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題名 自我效能對乳癌病人生活品質的影響 ─ 術前心理健康衛教團體之追蹤研究
The Relationship between Self-Efficacy and Quality of Life among Patients with Breast Cancer: A Longitudinal Study of the Preoperational Psychoeducation Program作者 吳文珺
Wu, Wen-Chun貢獻者 吳治勳
吳文珺
Wu, Wen-Chun關鍵詞 自我效能
生活品質
乳癌
追蹤研究
術前心理衛教
cancer self-efficacy
quality of life
breast cancer
longitudinal study
pre-surgical psychoeducation日期 2020 上傳時間 3-Aug-2020 17:55:10 (UTC+8) 摘要 研究背景:乳癌病人的照護一直是十分值得關注的重要議題。過去已有許多研究指出,自我效能在乳癌病人的身心適應歷程中扮演著相當關鍵的角色,且透過臨床心理的介入,乳癌病人的癌症因應自我效能可獲得有效的提升,其生活品質亦能有所進步。然而,台灣目前仍然缺乏相關臨床研究。故本研究嘗試將自我效能的概念落實於台灣乳癌病人的臨床心理照護,藉由追蹤研究,探討以自我效能理論為基礎之心理介入是否能提升台灣乳癌病人的癌症因應自我效能,並藉此改善其生活品質。研究方法:本研究以北部某醫學中心之158位乳癌病人為研究對象,首先翻譯、編制量測癌症因應自我效能的短版癌症行為量表(Cancer Behavior Inventory, CBI-B)為台灣中文版,並建立其信度與效度。心理介入部份為則於手術前一日為乳癌病人提供單次的術前心理健康衛教團體,並評估其團體前後的癌症因應自我效能與術後1、3、6個月的生活品質。以相依樣本t檢定檢驗病人癌症因應自我效能在心理衛教團體前後的變化,並以路徑分析檢驗心理衛教團體前後之癌症因應自我效能與術後1、3、6個月之生活品質間的關係。研究結果:(1) 中文版短版癌症行為量共包含「個人效能」與「社會效能」兩個因素,具有良好的信度、建構效度與同時效標關聯效度。(2) 乳癌病人的癌症因應自我效能在術前心理健康衛教團體後有顯著的提升。(3) 對於51歲以上或心理衛教團體前情緒壓力小於7分之乳癌病人而言,「團體後的個人 / 社會效能」多能完全中介「團體前個人 / 社會效能」與「術後1個月生活品質」間的關係,但在「團體前個人 / 社會效能」與「術後3 / 6個月生活品質」的關係間多無顯著的中介效果。而對於50歲以下或心理衛教團體前情緒壓力達7分以上之乳癌病人而言,「團體後的個人 / 社會效能」在「團體前個人 / 社會效能」與「術後1 / 3 / 6個月生活品質」的關係間多無顯著的中介效果。結論與討論:(1) 中文版短版癌症行為量表是評估乳癌病人癌症因應自我效能的良好工具,可應用於相關研究及臨床服務。(2) 以自我效能理論為基礎的心理衛教團體可於有限的時間內有效提升乳癌病人的癌症因應自我效能,在步調急促的醫療環境下,是快速、有效的臨床介入模式。(3) 本研究中的心理衛教團體可能藉由提升癌症因應自我效能,改善年紀較長或情緒壓力較低之乳癌病人的短期生活品質,但其效果隨時間遞減;對較年輕或高情緒壓力病人之生活品質帶來的助益則較不顯著。若希望能更有效、更長期提升乳癌病人的生活品質,後續應需要更多癌症臨床心理介入模式之相關研究。
Background: Psychological care for breast cancer patients has been an issue that deserves attention. Previous studies have pointed out that self-efficacy is critical to patients` adjustment to breast cancer, and psychological interventions can improve patients` self-efficacy for coping with cancer and, in turn, promote their quality of life. However, there is limited research on the effect of psychological interventions on self-efficacy for coping with cancer and the relationship between self-efficacy and quality of life in Taiwan. Therefore, the present longitudinal study aims to investigate if a psychological intervention based on self-efficacy theory can improve breast cancer patients` self-efficacy for coping with cancer and quality of life.Method: A total of one hundred and fifty-eight breast cancer patients were recruited from a medical center in northern Taiwan. The Cancer Behavior Inventory (CBI-B) was translated into Traditional Chinese (Taiwan) for measuring the self-efficacy for coping with cancer and evaluated in terms of reliability and validity. All participants were invited to a preoperational psychoeducation group a day before surgery. Cancer self-efficacy was measured pre-and-post group, and quality of life(QoL) was measured at 1, 3, and 6 months post-surgery. Paired sample t-tests were used to examine the change of cancer self-efficacy pre-and-post the psychoeducation group. Path analysis was used to explore the relationship between participants` self-efficacy for coping with cancer and QoL.Results: (1) The Taiwan version CBI-B, containing two factors, "personal self-efficacy" and "social self-efficacy," is a reliable and valid measure of self-efficacy for coping with cancer. (2) Breast cancer patients` cancer self-efficacy improved significantly after the preoperational psychoeducation group. (3) For patients "aged 51 years and older" or "with emotional distress (DT) score lower than 7", the post-group personal/social self-efficacy can fully mediate the relationship between pre-group personal/social self-efficacy and most domains of the QoL at 1-month post-surgery. However, the post-group personal/social self-efficacy did not mediate the relationship between pre-group personal/social self-efficacy and most QoL domains at 3- or 6-month post-surgery. Furthermore, for patients "aged 50 years and younger" or "with DT score 7 or higher", post-group cancer self-efficacy did not mediate the relationship between pre-group personal/social self-efficacy and most domains of the QoL at 1-, 3- and 6-month post-surgery.Discussion: (1) The Taiwan version CBI-B has proper psychometric properties and is suitable for research and clinical use. (2) The psychoeducation group based on self-efficacy theory can effectively improve breast cancer patients` cancer self-efficacy within a short time (30-60 mins). In fast-paced clinical settings, it is a practical and feasible psychological intervention program. (3) The psychoeducation group can promote the QoL at 1-month post-surgery for those older or less distressed breast cancer patients by improving their cancer self-efficacy, but its effect decreases with time. However, the effects of the psychoeducation on the QoL were insignificant for those younger or more distressed breast cancer patients. More researches on psychological interventions for cancer patients are needed to improve and prolong the effect on breast cancer patients` QoL.參考文獻 李作英、周桂如、穆佩芬、李惠玲、葉美玲(2012)。初診斷乳癌婦女其壓力感受。腫瘤護理雜誌,12(2),25-36。李昀芷(2019)。癌症病人術前憂慮量表之編製與心理計量特性(未出版之碩士論文)。國立政治大學,台北市。吳英璋(2007)。天然災難下防治心理創傷措施的建構與落實──總計畫暨子計畫:宗教系統於災難下防治心理創傷模式之探討與落實(I)。行政院國家科學委員會專題研究成果報告(編號:NSC95-2625-Z002-013 ),未出版。吳英璋、金樹人、許文耀(1991)。面對壓力-身心檢康手冊(高中職教師)(第一版)。台北市:教育部訓育委員會。李婉華(譯)(2002)。乳癌(原作者:R. Buckman & T. Whittaker)。台北市:智庫文化。(原著出版年:1999)姚開屏(2001)。台灣簡明版世界衛生組織生活品質問卷之發展及使用手冊。台北:台灣版世界衛生組織生活品質問卷發展小組姚開屏(2002)。台灣版世界衛生組織生活品質問卷之發展與應用。臺灣醫學,6,193-200。doi:10.6320/FJM.2002.6(2).09陳惠美、馬鳳歧、郭英調、石宜銘(1999)。乳癌術後婦女身心社會調適之探討──以羅氏適應模式為基礎。護理研究,7,321-332。doi:10.7081/NR.199908.0321游子覺(2013)。抗癌基本功。載於陳葵(責任編輯),知己知彼話乳癌。(19-41頁)。香港:明窗出版社。鄭逸如、何雪綾、陳秀蓉(2017)。醫病溝通之鑰:醫療人員同理心五大心法。台北市:五南圖書出版股份有限公司。衛生福利部國民健康署(2018):中華民國105年癌症登記報告。取自https://www.hpa.gov.tw/Home/Index.aspxBadana, A. N. S., Marino, V. R., Templeman, M. E., McMillan, S. C., Tofthagen, C. S., Small, B. J., & Haley, W. E. (2019). Understanding the roles of patient symptoms and subjective appraisals in well-being among breast cancer patients. Supportive Care in Cancer, 27, 4245-4252. doi: 10.1093/geroni/igy023.1048Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological Review, 84, 191-215. doi: 10.1016/0146-6402(78)90002-4Bandura, A. (1986). Social foundations of thought and action: a social cognitive theory. New Jersey, NJ: Prentice-Hall.Bandura, A. (1998). Health promotion from the perspective of social cognitive theory. Psychology and Health, 13, 623-649. doi: 10.1080/08870449808407422Baucom, D. H., Porter, L. S., Kirby, J. S., Gremore, T. M., & Keefe, F. J. (2006). Psychosocial issues confronting young women with breast cancer. Breast Disease, 23, 103-113. doi: 10.3233/BD-2006-23114Beatty, L., Kemp, E., Butow, P., Girgis, A., Schofield, P., Turner, J., …Koczwara, B. (2018). A systematic review of psychotherapeutic interventions for women with metastatic breast cancer: context matters. Psycho‐Oncology, 27, 34-42. doi: 10.1002/pon.4445Beckham, J. C., Burker, E. J., Lytle, B. L., Feldman, M. E., & Costakis, M. J. (1997). Self-efficacy and adjustment in cancer patients: a preliminary report. Behavioral Medicine, 23, 138-142. doi: 10.1080/08964289709596370Burgess, C., Cornelius, V., Love, S., Graham, J., Richard, M., & Ramirez, A. (2005). Depression and anxiety in women with early breast cancer: five year observational cohort study. British Medical Journal, 330, 702-705. doi: 10.1136/bmj.38343. 670868.D3Carver, C. S. (1997). You want to measure coping but your protocol’s too long: consider the Brief Cope. International journal of behavioral medicine, 4, 92-100. doi: 10.1207/s15327558ijbm0401_6Chirico, A., Serpentini, S., Merluzzi, T., Mallia, L., Bianco, P. D., Martino, R., …Giordano, A. (2017). Self-efficacy for coping moderates the effects of distress on quality of life in palliative cancer care. Anticancer research, 37, 1609-1615. doi: 10.21873/anticanres.11491Cunningham, A. J., Lockwood, G. A., & Cunningham, J. A. (1991). A relationship between perceived self-efficacy and quality of life in cancer patients. Patient Education and Counseling, 17, 71-78. doi: 10.1016/0738-3991(91)90052-7D’errico, G. M., Galassi, J. P., Schanberg., R., & Ware, W. B. (2000). Development and validation of the Cancer Worries Inventory. Journal of Psychosocial Oncology, 17, 119-137. doi: 10.1300/J077v17n03_07De Boer, M. F., Van den Borne, B., Pruyn, J. F. A., Ryckman, R. M., Volovics, L., Knegt, P. P., …Verwoerd, C. D. A. (1998). Psychosocial and physical correlates of survival and recurrence in patients with head and neck carcinoma: results of a 6-year longitudinal study. Cancer, 83, 2567-2579. doi: 10.1034/j.1399-0020.2000.290317-3.xEpplein, M., Zheng, Y., Zheng, W., Chen, Z., Gu, K., Penson, D., …Shu, X-O. (2011). Quality of life after breast cancer diagnosis and survival. Journal of Clinical Oncology, 29, 406-412. doi: 10.1200/JCO.2010.30.6951Germino, B. B., Mishel, M. H., Crandell, J., Porter, L. Blyler, D., Jenerette, C., & Gil, K. M. (2013). Outcomes of an uncertainty management intervention in younger African American and Caucasian breast cancer survivors. Oncology Nursing Forum, 40, 82-92. doi: 10.1188/13.ONF.82-92Graves, K. D. (2003). Social cognitive theory and cancer patients’ quality of life: a meta-analysis of psychosocial intervention components. Health Psychology, 22, 210–219. doi: 10.1037/0278-6133.22.2.210Gwaltney, C. J., Metrik, J., Kahler, C. W., & Shiffman, S. (2009). Self-efficacy and smoking cessation: a meta-analysis. Psychology of Addictive Behaviors, 23, 56-66. doi: 10.1037/a0013529Heitzmann, C. A., Merluzzi, T. V., Jean-Pierre, P., Roscoe, J. A., Kirsh, K. L., & Passik, S. D. (2011). Assessing self-efficacy for coping with cancer: development and psychometric analysis of the brief version of the Cancer Behavior Inventory (CBI-B). Psycho-Oncology, 20, 302-312. doi: 10.1002/pon.1735Hu, L-t., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1-55. doi: 10.1080/10705519909540118Kline, R. B. (2005). Principles and practice of structural equation modeling. New York, NY: Guilford Press.Kreitler, S., Peleg, D., & Ehrenfeld, M. (2007). Stress, self-efficacy and quality of life in cancer patients. Psycho-Oncology, 16, 329-341. doi: 10.1002/pon.1063Lam, W. W. T., & Fielding, R. (2007). Is self-efficacy a predictor of short-term post-surgical adjustment among Chinese women with breast cancer? Psycho-Oncology, 16, 651-659. doi: 10.1002/pon.1116Lev, E. L., Paul, D., & Owen, S. V. (1999). Age, self-efficacy, and change in patients` adjustments to cancer. Cancer Practice, 7(4), 170-176. doi: 10.1046/j.1523-5394.1999.74004.xLev, E. L., Daley, K. M., Conner, N. E., Reith, M., Fernandez, C., & Owen, S. V. (2001). An intervention to increase quality of life and self-care self-efficacy and decrease symptoms in breast cancer patients. Scholarly Inquiry for Nursing Practice, 15, 277-294. doi: 10.1891/0889-7182.15.3.277Liang, S. Y., Chao, T. C., Tseng, L. M., Tsay, S. L., Lin, K. C., & Tung, H. H. (2016). Symptom-management self-efficacy mediates the effects of symptom distress on the quality of life among Taiwanese oncology outpatients with breast cancer. Cancer Nursing, 39, 67-73. doi: 10.1097/NCC.0000000000000244Luszczynska, A., Mohamed, N. E., & Schwarzer, R. (2005). Self-efficacy and social support predict benefit finding 12 months after cancer surgery: the mediating role of coping strategies. Psychology, Health & Medicine, 10, 365-375. doi: 10.1080/13548500500093738MacKinnon, D. (2012). Introduction to statistical mediation analysis. Retrieved from https://www.routledge.com/Introduction-to-Statistical-Mediation-Analysis/MacKinnon/p/book/9780203809556 (Original work published 2008)Manne, S. L., Ostroff, J. S., Norton, T. R., Fox, K., Grana, G., & Goldstein, L. (2006). Cancer-specific self-efficacy and psychosocial and functional adaptation to early stage breast cancer. Annals of Behavioral Medicine, 31, 145-154. doi: 10.1207/s15324796abm3102_6Matthews, H., Grunfeld, E. A., & Turner, A. (2017). The efficacy of interventions to improve psychosocial outcomes following surgical treatment for breast cancer: a systematic review and meta-analysis. Psycho-oncology, 26, 593-607. doi: 10.1002/pon.4199Mitchell, A. J., Baker-Glenn, E. A., Granger, L., & Symonds, P. (2010). Can the Distress Thermometer be improved by additional mood domains? Part I. Initial validation of the Emotion Thermometers tool. Psycho-Oncology, 19, 125-133. doi: 10.1002/pon.1523Mitchell, A. J., Baker-Glenn, E. A., Park, B., Granger, L., & Symonds, P. (2010). Can the Distress Thermometer be improved by additional mood domains? Part II. What is the optimal combination of Emotion Thermometers? Psycho-Oncology, 19, 134-140. doi:10.1002/pon.1557Mols, F., Vingerhoets, A. J. J. M., Coebergh, J. W., & van de Poll-Franse, L. V. (2005). Quality of life among long-term breast cancer survivors: a systematic review. European Journal of Cancer, 41, 2613-2619. doi: 10.1016/j.ejca.2005.05.017Montazeri, A. (2008). Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. Journal of Experimental & Clinical Cancer Research, 27, 32-62.doi: 10.1186/1756-9966-27-32Nafradi, L., Nakamoto, K., & Schulz, P. J. (2017). Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One, 12, e0186458. doi: 10.1371/journal. pone.0186458National Comprehensive Cancer Network. (2017). NCCN Practice Guidelines in Oncology—V. 2.2017, Distress Management. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/distress.pdfPaek, M-S., Ip, E. H., Levine, B., & Avis, N. E. (2016). Longitudinal reciprocal relationships between quality of life and coping strategies among women with breast cancer. Annals of Behavioral Medicine, 50, 775-783. doi:10.1007/s12160-016-9803-y.Roth, A. J., Kornblith, A. B., Batel-Copel, L., Peabody, E., Scher, H. I., & Holland, J. C. (1998). Rapid screening for psychologic distress in men with prostate carcinoma. Cancer, 82, 1904-1908. doi: 10.1002/(SICI)1097-0142(19980515)82:10<1904::AID-CNCR13>3.0.CO;2-XRottmann, N., Dalton, S. O., Christensen, J., Frederiksen, K., & Johansen, C. (2010). Self-efficacy, adjustment style and well-being in breast cancer patients: a longitudinal study. Quality of Life Research, 19, 827-836. doi: 10.1007/s11136-010-9653-1Schnoll, R. A., Harlow, L. L., Stolbach, L. L., & Brandt, U. (1998). A structural model of the relationships among stage of disease, age, coping, and psychological adjustment in women with breast cancer. Psycho-Oncology, 7, 69-77. doi: 10.1002/(SICI)1099-1611(199803/04)7:2<69::AID-PON286>3.0.CO;2-8Sheard, T., & Maguire, P. (1999). The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. British journal of cancer, 80, 1770-1780. doi: 10.1038/sj.bjc.6690596Sheeran, P., Maki, A., Montanaro, E., Avishai-Yitshak, A., Bryan, A., Klein, W. M. P., …Rothman, A. J. (2016). The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: a meta-analysis. Health Psychology, 35, 1178-1188. doi: 10.1037/hea0000387Shelby, R. A., Edmond, S. N., Wren, A. A., Keefe, F. J., Peppercorn, J. M., Marcom, P. K., …Kimmick, G.G. (2014). Self-efficacy for coping with symptoms moderates the relationship between physical symptoms and well-being in breast cancer survivors taking adjuvant endocrine therapy. Support Care Cancer, 22, 2851-2859. doi: 10.1007/s00520-014-2269-1Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychological methods, 7, 422-445.Silver, J. K., & Baima, J. (2013). Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. American Journal of Physical Medicine & Rehabilitation, 92, 715-727. doi: 10.1097/PHM.0b013e31829b4afeStiegelis, H. E., Hagedoorn, M., Sanderman, R., Bennenbroek, F. T. C., Buunk, B. P., van den Bergh, A. C. M., …Ranchor, A. V. (2004). The impact of an informational self-management intervention on the association between control and illness uncertainty before and psychological distress after radiotherapy. Psycho-Oncology, 13, 248-259. doi: 10.1002/pon.738Vickberg, S. M. J. (2001). Fears about breast cancer recurrence: interviews with a diverse sample. Cancer Practice, 9, 237-243. doi: 10.1046/j.1523-5394.2001.009005237.xWang, A. W. T., Cheng, C. P., Chang, C. S., Chen, D. R., Chen, S. T., Shieh, V., . . . Hsu, W. Y. (2018). Does the factor structure of the Brief COPE fit different types of traumatic events? A test of measurement invariance. European Journal of Psychological Assessment, 34, 162-173. doi:10.1027/1015-5759/a000321Wang, G. L., Hsu, S. H., Feng, A. C., Chiu, C. Y., Shen, J. F., Lin, Y. J., & Cheng, C. C. (2011). The HADS and the DT for screening psychosocial distress of cancer patients in Taiwan. Psycho-Oncology, 20, 639-646. doi: 10.1002/pon.1952Wong-Kim, E. C., & Bloom, J. R. (2005). Depression experienced by young women newly diagnosed with breast cancer. Psycho-Oncology, 14, 564-573. doi: 10.1002/pon.873Yan, B., Yang, L. M., Hao, L. P., Yang, C. Quan, L., Wang, L. H., …Yuan, J. M. (2016). Determinants of quality of life for breast cancer patients in Shanghai, China. PLoS ONE, 11, e0153714. doi:10.1371/journal.pone.0153714Yao, G., Chung, C. W., Yu, C. F., & Wang, J. D. (2002). Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version. Journal of the Formosan Medical Association, 101, 342-351.Zhang, M., Chan, S. W., You, L., Wen, Y., Peng, L., Liu, W., & Zheng, M. (2014). The effectiveness of a self-efficacy-enhancing intervention for Chinese patients with colorectal cancer: a randomized controlled trial with 6-month follow up. International Journal of Nursing Studies, 51, 1083-1092. doi: 10.1016/j.ijnurstu.2013.12.005Zhang Y, Kwekkeboom K., & Petrini, M. (2015). Uncertainty, self-efficacy, and self-care behavior in patients with breast cancer undergoing chemotherapy in China. Cancer Nursing, 38(3), 19-26. doi: 10.1097/NCC.0000000000000165 描述 碩士
國立政治大學
心理學系
105752007資料來源 http://thesis.lib.nccu.edu.tw/record/#G0105752007 資料類型 thesis dc.contributor.advisor 吳治勳 zh_TW dc.contributor.author (Authors) 吳文珺 zh_TW dc.contributor.author (Authors) Wu, Wen-Chun en_US dc.creator (作者) 吳文珺 zh_TW dc.creator (作者) Wu, Wen-Chun en_US dc.date (日期) 2020 en_US dc.date.accessioned 3-Aug-2020 17:55:10 (UTC+8) - dc.date.available 3-Aug-2020 17:55:10 (UTC+8) - dc.date.issued (上傳時間) 3-Aug-2020 17:55:10 (UTC+8) - dc.identifier (Other Identifiers) G0105752007 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/131095 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 心理學系 zh_TW dc.description (描述) 105752007 zh_TW dc.description.abstract (摘要) 研究背景:乳癌病人的照護一直是十分值得關注的重要議題。過去已有許多研究指出,自我效能在乳癌病人的身心適應歷程中扮演著相當關鍵的角色,且透過臨床心理的介入,乳癌病人的癌症因應自我效能可獲得有效的提升,其生活品質亦能有所進步。然而,台灣目前仍然缺乏相關臨床研究。故本研究嘗試將自我效能的概念落實於台灣乳癌病人的臨床心理照護,藉由追蹤研究,探討以自我效能理論為基礎之心理介入是否能提升台灣乳癌病人的癌症因應自我效能,並藉此改善其生活品質。研究方法:本研究以北部某醫學中心之158位乳癌病人為研究對象,首先翻譯、編制量測癌症因應自我效能的短版癌症行為量表(Cancer Behavior Inventory, CBI-B)為台灣中文版,並建立其信度與效度。心理介入部份為則於手術前一日為乳癌病人提供單次的術前心理健康衛教團體,並評估其團體前後的癌症因應自我效能與術後1、3、6個月的生活品質。以相依樣本t檢定檢驗病人癌症因應自我效能在心理衛教團體前後的變化,並以路徑分析檢驗心理衛教團體前後之癌症因應自我效能與術後1、3、6個月之生活品質間的關係。研究結果:(1) 中文版短版癌症行為量共包含「個人效能」與「社會效能」兩個因素,具有良好的信度、建構效度與同時效標關聯效度。(2) 乳癌病人的癌症因應自我效能在術前心理健康衛教團體後有顯著的提升。(3) 對於51歲以上或心理衛教團體前情緒壓力小於7分之乳癌病人而言,「團體後的個人 / 社會效能」多能完全中介「團體前個人 / 社會效能」與「術後1個月生活品質」間的關係,但在「團體前個人 / 社會效能」與「術後3 / 6個月生活品質」的關係間多無顯著的中介效果。而對於50歲以下或心理衛教團體前情緒壓力達7分以上之乳癌病人而言,「團體後的個人 / 社會效能」在「團體前個人 / 社會效能」與「術後1 / 3 / 6個月生活品質」的關係間多無顯著的中介效果。結論與討論:(1) 中文版短版癌症行為量表是評估乳癌病人癌症因應自我效能的良好工具,可應用於相關研究及臨床服務。(2) 以自我效能理論為基礎的心理衛教團體可於有限的時間內有效提升乳癌病人的癌症因應自我效能,在步調急促的醫療環境下,是快速、有效的臨床介入模式。(3) 本研究中的心理衛教團體可能藉由提升癌症因應自我效能,改善年紀較長或情緒壓力較低之乳癌病人的短期生活品質,但其效果隨時間遞減;對較年輕或高情緒壓力病人之生活品質帶來的助益則較不顯著。若希望能更有效、更長期提升乳癌病人的生活品質,後續應需要更多癌症臨床心理介入模式之相關研究。 zh_TW dc.description.abstract (摘要) Background: Psychological care for breast cancer patients has been an issue that deserves attention. Previous studies have pointed out that self-efficacy is critical to patients` adjustment to breast cancer, and psychological interventions can improve patients` self-efficacy for coping with cancer and, in turn, promote their quality of life. However, there is limited research on the effect of psychological interventions on self-efficacy for coping with cancer and the relationship between self-efficacy and quality of life in Taiwan. Therefore, the present longitudinal study aims to investigate if a psychological intervention based on self-efficacy theory can improve breast cancer patients` self-efficacy for coping with cancer and quality of life.Method: A total of one hundred and fifty-eight breast cancer patients were recruited from a medical center in northern Taiwan. The Cancer Behavior Inventory (CBI-B) was translated into Traditional Chinese (Taiwan) for measuring the self-efficacy for coping with cancer and evaluated in terms of reliability and validity. All participants were invited to a preoperational psychoeducation group a day before surgery. Cancer self-efficacy was measured pre-and-post group, and quality of life(QoL) was measured at 1, 3, and 6 months post-surgery. Paired sample t-tests were used to examine the change of cancer self-efficacy pre-and-post the psychoeducation group. Path analysis was used to explore the relationship between participants` self-efficacy for coping with cancer and QoL.Results: (1) The Taiwan version CBI-B, containing two factors, "personal self-efficacy" and "social self-efficacy," is a reliable and valid measure of self-efficacy for coping with cancer. (2) Breast cancer patients` cancer self-efficacy improved significantly after the preoperational psychoeducation group. (3) For patients "aged 51 years and older" or "with emotional distress (DT) score lower than 7", the post-group personal/social self-efficacy can fully mediate the relationship between pre-group personal/social self-efficacy and most domains of the QoL at 1-month post-surgery. However, the post-group personal/social self-efficacy did not mediate the relationship between pre-group personal/social self-efficacy and most QoL domains at 3- or 6-month post-surgery. Furthermore, for patients "aged 50 years and younger" or "with DT score 7 or higher", post-group cancer self-efficacy did not mediate the relationship between pre-group personal/social self-efficacy and most domains of the QoL at 1-, 3- and 6-month post-surgery.Discussion: (1) The Taiwan version CBI-B has proper psychometric properties and is suitable for research and clinical use. (2) The psychoeducation group based on self-efficacy theory can effectively improve breast cancer patients` cancer self-efficacy within a short time (30-60 mins). In fast-paced clinical settings, it is a practical and feasible psychological intervention program. (3) The psychoeducation group can promote the QoL at 1-month post-surgery for those older or less distressed breast cancer patients by improving their cancer self-efficacy, but its effect decreases with time. However, the effects of the psychoeducation on the QoL were insignificant for those younger or more distressed breast cancer patients. More researches on psychological interventions for cancer patients are needed to improve and prolong the effect on breast cancer patients` QoL. en_US dc.description.tableofcontents 第一章 緒論 1第一節 研究動機與目的 1第二節 文獻回顧 2第三節 研究架構與假設 11第二章 研究方法 15第一節 研究參與者 15第二節 研究流程 15第三節 術前心理健康衛教團體 16第四節 研究工具 19第五節 資料分析與預期結果 23第三章 研究結果 29第一節 研究參與者與人口學變項之描述統計 29第二節 中文版短版癌症行為量表的建立 31第三節 心理衛教團體對癌症因應自我效能的效果 38第四節 心理衛教團體對術後生活品質的效果 40第四章 結果討論 73第一節 中文版短版癌症行為量表的建立 73第二節 心理衛教團體對癌症因應自我效能的影響 74第三節 心理衛教團體對術後生活品質的影響 76第四節 研究貢獻與應用 82第五節 研究限制與未來方向 83參考文獻 85附錄一 中文版短版癌症行為量表 97附錄二 台灣簡明版世界衛生組織生活品質問卷 98附錄三 情緒壓力篩檢與情緒評估 100附錄四 癌症病人術前憂慮量表 101附錄五 短版因應量 102 zh_TW dc.format.extent 4924340 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0105752007 en_US dc.subject (關鍵詞) 自我效能 zh_TW dc.subject (關鍵詞) 生活品質 zh_TW dc.subject (關鍵詞) 乳癌 zh_TW dc.subject (關鍵詞) 追蹤研究 zh_TW dc.subject (關鍵詞) 術前心理衛教 zh_TW dc.subject (關鍵詞) cancer self-efficacy en_US dc.subject (關鍵詞) quality of life en_US dc.subject (關鍵詞) breast cancer en_US dc.subject (關鍵詞) longitudinal study en_US dc.subject (關鍵詞) pre-surgical psychoeducation en_US dc.title (題名) 自我效能對乳癌病人生活品質的影響 ─ 術前心理健康衛教團體之追蹤研究 zh_TW dc.title (題名) The Relationship between Self-Efficacy and Quality of Life among Patients with Breast Cancer: A Longitudinal Study of the Preoperational Psychoeducation Program en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 李作英、周桂如、穆佩芬、李惠玲、葉美玲(2012)。初診斷乳癌婦女其壓力感受。腫瘤護理雜誌,12(2),25-36。李昀芷(2019)。癌症病人術前憂慮量表之編製與心理計量特性(未出版之碩士論文)。國立政治大學,台北市。吳英璋(2007)。天然災難下防治心理創傷措施的建構與落實──總計畫暨子計畫:宗教系統於災難下防治心理創傷模式之探討與落實(I)。行政院國家科學委員會專題研究成果報告(編號:NSC95-2625-Z002-013 ),未出版。吳英璋、金樹人、許文耀(1991)。面對壓力-身心檢康手冊(高中職教師)(第一版)。台北市:教育部訓育委員會。李婉華(譯)(2002)。乳癌(原作者:R. Buckman & T. Whittaker)。台北市:智庫文化。(原著出版年:1999)姚開屏(2001)。台灣簡明版世界衛生組織生活品質問卷之發展及使用手冊。台北:台灣版世界衛生組織生活品質問卷發展小組姚開屏(2002)。台灣版世界衛生組織生活品質問卷之發展與應用。臺灣醫學,6,193-200。doi:10.6320/FJM.2002.6(2).09陳惠美、馬鳳歧、郭英調、石宜銘(1999)。乳癌術後婦女身心社會調適之探討──以羅氏適應模式為基礎。護理研究,7,321-332。doi:10.7081/NR.199908.0321游子覺(2013)。抗癌基本功。載於陳葵(責任編輯),知己知彼話乳癌。(19-41頁)。香港:明窗出版社。鄭逸如、何雪綾、陳秀蓉(2017)。醫病溝通之鑰:醫療人員同理心五大心法。台北市:五南圖書出版股份有限公司。衛生福利部國民健康署(2018):中華民國105年癌症登記報告。取自https://www.hpa.gov.tw/Home/Index.aspxBadana, A. N. S., Marino, V. R., Templeman, M. E., McMillan, S. C., Tofthagen, C. S., Small, B. J., & Haley, W. E. (2019). Understanding the roles of patient symptoms and subjective appraisals in well-being among breast cancer patients. Supportive Care in Cancer, 27, 4245-4252. doi: 10.1093/geroni/igy023.1048Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological Review, 84, 191-215. doi: 10.1016/0146-6402(78)90002-4Bandura, A. (1986). Social foundations of thought and action: a social cognitive theory. New Jersey, NJ: Prentice-Hall.Bandura, A. (1998). Health promotion from the perspective of social cognitive theory. Psychology and Health, 13, 623-649. doi: 10.1080/08870449808407422Baucom, D. H., Porter, L. S., Kirby, J. S., Gremore, T. M., & Keefe, F. J. (2006). Psychosocial issues confronting young women with breast cancer. Breast Disease, 23, 103-113. doi: 10.3233/BD-2006-23114Beatty, L., Kemp, E., Butow, P., Girgis, A., Schofield, P., Turner, J., …Koczwara, B. (2018). A systematic review of psychotherapeutic interventions for women with metastatic breast cancer: context matters. Psycho‐Oncology, 27, 34-42. doi: 10.1002/pon.4445Beckham, J. C., Burker, E. J., Lytle, B. L., Feldman, M. E., & Costakis, M. J. (1997). Self-efficacy and adjustment in cancer patients: a preliminary report. Behavioral Medicine, 23, 138-142. doi: 10.1080/08964289709596370Burgess, C., Cornelius, V., Love, S., Graham, J., Richard, M., & Ramirez, A. (2005). Depression and anxiety in women with early breast cancer: five year observational cohort study. British Medical Journal, 330, 702-705. doi: 10.1136/bmj.38343. 670868.D3Carver, C. S. (1997). You want to measure coping but your protocol’s too long: consider the Brief Cope. International journal of behavioral medicine, 4, 92-100. doi: 10.1207/s15327558ijbm0401_6Chirico, A., Serpentini, S., Merluzzi, T., Mallia, L., Bianco, P. D., Martino, R., …Giordano, A. (2017). Self-efficacy for coping moderates the effects of distress on quality of life in palliative cancer care. Anticancer research, 37, 1609-1615. doi: 10.21873/anticanres.11491Cunningham, A. J., Lockwood, G. A., & Cunningham, J. A. (1991). A relationship between perceived self-efficacy and quality of life in cancer patients. Patient Education and Counseling, 17, 71-78. doi: 10.1016/0738-3991(91)90052-7D’errico, G. M., Galassi, J. P., Schanberg., R., & Ware, W. B. (2000). Development and validation of the Cancer Worries Inventory. Journal of Psychosocial Oncology, 17, 119-137. doi: 10.1300/J077v17n03_07De Boer, M. F., Van den Borne, B., Pruyn, J. F. A., Ryckman, R. M., Volovics, L., Knegt, P. P., …Verwoerd, C. D. A. (1998). Psychosocial and physical correlates of survival and recurrence in patients with head and neck carcinoma: results of a 6-year longitudinal study. Cancer, 83, 2567-2579. doi: 10.1034/j.1399-0020.2000.290317-3.xEpplein, M., Zheng, Y., Zheng, W., Chen, Z., Gu, K., Penson, D., …Shu, X-O. (2011). Quality of life after breast cancer diagnosis and survival. Journal of Clinical Oncology, 29, 406-412. doi: 10.1200/JCO.2010.30.6951Germino, B. B., Mishel, M. H., Crandell, J., Porter, L. Blyler, D., Jenerette, C., & Gil, K. M. (2013). Outcomes of an uncertainty management intervention in younger African American and Caucasian breast cancer survivors. Oncology Nursing Forum, 40, 82-92. doi: 10.1188/13.ONF.82-92Graves, K. D. (2003). Social cognitive theory and cancer patients’ quality of life: a meta-analysis of psychosocial intervention components. Health Psychology, 22, 210–219. doi: 10.1037/0278-6133.22.2.210Gwaltney, C. J., Metrik, J., Kahler, C. W., & Shiffman, S. (2009). Self-efficacy and smoking cessation: a meta-analysis. Psychology of Addictive Behaviors, 23, 56-66. doi: 10.1037/a0013529Heitzmann, C. A., Merluzzi, T. V., Jean-Pierre, P., Roscoe, J. A., Kirsh, K. L., & Passik, S. D. (2011). Assessing self-efficacy for coping with cancer: development and psychometric analysis of the brief version of the Cancer Behavior Inventory (CBI-B). Psycho-Oncology, 20, 302-312. doi: 10.1002/pon.1735Hu, L-t., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1-55. doi: 10.1080/10705519909540118Kline, R. B. (2005). Principles and practice of structural equation modeling. New York, NY: Guilford Press.Kreitler, S., Peleg, D., & Ehrenfeld, M. (2007). Stress, self-efficacy and quality of life in cancer patients. Psycho-Oncology, 16, 329-341. doi: 10.1002/pon.1063Lam, W. W. T., & Fielding, R. (2007). Is self-efficacy a predictor of short-term post-surgical adjustment among Chinese women with breast cancer? Psycho-Oncology, 16, 651-659. doi: 10.1002/pon.1116Lev, E. L., Paul, D., & Owen, S. V. (1999). Age, self-efficacy, and change in patients` adjustments to cancer. Cancer Practice, 7(4), 170-176. doi: 10.1046/j.1523-5394.1999.74004.xLev, E. L., Daley, K. M., Conner, N. E., Reith, M., Fernandez, C., & Owen, S. V. (2001). An intervention to increase quality of life and self-care self-efficacy and decrease symptoms in breast cancer patients. Scholarly Inquiry for Nursing Practice, 15, 277-294. doi: 10.1891/0889-7182.15.3.277Liang, S. Y., Chao, T. C., Tseng, L. M., Tsay, S. L., Lin, K. C., & Tung, H. H. (2016). Symptom-management self-efficacy mediates the effects of symptom distress on the quality of life among Taiwanese oncology outpatients with breast cancer. Cancer Nursing, 39, 67-73. doi: 10.1097/NCC.0000000000000244Luszczynska, A., Mohamed, N. E., & Schwarzer, R. (2005). Self-efficacy and social support predict benefit finding 12 months after cancer surgery: the mediating role of coping strategies. Psychology, Health & Medicine, 10, 365-375. doi: 10.1080/13548500500093738MacKinnon, D. (2012). Introduction to statistical mediation analysis. Retrieved from https://www.routledge.com/Introduction-to-Statistical-Mediation-Analysis/MacKinnon/p/book/9780203809556 (Original work published 2008)Manne, S. L., Ostroff, J. S., Norton, T. R., Fox, K., Grana, G., & Goldstein, L. (2006). Cancer-specific self-efficacy and psychosocial and functional adaptation to early stage breast cancer. Annals of Behavioral Medicine, 31, 145-154. doi: 10.1207/s15324796abm3102_6Matthews, H., Grunfeld, E. A., & Turner, A. (2017). The efficacy of interventions to improve psychosocial outcomes following surgical treatment for breast cancer: a systematic review and meta-analysis. Psycho-oncology, 26, 593-607. doi: 10.1002/pon.4199Mitchell, A. J., Baker-Glenn, E. A., Granger, L., & Symonds, P. (2010). Can the Distress Thermometer be improved by additional mood domains? Part I. Initial validation of the Emotion Thermometers tool. Psycho-Oncology, 19, 125-133. doi: 10.1002/pon.1523Mitchell, A. J., Baker-Glenn, E. A., Park, B., Granger, L., & Symonds, P. (2010). Can the Distress Thermometer be improved by additional mood domains? Part II. What is the optimal combination of Emotion Thermometers? Psycho-Oncology, 19, 134-140. doi:10.1002/pon.1557Mols, F., Vingerhoets, A. J. J. M., Coebergh, J. W., & van de Poll-Franse, L. V. (2005). Quality of life among long-term breast cancer survivors: a systematic review. European Journal of Cancer, 41, 2613-2619. doi: 10.1016/j.ejca.2005.05.017Montazeri, A. (2008). Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. Journal of Experimental & Clinical Cancer Research, 27, 32-62.doi: 10.1186/1756-9966-27-32Nafradi, L., Nakamoto, K., & Schulz, P. J. (2017). Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One, 12, e0186458. doi: 10.1371/journal. pone.0186458National Comprehensive Cancer Network. (2017). NCCN Practice Guidelines in Oncology—V. 2.2017, Distress Management. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/distress.pdfPaek, M-S., Ip, E. H., Levine, B., & Avis, N. E. (2016). Longitudinal reciprocal relationships between quality of life and coping strategies among women with breast cancer. Annals of Behavioral Medicine, 50, 775-783. doi:10.1007/s12160-016-9803-y.Roth, A. J., Kornblith, A. B., Batel-Copel, L., Peabody, E., Scher, H. I., & Holland, J. C. (1998). Rapid screening for psychologic distress in men with prostate carcinoma. Cancer, 82, 1904-1908. doi: 10.1002/(SICI)1097-0142(19980515)82:10<1904::AID-CNCR13>3.0.CO;2-XRottmann, N., Dalton, S. O., Christensen, J., Frederiksen, K., & Johansen, C. (2010). Self-efficacy, adjustment style and well-being in breast cancer patients: a longitudinal study. Quality of Life Research, 19, 827-836. doi: 10.1007/s11136-010-9653-1Schnoll, R. A., Harlow, L. L., Stolbach, L. L., & Brandt, U. (1998). A structural model of the relationships among stage of disease, age, coping, and psychological adjustment in women with breast cancer. Psycho-Oncology, 7, 69-77. doi: 10.1002/(SICI)1099-1611(199803/04)7:2<69::AID-PON286>3.0.CO;2-8Sheard, T., & Maguire, P. (1999). The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. British journal of cancer, 80, 1770-1780. doi: 10.1038/sj.bjc.6690596Sheeran, P., Maki, A., Montanaro, E., Avishai-Yitshak, A., Bryan, A., Klein, W. M. P., …Rothman, A. J. (2016). The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: a meta-analysis. Health Psychology, 35, 1178-1188. doi: 10.1037/hea0000387Shelby, R. A., Edmond, S. N., Wren, A. A., Keefe, F. J., Peppercorn, J. M., Marcom, P. K., …Kimmick, G.G. (2014). Self-efficacy for coping with symptoms moderates the relationship between physical symptoms and well-being in breast cancer survivors taking adjuvant endocrine therapy. Support Care Cancer, 22, 2851-2859. doi: 10.1007/s00520-014-2269-1Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychological methods, 7, 422-445.Silver, J. K., & Baima, J. (2013). Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. American Journal of Physical Medicine & Rehabilitation, 92, 715-727. doi: 10.1097/PHM.0b013e31829b4afeStiegelis, H. E., Hagedoorn, M., Sanderman, R., Bennenbroek, F. T. C., Buunk, B. P., van den Bergh, A. C. M., …Ranchor, A. V. (2004). The impact of an informational self-management intervention on the association between control and illness uncertainty before and psychological distress after radiotherapy. Psycho-Oncology, 13, 248-259. doi: 10.1002/pon.738Vickberg, S. M. J. (2001). Fears about breast cancer recurrence: interviews with a diverse sample. Cancer Practice, 9, 237-243. doi: 10.1046/j.1523-5394.2001.009005237.xWang, A. W. T., Cheng, C. P., Chang, C. S., Chen, D. R., Chen, S. T., Shieh, V., . . . Hsu, W. Y. (2018). Does the factor structure of the Brief COPE fit different types of traumatic events? A test of measurement invariance. European Journal of Psychological Assessment, 34, 162-173. doi:10.1027/1015-5759/a000321Wang, G. L., Hsu, S. H., Feng, A. C., Chiu, C. Y., Shen, J. F., Lin, Y. J., & Cheng, C. C. (2011). The HADS and the DT for screening psychosocial distress of cancer patients in Taiwan. Psycho-Oncology, 20, 639-646. doi: 10.1002/pon.1952Wong-Kim, E. C., & Bloom, J. R. (2005). Depression experienced by young women newly diagnosed with breast cancer. Psycho-Oncology, 14, 564-573. doi: 10.1002/pon.873Yan, B., Yang, L. M., Hao, L. P., Yang, C. Quan, L., Wang, L. H., …Yuan, J. M. (2016). Determinants of quality of life for breast cancer patients in Shanghai, China. PLoS ONE, 11, e0153714. doi:10.1371/journal.pone.0153714Yao, G., Chung, C. W., Yu, C. F., & Wang, J. D. (2002). Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version. Journal of the Formosan Medical Association, 101, 342-351.Zhang, M., Chan, S. W., You, L., Wen, Y., Peng, L., Liu, W., & Zheng, M. (2014). The effectiveness of a self-efficacy-enhancing intervention for Chinese patients with colorectal cancer: a randomized controlled trial with 6-month follow up. International Journal of Nursing Studies, 51, 1083-1092. doi: 10.1016/j.ijnurstu.2013.12.005Zhang Y, Kwekkeboom K., & Petrini, M. (2015). Uncertainty, self-efficacy, and self-care behavior in patients with breast cancer undergoing chemotherapy in China. Cancer Nursing, 38(3), 19-26. doi: 10.1097/NCC.0000000000000165 zh_TW dc.identifier.doi (DOI) 10.6814/NCCU202000814 en_US