乳癌病人之社會支持、決策衝突對重建術後憂鬱、焦慮及生活品質相關因素探討

目的：本研究目的為乳癌重建病人術前社會支持、決策衝突及術後生活品質、憂鬱及焦慮相關影響因素之探討，藉此了解乳癌重建病人術前社會支持及決策衝突，是否影響術後憂鬱、焦慮、生活品質之變化及其重要構面。方法：採行回溯性研究 (retrospective study)立意取樣，蒐集台北市某醫學中心自105年4月1日起至107年5月31日止，乳癌切除後立即乳房重建者為研究對象，藉由半結構開放式問卷訪談及問卷填答個人基本資料、決策衝突、社會支持、憂鬱、焦慮、生活品質等量表調查。結果：個人背景因素中的婚姻狀態、家族病史、決定前閱讀重建資料、有無接受醫美重建會談、疾病治療資訊衝突等與術前社會支持及決策衝突有達顯著相關；乳癌外科手術方式、乳房重建距今時間、人身保險、家族病史、家庭總收入、疾病治療資訊衝突等與術後憂鬱、焦慮、生活品質有達顯著相關。各量表中相關性可知社會支持與決策衝突、焦慮、憂鬱與生活品質無顯著相關；決策衝突與焦慮達顯著相關；憂鬱與決策衝突、社會支持無顯著相關；生活品質與憂鬱、焦慮、決策衝突有達顯著相關。結論和建議：接受乳房重建婦女獲得較高的社會支持時，術後憂鬱、焦慮、生活品質狀態也較佳；而減少決策衝突和遺憾，建議醫療人員應先瞭解病人文化水準、教育背景、使用資源能力及其支持系統等背景因素，並提供病友協會及癌症腫瘤心理諮商師主動介入評估等立即性情感性支持，能降低重建術後的憂鬱與焦慮造成生活品質下降的衝擊。也建議政府將乳癌重建納入全民健保給付範圍，避免因自費無法重建，恐導致衍生更多心理層面問題進而浪費更多醫療成本。

關鍵字

乳癌重建；社會支持；決策衝突；憂鬱；焦慮；生活品質

並列摘要

Purpose This study investigates how pre-operative social support impacts post-operative quality of life for breast cancer patients who have undergone reconstruction surgery. Methods A retrospective study was conducted to collect data from a medical center in Taipei City from April 1, 2016 to May 31, 2018. Patients who had breast reconstruction surgery immediately after mastectomy were surveyed using open-ended interviews and questionnaires to gather demographic information and factors related to the patients’ decision-making process, social support structure, and quality of life, including feelings of depression or anxiety. Results Information such as marital status, family medical history, pre-operative knowledge of reconstruction survey, and pre-consultation with a plastic surgeon were significantly associated with pre-operative social support. Breast cancer surgery methods, health insurance, family medical history, family income, pre-operative knowledge of reconstruction surgery are significantly associated with post-operative rates of depression and anxiety in patients. Conclusions and recommendations When women with breast reconstruction receive more social support, post-operative quality of life is better with fewer incidences of depression and anxiety. To help reduce decision-making conflicts for patients, medical professionals should first understand the patient’s social support structure and educational background. If patients do not have pre-operative knowledge of the process or social support, medical professionals should refer the patient to the Association of Patients and Cancer Oncology Counselors for an intervention assessment that can reduce the likelihood of depression and anxiety after reconstruction. It is also recommended that the government include breast cancer reconstruction into the scope of universal health insurance payments. Funding breast reconstruction will lead to fewer long-term psychological problems, which would cost more to treat in the long run.

並列關鍵字

breast cancer reconstruction ； social support ； decision-making conflicts ； depression ； anxiety ； quality of life

參考文獻

黃寶園(2010)。社會支持在壓力反應歷程中的中介效果。 [The Mediatory Effect of Social Support in the Stress-Response Process]。中華心理衛生學刊，23(3)，401-436。

Goel, V., Sawka, C. A., Thiel, E. C., Gort, E. H., & O’Connor, A. M. (2001). Randomized Trial of a Patient Decision Aid for Choice of Surgical Treatment for Breast Cancer. Medical Decision Making, 21(1), 1-6. doi: 10.1177/0272989x0102100101

O’Connor A. M., Tugwell, P., Wells, G. A., Elmslie, T., Jolly, E., Hollingworth, G., …Drake E. (1998). A decision aid for women considering hormone therapy after menopause: Decision support framework and evaluation. Patient Education and Counseling, 33(3), 267-279. doi: 10.1016/S0738-3991(98)00026-3.

英文

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Abbey, A., & Andrew, F.M. (1984). Modeling the psychological determinants of life quality. Social Indicator Research, 16, 1-34.

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乳癌病人之社會支持、決策衝突對重建術後憂鬱、焦慮及生活品質相關因素探討

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