 2-month 8 sessions under the lead of the advisor and research assistants according to 2 hour session a week. Patients in the group with no intervention had been received some information which are relevant to the prevention of recurrence. The repeated measures ANOVA had been applied to the psychological intervention program for the mental health outcome evaluation. Results: A total of 60 (21 in the intervention group and 39 in the comparison group) breast cancer survivors after finishing surgical treatment participated in the study. The repeated measures ANOVA with biobehavioral data showed that all patients responded with significant anxiety and psychological distress, but thereafter only the intervention group improved respectively (P=.010；P=.040). The scores of depression were significantly lower for the intervention group at 2 months (P=.038). Conclusion: A significant interaction effect has been found that the reduction of the level of depression, anxiety and cancer specific distress in the intervention group have been greatly significant than that of comparison group. Therefore, for the prevention of the recurrence of breast cancer after treatment effective, the implementation of psychological intervention program is highly suggested.

並列關鍵字

breast cancer survivors ； quasi-experimental design ； psychological intervention ； repeated measures ANOVA

參考文獻

Falagas, M. E., Zarkadoulia, E. A., Ioannidou, E. N., Peppas, G., Christodoulou, C., & Rafailidis, P. I. (2007). The effect of psychosocial factors on breast cancer outcome: a systematic review. Breast Cancer Research, 9(4), R44. doi: 10.1186/bcr1744

英文參考文獻

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Alexander, P., Dinesh, N., & Vidyasagar, M. (1993). Psychiatric morbidity among cancer patients and its relationship with awareness of illness and expectations about treatment outcome. Acta Oncol, 32(6), 623-626.

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Anagnostopoulos, F., Vaslamatzis, G., & Markidis, M. (2004). Coping strategies of women with breast cancer: a comparison of patients with healthy and benign controls. Psychother Psychosom. , 73(1), 43-52.