乳癌病人之罹病心理歷程與需求初探

乳癌病人的需求於近幾年來逐漸被重視且多被提出談論的議題。但多以感受的表達與困擾探討，因此，為了更真實的反映初診斷乳癌病人之需求，本論文以首次療程治療中或治療結束後的乳癌病人為對象，透過焦點團體訪談，以回溯性的經驗分享來探討他們對於剛罹病時的需求。本論文是透過中華民國乳癌病友協會的協助下，完成台灣北、中、南部十四場焦點團體訪談，共招募117位病友進行研究。研究目的共分幾部份，首先，了解乳癌病人診斷初期被告知病情的感受與需求；第二部份探討擔憂的本質；第三步驟瞭解治療過程中身心靈社會四部份獲得需求滿足的經驗。訪談之後，將每場焦點團體對話錄音內容轉成逐字稿，依討論內容主題設立分類，依此發展架構，將字句意義予以編碼，進行內容分析，歸納出概念，藉以整理訪談對象的意見與論述。訪談內容經反覆詳細討論與歸類，內容一致性達0.95。本研究整理發現分為九大面向:從發現症狀到診斷的煎熬、乳癌病人面對疾病的衝擊、生理需求、社經需求、心理需求、靈性需求、病友團體介入、衛教需求-病情告知態度、衛教需求-訊息提供。乳癌病人的需求在接受診斷之前已開始發生，醫護團隊不宜忽略家庭、社會關係的影響，從診斷初期，病情告知開始，需求評估亟需啟動並配合個人化需要而透過正確管道提供訊息，此時照護的介入與乳癌團隊的支持能增進醫病關係，如此形成的照護網絡才能有效促使乳癌病人接受治療並完成治療。

關鍵字

乳癌；病友團體；焦點團體；需求；質性研究

並列摘要

The needs of patients with breast cancer in recent years has been gradually being valued and talked about. However, previous studies emphasized more on the expression of feelings and distress. In order to be more reflective of the needs of breast cancer patients at the initial stage of diagnosis, focus group interviews were conducted with patients at the first course or at the end of treatments. Retrospective experiences were shared to explore their needs for the time the illness was diagnosed. This study was completed with the assistance of the China Association of Breast Cancer Patients. A total of 117 patients from northern, central and southern Taiwan were recruited to conduct 14 focus group interviews. The purposes were as following. First, to understand the feelings and the needs of breast cancer patients at the early stage of diagnosis. The second part was regarding the nature of the concerns. The third part was regarding the experience of the fulfillment of the needs of physical, mental, spiritual and social aspects. All interviews were tape-recorded and the transcripts were content analyzed. The inter-coder reliability reached 0.95. Findings of the themes extracted from this study were as following: (1).From the discovery of symptoms to the diagnosis and suffering, (2).facing the impact of the disease, (3). physiological needs, (4)social needs, (5).psychological needs, (6).spiritual needs, (7).patient groups involved, (8).need for health education-attitude of informing disease, (9). Need for health education –contents of information. The needs of breast cancer patients began before the disease diagnosed. It is not appropriate to ignore the effects of family and social relationships. Medical care providers should implement the needs assessment right after the disease was diagnosed and the patients was informed. Also, they should provide tailed message through appropriate channels. Only after these measures were taken, doctor-patient relationship can be improved with medical intervention and support from treatment groups. In addition, the formation of the care networks can effectively encourage breast cancer patients to receive treatment and complete the treatment. assessment right after the disease was diagnosed and the patients was informed. Also, they should provide tailed message through appropriate channels. Only after these measures were taken, doctor-patient relationship can be improved with medical intervention and support from treatment groups. In addition, the formation of the care networks can effectively encourage breast cancer patients to receive treatment and complete the treatment.