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系統識別號 U0026-3007201321162100
論文名稱(中文) 紀錄影片與衛教手冊對早期乳癌婦女手術決策與結果之影響
論文名稱(英文) Documentary and Health Education Brochure on the Decision of Receiving Surgery for Women with Breast Cancer in Early Stage
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 101
學期 2
出版年 102
研究生(中文) 邱幸嬋
研究生(英文) Shing-Charn Chiu
學號 T26981085
學位類別 碩士
語文別 中文
論文頁數 201頁
口試委員 指導教授-徐畢卿
召集委員-温義煇
口試委員-方素瓔
中文關鍵字 乳癌婦女  決策輔助  手術決策  不確定感  紀錄片 
英文關鍵字 Breast cancer women  Decision aids  Decision about treatment  Uncertainty  Documentary 
學科別分類
中文摘要   乳房之於女性,是女性建構自我認同的媒介;隨乳癌罹患率躍升,外科切除乳癌病灶為治療的首選,面臨治療風險的考量、術後非預期成果的負面情緒,以及自我概念圖像改變的困境,將使女性於乳癌手術抉擇上,充斥著不確定性。本研究欲探討於使用不同的決策輔助措施下,對罹患乳癌女性在手術決定成效上的影響。採實驗性研究設計、方便取樣法,於南台灣之二醫學中心,針對首次診斷為第0期至第3A期早期之早期乳癌婦女,隨機分配於三子群;共收案 35 位,30 位個案全程參與,每組各 10 位,以診斷且決行手術當日施予前測、術後一週後測、術後一個月則為追蹤後測;前測後立即施以衛教措施:(一)單一提供乳房手術衛教手冊;(二)單一提供乳癌紀錄片;(三)合併提供乳房手術衛教手冊與乳癌紀錄片;研究工具有,決策衝突量表中文版、決策後悔量表中文版與身體心像量表中文版。因資料屬非常態分佈,故除描述性統計使用次數分佈表、百分比和標準差外,推論性統計使用無母數分析法,卡方檢定、Mann-Whitney U 考驗、Wilcoxon 二樣本考驗、 Kruskal-Wallis單因子等級變異數分析及Friedman 二因子等級變異數分析 。
  研究結果顯示:不同的決策輔助對於決策衝突的成效有影響,且隨時間變化有差異;單一使用乳房手術衛教手冊的整體決策衝突,可於橫斷較其它二組有顯著效果(p=.020),決策附帶作用與副作用衝突改善較乳癌紀錄片成效顯著(p=.009),不確定感的衝突則較合併組有明顯差異(p=.017);單一使用乳癌紀錄片(p=.002)或是合併兩種措施(p=.001),在較長時間的整體決策衝突改善上,改善成效顯著優於乳房手術衛教手冊;乳癌紀錄片可顯著改善資訊獲得(p=.004)、決策附帶作用與副作用(p=.003)、決策過程支持(p=.012)、不確定(p=.018)和有效決策的衝突層面(p=.034),合併組則於資訊獲得(p=.002)、決策附帶作用與副作用(p=.001)、決策過程支持(p=.032)與不確定感層面(p=.003)可獲明顯助益;決策後悔與身體心像,則未有組別或隨時間變化上的差異。此外,進一步將各組決策輔助中,不同術式的手術決定成效上發現,合併使用乳房手術衛教手冊和乳癌紀錄片的個案中,選擇乳房全切除手術者,於較長時間上的決策衝突(p=.003)可得顯著的改善。
  本研究以不同的決策輔助為介入,探究輔助措施對於手術決定成效的影響。除可為罹患乳癌婦女在手術決策的輔助上,帶來降低手術決策衝突的實質幫助,亦可推知現有決策輔助的缺漏,及未來相關資訊或研究的補強,期能藉研究結果,提升罹患乳癌婦女對於疾病與手術的相關資訊、減低手術抉擇的不確定感,進而促使疾病術後的適應與安適。
英文摘要 The women with breast cancer are rapidly increasing. In Taiwan, breast cancer became the 1st common cancer and the 4th leading cause of cancer death for women. Surgery is a main treatment for women with breast cancer. However, limited information and unexpected outcomes after breast surgery were expressed by some of these women. The purpose of this study was to examine the effect of the decision aids including documentary and health education brochure among women with non-metastatic breast cancer.
1. Decision conflict in health education brochure group was significantly lower than the other groups (p=.020), in which conflict on personal value was lower than documentary (p=.009), and conflict on uncertainty about treatment options was lower than both health education brochure and documentary groups (p=.017).
2. The decision conflict on the documentary (p=.002) and both health education brochure and documentary group (p=.001) were significant decreasing in terms of the time. Conflict on feeling informed (p=.004), personal value (p=.003), support in decision making (p=.012), conflict on uncertainty about treatment options (p=.018) and effective decision making (p=.034) were significant decreasing when compared to the baseline data. Conflict on feeling informed (p=.002), value clarity (p=.001), supported (p=.032) and uncertainty (p=.003) were significant decreasing in health education brochure and documentary groups when compared to the baseline data.
3. There was no effect on decision regret and body image in terms of intervention difference and time
The findings from this study help the women with breast cancer to make surgery decision on their own needs and then having lower decisional conflict after the surgery.
論文目次 中文摘要....................................................i
英文摘要..................................................iii
誌謝......................................................vi
第壹章 緒論...............................................1
 第一節 研究背景與重要性.....................................1
 第二節 研究問題描述.........................................4
 第三節 研究目的............................................5
第貳章 文獻回顧............................................6
 第一節 乳房與女體關連之歷史演進...............................6
 第二節 乳癌的歷史─疾病與治療................................10 第三節 乳房重建─失去乳房之輔助..............................17
 第四節 醫療決策輔助( Decision Aids)........................22
第參章 研究方法...........................................28
 第一節 研究方法架構........................................28
 第二節 名詞界定...........................................29
 第三節 研究設計與研究對象...................................33
 第四節 研究工具...........................................36
 第五節 收案過程...........................................40
 第六節 研究倫理...........................................43
 第七節 資料分析方法........................................44
第肆章 研究結果...........................................47
 第一節 人口學屬性、疾病資料與其它干擾變項.....................50
 第二節 決策衝突、決策後悔與身體心像的常態檢定..................61
 第三節 不同決策輔助對決策衝突、決策後悔與身體心像影響之分析......68
 第四節 時間對不同決策輔助介入組別決策衝突、決策後悔與身體心像的影響 ..................................................77
 第五節 不同手術方式在決策衝突、決策後悔與身體心像的影響..........87
 第六節 手術方式對不同決策輔助在決策衝突、決策後悔與身體心像的影響 .................................................101
 第七節 手術方式對時間於不同決策輔助介入組別在決策衝突、決策後悔與身體     心像的影響........................................120
第伍章 討論.............................................138
 第一節 樣本數估算........................................138
 第二節 決策輔助對於罹患乳癌的婦女於決策衝突之影響..............141
 第三節 決策輔助對於罹患乳癌的婦女於決策後悔之影響..............147
 第四節 決策輔助對於罹患乳癌的婦女於身體心像變化感受之影響.......151
第陸章 結論與建議........................................156
 第一節 結論.............................................156
 第二節 研究限制..........................................159
 第三節 未來研究方向.......................................160
參考文獻..................................................161
中文部份..................................................161
英文部份..................................................164
附錄目錄..................................................176
 附錄一 人體試驗委員會同意臨床試驗證明文件....................177
 附錄二 研究參與說明及問卷同意書.............................185
 附錄三 量表使用授權同意書─艾氏人格特質量表...................186
 附錄四 量表使用授權同意書─身體心像量表.......................188
 附錄五 研究問卷..........................................190

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