首次接受化學治療乳癌婦女介入護理指導後不確定感、焦慮及自我照顧之成效探討

Effectiveness of Nursing Instruction in Reducing Uncertainty, Anxiety and Self-Care in Breast Cancer Women Undergoing Initial Chemotherapy

背景：乳癌婦女化學治療期間，因無法預期及處理化學治療副作用所帶來的不適，焦慮與不確定感因而產生。
目的：探討首次接受化學治療乳癌婦女介入護理指導後不確定感、焦慮與自我照顧之成效。
方法：採方便取樣，類實驗法，於民國97年1~9月台灣北部某醫學中心，選取首次接受化學治療之乳癌婦女，依入院先後次序分成常規組及介入組，分別收案37人及38人；常規組提供病房常規照護，介入組提供以實証醫學為基礎的「乳癌抗癌治療自我照顧手冊」並配合個別護理指導，兩組皆在第一次、第三次及第六次化學治療時，進行結構性問卷調查，研究工具包括：「基本資料表」、「疾病不確定感量表」、「醫院焦慮與憂鬱量表」、「自我照顧量表」。
結果：兩組基本屬性及疾病特性具同質性。第一次化學治療前，兩組整體疾病不確定感程度，皆處於中高程度，但焦慮程度並不高。兩組整體不確定感、焦慮及自我照顧程度，並無顯著組別差異。第六次化學治療時，兩組整體不確定感及不明確性感受皆有降低，自我照顧程度皆有提升，且呈統計上顯著性差異（p < .05*）；但介入組整體不確定感、不明確性感受降低程度及自我照顧提升程度，較對照組明顯。第六次化學治療時，介入組複雜性感受降低程度呈統計上顯著差異（p = .02*），而常規組無統計上差異，即介入組複雜性感受降低程度優於常規組。
結論：實務應用 本研究顯示介入護理指導後整體不確定感降低及自我照顧提升程度較介入前佳；介入組整體不確定感降低及自我照顧提升程度比常規組佳；兩組焦慮程度並無差異。建議護理人員應隨時評估首次接受化學治療之乳癌婦女不確定感程度，提供以實証醫學為基礎之結構性化學治療居家照護知識，以提升病人對疾病、治療的控制感與自我照顧能力，及有效減輕病人與家屬化學治療期間之複雜性感受。

Background: Level of uncertainty and anxiety may increase when breast cancer women experience unexpected side effects during chemotherapy.
Purpose: This longitudinal study explored the effectiveness of nursing instruction in reducing uncertainty, anxiety and self-care in breast cancer women undergoing initial chemotherapy.
Methods: This study used a quasi-experimental design. Convenience sampling was used to recruit 75 women with breast cancer at a medical centre in northern Taiwan between January 2008 and September 2008. Participants were divided into either the control (n = 37) or experimental (n = 38) group. Control group patients received usual care. Experimental group patients were provided with nursing instructions that followed the evidence-based guidelines prescribed in the “Chemotherapy Self-Care for Breast Cancer” handbook and individualized education. Both groups received repeated questionnaires in the first, third and sixth chemotherapy cycles. Demographic data, Mishel's Uncertainty Illness Scale, Hospital Anxiety and Depression Scale and the Self-Care Scale were used for data collection and analysis.
Results: There were no significant differences in demographic data between the two groups. There were moderate to high levels of uncertainty and low levels of anxiety in both groups prior to the first chemotherapy cycle. There was a significant decrease in uncertainty and an elevation in self-care level (p < .05*) in both groups at the sixth chemotherapy cycle. However, the experimental group showed less uncertainty and higher levels of self-care in comparison with the control group. There was a significant decrease in complexity uncertainty in the experimental group (p = .02*) and no significant decrease in the control group.
Conclusions: Study results indicate that nursing instruction can decrease uncertainty and elevate self-care levels. We suggest that nurses provide structured nursing instructions based on evidence-based guidelines to breast cancer women undergoing initial chemotherapy in order to promote self-care level and patient degree of control over their disease and treatment. This intervention may ameliorate patient and family uncertainties with regard to disease and chemotherapy complexity.