身心靈賦能暨衛教團體對乳癌患者成效之初探

A Study on Efficacy of Body-Mind-Spirit Empowerment and Education Group for Women with Breast Cancer：A Pilot Study

蘇美雅(Mei-Ya Su)

指導教授 ： 熊秉荃

國立臺灣大學/醫學院/護理學研究所/碩士(2008年)

https://doi.org/10.6342/NTU.2008.10610

摘要

目的：本研究目的(1)了解身心靈賦能暨衛教團體對於降低乳癌婦女焦慮和身心靈鬱結狀態之效果，以及(2)乳癌婦女對於團體治療如何產生療效之主觀看法。
方法：本研究採隨機控制試驗(randomized controlled trial)設計。於2007年10月至2008年4月於台北市某醫學中心乳癌外科門診和乳癌基金會收案，以單純隨機方式將研究對象分成實驗組和控制組，最後完成研究的人數實驗組為11人，控制組為10人。實驗組除了接受醫院例行性門診照護外，另有8週精神科護理人員和腫瘤科護理人員共同帶領的身心靈賦能暨衛教團體，每週一次，一次團體120分鐘。對照組僅接受醫院門診的例行性照護。成效測量以結構式自填量表，於實驗前後測量，測量量表為「焦慮狀態量表」、「鬱結量表」。實驗組個案於最後一次團體時，以半結構式訪談團體成員，所獲得的質性資料來了解產生療效的過程。
結果：經研究結果所收集資料顯示，實驗組和控制組之鬱結和焦慮狀態量表分數於八週實驗後皆有下降情形。經Mann-Whitney U test 檢定兩組前後進步值，發現兩組於鬱結量表(Z = -.353，p=.756)，焦慮狀態量表(Z= -.388，p= .705)，並無顯著差異。質性結果發現，乳癌患者身體困擾包括疲倦、失眠、疼痛、和手活動受限。心理困擾有焦慮、情緒低落、無望感。靈性困擾包含自責、質疑生命存在的意義、覺得自己是孤獨的。分析乳癌患者對於身心靈賦能暨衛教團體療效機轉的看法共產生7個療效層面：傳達資訊、灌輸希望、普同感、情緒宣洩、社交技巧發展、存在因素和自我了解。結果說明藉由團體療效機轉的產生，降低乳癌患者焦慮、改善情緒低落和對於疾病的不確定感、增加對疾病復原信心、知覺生命是有希望的、重建社交網絡和重新面對自己找回生命意義和目標。
結論：精神科和腫瘤科護理人員合作之身心靈賦能暨衛教團體，可藉由精神科護理人員運用其團體治療的知識及身心靈賦能的技能，使乳癌婦女感受團體成員支持力量，並提升自我內在正向的力量。腫瘤科護理人員運用其腫瘤專業領域，提供關於疾病之相關衛教知識，以改善乳癌婦女身心靈的困擾。未來研究可根據此模式加以擴大研究樣本以檢驗其效果。

關鍵字

乳癌婦女 ； 身心靈賦能暨衛教團體 ； 鬱結 ； 焦慮

並列摘要

Aims：The aims of this study were to understand (1) the effects of body-mind-spirit empowerment and education group on reducing the sense of anxiety and status of stagnation for women with breast cancer, and to examine (2) what aspects of group therapy worked to contribute to the therapeutic effects in the views of women with breast cancer.
Methods：This study was a randomized controlled trail design. The subjects were recruited from outpatient department of breast cancer surgery of medical centre in Taipei and Foundation of Breast Cancer Prevention and Treatment from October 2007 to April 2008. The subjects were randomly assigned to the experimental or the control group by using simple random method. The eleven subjects in the experimental group and the ten subjects in the control group completed this study. The subjects in the experimental group received both the physician’s usual care of the outpatient department and the eight-session group therapy, with each session lasting for 120 minutes weekly. The group therapy was provided by one psychiatric nurse and one oncology nurse. The subjects in the control group received physician’s usual care of the outpatient department only. The outcome measures included State Anxiety Inventory and Stagnation Scale and they were assessed at pre and post treatments. In the last session of group therapy, the subjects in the experimental group were invited to participate in a semi-structured interview regarding their views on the therapeutic mechanisms of group therapy.
Results：The scores of the scale of State Anxiety Inventory and Stagnation Scale after 8-week trial were reduced in the both the experimental and control groups. According to Mann-Whitney U test, the results indicated that there were no significant differences in changing the scores of Stagnation Scale (Z = -.353, p=.756) and State Anxiety Inventory (Z= -.388, p= .705) after treatment between the experimental group and the control group. In the views of women with breast cancer, their physical distress included fatigue, insomnia, pain and decreased activity function of hands. The psychological distress included the senses of anxiety, depression, and hopelessness. The spirits distress included self-blame, doubt about the meanings of life, and sense of being alone. There were seven domains of the therapeutic factors of the body-mind-spirit empowerment and education group: imparting of information, instillation of hope, university, catharsis, interpersonal learning, existential factors and self-understanding. The results indicated that through emerged therapeutic factors, the group effectively reduced the senses of anxiety, depression, and uncertainty, increased the confidence about illness recovery, improved the sense of hope toward the future life, established social support network, and discovered the meanings and the purposes of life.
Conclusion: By the psychiatric nurse’s cooperation with oncology nurse in the body-mind-spirit empowerment and education group, the psychiatric nurse’s knowledge about group therapy and empowerment skills help breast cancer women to obtain supports from group members and to strengthen their inner self positive power. The oncology nurse’s knowledge about cancer care helps to decrease body-mind-spirit distress. The future may enlarge the size of sample in order to demonstrate the effects of the body-mind-spirit empowerment and education group.

並列關鍵字

women with breast cancer ； body-mind-spirit empowerment and education group ； stagnation ； anxiety

參考文獻

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