[[alternative]]Triangulation research on psychological factors and breast cancer patients

Abstract

[[abstract]]在台灣地區2005年的乳癌發生率逐漸升高已成警惕，好發年齡亦逐漸年輕化。乳癌發生的許多因子當中，心理因子的影響仍是爭論的，探討乳癌之發展與心理因子的關係，面臨了一些研究方法學上的困難，如缺乏標準測量、樣本數少或研究前個案已知為乳癌診斷的干擾等。本研究目的在探討心理因子與乳癌發生之相關性，以及罹患乳癌病人之壓力感受，最終期望發展一份測量初罹患乳癌婦女之壓力感受量表。 本研究第一階段探討心理因子與乳癌發展之關係，採橫斷面研究，以某醫學中心門診為研究場所，接受乳房攝影篩檢前之婦女為研究對象，以壓力、焦慮、憂鬱等量表為工具，進行獨立t檢定,卡方檢定, 皮爾森相關檢定, 邏輯斯複回歸及危險對比值之統計分析。第二階段探討初罹患乳癌婦女之壓力經驗感受，採質性訪談法，了解個案罹癌經驗，並發展一份量表。此階段以乳房外科病房為研究場所，初罹患乳癌術前患者為研究對象，研究工具採半結構式問卷進行深度訪談，以內容分析法進行分析。第三階段之研究設計為問卷發展之信效度檢定，以乳房外科病房為研究場所，初罹患乳癌之術前患者為研究對象，進行內容效度、專家效度、內在一致性信度及探索性因素分析之信效度檢定。 本研究收案時間自2007年10月自2008年4月，共收集1160份乳房攝影篩檢者問卷、20份初罹患乳癌婦女之訪談及125份初罹患乳癌婦女之問卷，研究結果如下：1教育程度與乳癌之風險有相關性2.經教育因子校正後，心理因子(焦慮、憂鬱、壓力)在乳癌風險上為預測因子3.初罹患乳癌婦女從接獲診斷、面對問題、進行調適到接受治療，經驗到害怕癌症、負向情緒、失眠、失去吸引力與社會化之衝擊、生命改變、擔心治療、家人、工作與未來4.新發展量表(Stress of Newly Diagnosed Breast Cancer Scale, SNDBCS)經探索性因素分析產生四個構面：不可預期之感受、不可控制之感受、心理負荷重之感受、挑戰之感受；量表內在一致性信度Cronbach`sα=0.844，與SPSS-10壓力量表之效標效度為r=0.462(p=0.000)，與HADS-14量表之輻合效度焦慮為r=0.566(p=0.000)，憂鬱為r=0.354(p=0.000)。 本研究結果建議醫護理人員應加強重視婦女心理衛生，對於初罹患乳癌婦女之壓力感受應給於適當之護理措施，本研究發展具有信效度之SNDBCS量表，可有效方便的提供醫護人員評估參考。[[abstract]]The growing prevalence rate of breast cancer is alarming. The susceptible age of breast cancer was changed more and more young. Many risk factors are involved with breast cancer, whereas psychological impact of cancer is still a controversial factor to breast cancer. To study the relationship between psychological factors and breast cancer development was faced methodological handicap as lack of standard measurements, few sample or confounders of cases suspicious of their breast cancer diagnosis before research. To overcome a number of research methodological issues, this study aimed to explore the psychological factors associated with breast cancer development, conduct the qualitative research with new diagnosed breast cancer women of their stress experience, and then to develop a stress scale. In Phase I, a cross-sectional design was used to explore the relationship between breast cancer and stress development. Research participants were recruited from the outpatient department of a medical center. Stress, anxiety, and depression data were collected. The t test, Pearson correlation, multiple logistic regressions, odds ratio was used to analyze data. In Phase II, a qualitative method was used to interview newly diagnosed breast cancer women to understand their stress experiences and then develop a questionnaire. Research participants were recruited from the breast surgical ward of a medical center. Before operation, in-depth interview were administered under a semi-structured questionnaire. Content analysis was use to analyze data. In Phase III, a methodological design was used to test reliability and validity of developed questionnaire. The newly diagnosed breast cancer women were recruited from the breast surgical ward of a medical center. Internal consistency reliability, content validity, expert validity, and exploratory factor analysis were test to establish reliability and validity.Cases were sampled form Oct 2008. to April 2009, including 1160 mammography screening women, 20 newly diagnosed breast cancer women interviewed, and 125 newly diagnosed breast cancer women tested by the new questionnaire. Results were: 1) Relationship existed between breast cancer risk and educational levels. 2) After adjusting education, psychological factors served as breast cancer predictors. 3) Newly diagnosed breast cancer women experienced suffering from cancer, adjusting life, facing challenge, being afraid of cancer, negative moods, insomnia, impact on the attractiveness and socialization, life change, and worrying about treatment, families, jobs, and future. To collect information and to choose good reputation hospitals/physicians to build up confidence were also involved. 4) The new stress questionnaire (Stress of Newly Diagnosed Breast Cancer Scale, SNDBCS) was categorized four factors: unpredictable feelings, uncontrollable feelings, overloaded feelings, and challenged feelings. Internal consistency reliability showed Cronbach’s α=0.84, criterion validity showed r=0.46 (p<0.001) with a SPSS-10 stress scale, and r=0.57 (p<0.001) with HADS-14 anxiety, r= 0.35 (p<0.001) with depression scale.This study recommends that psychological health of women should be strengthened. As to women in newly diagnosed breast cancer, professionals should provide adequate interventions depending on the finding of woman’s stress perception and experience. For measuring breast cancer women stress, the SNDBCS with reliability and validity can effectively facilitate the professionals assess reference to breast cancer