癌症病人音樂／認知治療與情緒支持改善其困擾之先驅性研究

Music/Cognitive Therapy and Emotional Support to Improve Distress in Cancer Patients: A Pilot Study

背景：癌症治療過程的不確定性帶給病人頗多的煎熬與困擾，不僅造成病人極大的痛苦，也降低其生活品質，因此，本研究目的為瞭解癌症病人介入非藥物處置後在困擾度、症狀嚴重度及生活品質之改善情形。方法：本研究樣本選自北部某醫學中心腫瘤科住院癌症病人，採類實驗縱貫性研究設計，以病房別分派為音樂／認知治療組及情緒支持組，以困擾度(distress thermometer, DT) 得分篩檢，大於等於4 分者方予收案，共收案21 名，其中音樂／認知治療組11 名、情緒支持組10 名。每組僅予一次介入措施約30 分鐘。並收集前測、後測48 小時及第二週之資料。結果：二組基本屬性於前測除音樂／認知治療組有癌症轉移者較情緒支持組多外，其他變項並無統計上之差別。統計以廣義估計函數式(GeneralizedEstimation Equation, GEE) 分析，結果情緒支持組於48 小時後測之DT 達統計上明顯下降(p<.05)、症狀嚴重度並未達統計差異，而音樂／認知治療組於48 小時後測在DT、症狀嚴重度與情緒支持組均顯示無差異，顯示在48 小時後測兩組病人的DT 皆有顯著改善，而症狀嚴重度皆無顯著改善；第二週後測在DT、症狀嚴重度及生活品質變項皆無統計上顯著的差異。結論：本研究結果說明住院癌症病人無論是提供音樂／認知治療或予情緒支持等處置，對其有立即支持性的幫助，因此，建議未來腫瘤科護理人員在照護過程中對困擾度較高之病人，可考量將音樂／認知治療或情緒支持納入即刻照護措施中，以改善其困擾度。

Background: Most cancer patients suffer from uncertainty anticancer treatment. This uncertainty, including the inability to predict whether cancer will return, causes substantial psychological distress and may impair patients’ quality of life. Therefore, this study explored the effects of nonpharmacological interventions for cancer patients regarding the severity of their symptoms, psychological distress, and quality of life. Methods: A quasiexperimental and longitudinal design was used for our study. The patients in the wards were assigned to music/cognitive and emotional support groups. Samples were selected from fi ve oncology units of cancer patients in a medical center in Northern Taiwan. A distress thermometer (DT) was used to screen eligible patients, and those with scores greater than or equal to 4 were enrolled. A total of 21 patients were enrolled, including 11 in the music/cognitive group and 10 in the emotional support group. Both groups received one 30-minute intervention. Data were collected through a pretest, posttest after 48 hours, and posttest after 2 weeks. Results: No statistical difference was found in the pretest characteristics between the two groups, except that more patients with metastatic disease were observed in the music/cognitive group. The DT values at the posttest after 48 hours significantly decreased (compared with the pretest DT values) in the emotional support group ( p < .05), determined using a generalized estimation equation (GEE). The DT values and the severity of symptoms at the posttest after 48 hours did not change significantly after either of the two interventions compared with those of the pretest. The DT values at the posttest after 48 hours showed signifi cantly difference, but the severity of symptoms did not significantly changed between the two groups. Moreover, the DT values, severity of symptoms, and quality of life between the pretest and posttest after 2 weeks showed no significant difference based on the GEE. Conclusions: The results showed that providing music/cognitive intervention or emotional support may immediately improve distress in cancer inpatients. Therefore, oncology nurses can consider providing music/cognitive intervention or emotional support as care in the nursing process to improve patient distress.