社區關懷措施於改善治療期間乳癌病患身心困擾之成效

The Effect of Community-based Caring Intervention on Physical and Emotional Distress of Breast Cancer Patients during Treatment

背景：乳癌是女性發生率最高的癌症，治療期間可能造成患者生理、情緒等層面的困擾，除了臨床提供醫療照顧之外，社區關懷的角色也值得關注。目的：1.瞭解乳癌病人接受社區關懷措施前的身心困擾及其相關因素；2.瞭解乳癌病人接受關懷措施後身心困擾之改善情形及其影響因素。方法：以回溯性方法收集某癌症社區機構乳癌病患服務資料，包括個人疾病與治療紀錄，接受關懷措施的種類與次數，並於措施前、後以「困擾溫度計」評估身心困擾的程度及其改善情形。關懷措施包括先個別諮詢以確認問題與需要，再依需求提供疾病與營養衛教、康復用品、心理輔導、社會資源等。結果：乳癌病人接受關懷措施後的身心困擾顯著改善。年齡、教育程度、疾病分期、化療、標靶治療、治療副作用顯著影響措施前身心困擾，身心困擾較嚴重的人顯著接受較多種的關懷措施。年齡、居住地區、治療狀態、疾病分期、治療副作用、措施前或措施後的身心困擾程度、接受措施的項數以及接受的措施皆顯著影響措施後的困擾改善程度。結論：結果顯示社區癌症關懷措施對於病人治療期間身心困擾的成效，也表示社區照護資源可促進臨床癌症照護品質，藉此提供醫療衛生政策制定之參考，未來值得繼續促進並提升癌症社區照護服務品質。

Background: Breast cancer is the most common cancer of female population in the world and may lead to increasing physical and emotional distress during treatment. Therefore, the roles of community care and medical care are both emphasized. Purpose: The aims of this study were to investigate the affecting factors of physical and emotional distress before receiving community care and to investigate the effectiveness of intervention and factors associated with it. Methods: Information of patients with breast cancer were collected retrospectively from a community cancer institute. Variables collected included history of personal diseases and treatment, frequency and type of caring interventions, and physical and emotional distress evaluated by distress thermometer before and after receiving interventions. Caring interventions included individual consultation, identification of problems and needs, education of disease and nutrition, management of treatment side effects, psychological counseling, and provision of social resources. Results: Physical and emotional distresses were significantly improved after receiving community-based caring interventions. Age, education level, disease stage, receiving chemotherapy and target therapy, and adverse effects of treatments were associated with physical and emotional distresses before interventions, leading to increased willingness to receiving intervention. Age, residency, disease stage, treatment status, adverse effects, pre- and post-interventional physical and emotional distress, and numbers and types of intervention were associated with effectiveness of caring interventions. Conclusion: Community-based caring interventions not only relieved physical and emotional distress during treatment, but also improved quality of clinical care. Therefore, it is valuable to promote community-based caring intervention among patients with breast cancer.