早期乳癌婦女憂鬱程度與生活品質相關因素探討-以中部某區域醫院為例

Exploration of Relevant Factors between Degree of Depression and Quality of Life of Women with Early Stage Breast Cancer—Taking A District Hospital in Central Taiwan as An Example

程雪敏(Hsueh-Ming Cheng)

指導教授 ： 黃心樹

中臺科技大學/護理學院/護理研究所/碩士(2011年)

摘要

乳癌對於女性來說佔癌症發生率的第一位。乳癌病人所感受的憂鬱狀態是所有癌症病人中的第三位。而憂鬱症會降低個案對醫療的參與性，增加住院日數、增加醫療成本、降低自我照顧能力、使疾病病程惡化、性慾降低、降低生活品質與存活率。本研究旨在探討早期乳癌婦女人口學、疾病特性、憂鬱程度與生活品質的現況和變項間之相關性。採橫斷式研究設計，以中部某區域醫院門診接受追蹤治療的乳癌個案為研究樣本，以貝克憂鬱量表第二版中文版、台灣簡明版世界衛生組織生活品質橫斷式問卷調查與紀錄最近一次的腫瘤標誌CA15-3檢驗值進行資料收集。回收有效樣本95份，回收率為80.5%。將收集所得資料以SPSS forWindow 18.0軟體進行次數、百分比、平均值、標準差及t檢定、單因子變異數分析、皮爾森基差相關及階層迴歸分析，找出影響早期乳癌婦女生活品質之預測因子。
研究結果顯示：早期乳癌婦女憂鬱總分平均分數為 9.02 分，正常範
圍得分有71位佔74.7%；輕度憂鬱得分有18位佔18.9%；中度憂鬱得分有4位佔4.2%；嚴重憂鬱得分有2位佔2.1%。早期乳癌婦女生活品質總平均值為97.14分，顯示本研究的早期乳癌婦女之生活品質達中上程度；而四大範疇顯示以環境範疇得分最高，社會關係範疇得分最低分。人口學特性對於憂鬱程度達顯著差異而疾病特性無顯著差異。人口學特性及疾病特性對於生活品質四範疇皆達顯著差異。憂鬱程度對於生活品質為顯著負相關。早期乳癌婦女的年齡、自覺個人健康狀況、自覺整體生活快樂狀況、腫瘤標誌及憂鬱程度皆能顯著預測生活品質，其中又以憂鬱程度有較高的預測力。
因此本研究提出三項乳癌婦女臨床護理照顧的建議：一、臨床個案管理師應主動關心個案的身心困擾 ，如有問題時能馬上獲得專業照護諮詢和生活困擾上的協助，多辦理兩性關係講座及病友團體心得分享座談活動，鼓勵個案走出乳癌的陰影，積極參與病友會等社交活動。二、教育個案勇於表達疼痛，並且導正病人對於止痛藥的錯誤觀念，臨床上以減輕病人生理上症狀困擾為首要任務，進而改善睡眠品質。三、提供護理人員多專科在職教育及多能工之跨科交叉訓練，增強其專業性及自主性，以期及早發現問題並促進乳癌婦女之身心健康，或做適當的轉介，期待提昇乳癌個案的照護品質，並且增加本院癌症醫療照顧服務之競爭優勢。

關鍵字

憂鬱 ； 生活品質 ； 乳癌

並列摘要

Breast cancer for women comes first in the incidence of cancers. The depression state felt by the breast cancer patients comes third when compared to all of the other cancer patients. Depression causes a decrease in the willingness of an individual to participate in the medical care, increases the length of stay in a hospital, increases health care costs, decreases the ability of one to look after oneself, deteriorates the course of a disease, decreases quality of life and survival rate as well. The aim of this research is to investigate the women population for early breast cancer, disease characteristics, state of depression, and the correlation between the current status of the quality of life and the variables. The design of the research adopts cross-section method, and takes an outpatient unit of a hospital somewhere in the mid region to follow up on cases of breast cancers to be the sample for this research. To carry out with the data collection, the Chinese version of the Beck Depression Inventory Ⅱ, the cross-section questionnaire of the quality of life for the World Health Organization Taiwan concise version, and the last record of the tumor marker CA15-3 investigation are used. There are 95 effective sample recovered, and the rate of recovery is 80.5%. The SPSS forWindow 18.0 software is used to test for the frequency, percentage, means, standard deviation and t-tests, ANOVA analysis, Pearson correlation and level regression analysis, in an attempt to find the predictors affecting the quality of life for the women in early breast cancers.
The findings of the research have shown: the average score of the total for the women in early breast cancers in depression is 9.02, there are 71 individuals scored within the normal range and covered 74.7%; 18 individuals scored in the mild depression range and covered 18.8%; 4 individuals scored in the moderate depression range and covered 4.2%; 2 individuals scored in the severe depression range and covered 2.1%. The total average value of the quality of life for the women in early breast cancer is 97.14, which indicates that he quality of life for the women in early breast cancer in this research achieved a level well above the middle range. As with the four areas, the environmental area has come on top, and the area of the social relation has scored the lowest. The characteristics of demographics for the degree of depression have achieved significant difference, while the characteristics of disease have caused no significant difference. Both the characteristics of the demographics and disease for the four areas in the quality of life have caused no significant difference. The status of depression has caused a significant negative correlation for the quality of life. The age, personal health conscious status, personal overall life-happiness status, tumor marker and the degree of depression can all be used to significantly predict the quality of life, and out of all the abovementioned predictors, the degree of depression possesses higher predictive power.
Therefore, this research has proposed three suggestions of the clinical medical care for the women in breast cancer: 1. the clinical case manager responsible for the clinical case should care actively about the physical and mental problems of the individual involved, if problems arise, patients should be able to obtain professional caring consultation, and the assistance for the problems in life, lectures for gender relations and the discussion activities of the experience-sharing for the patient groups should be held more often to encourage individuals walk out of the shadow of breast cancers. 2. Individuals should be taught to express pains with hesitation, and misconceptions of patients about painkillers should be corrected, and clinically speaking, the primary job is to ease the physical symptom distress for the patient, so that the quality of sleep can be improved. 3. Multidisciplinary in-service education and interdisciplinary cross-training of multiple tasks for the nursing staff should be provided, in order to elevate their autonomy and professionalism, so that the problems can be detected earlier, mental and physical health for the women in breast cancer can also be promoted, or appropriate referral should be done. It is to expect that the care quality of the breast cancer cases can be raised, and in doing so, increase the competitive advantage of this hospital in health care service for cancer patients.

並列關鍵字

breast cancer ； depression ； quality of life

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