2015-08-012024-05-17https://scholars.lib.ntu.edu.tw/handle/123456789/683658摘要：研究計畫名稱：整合照顧模式和可體松反應對年輕乳癌病患的局部復發和存活之影響背景. 護理專業人員所領導的持續照顧模式和病患可體松反應對乳癌存活影響的重要性較被忽略，且目前研究發現護理所領導的持續照顧無法有效的解決乳癌病患的心理困擾。因此本研究團隊期望能發展同時合併健康衛教和心理治療的整合性持續照顧模式以符合年輕乳癌婦女全人的照護需求。目的.本研究計畫為期五年的追蹤，目的為探討1.整合健康衛教和心理治療之持續照顧模式的介入對於改善可體松反應、主觀整體安適狀態、局部復發率和存活率之成效。2 探討五年追蹤時期年輕乳癌婦女其唾液可體松晝夜模式於乳癌診斷期、積極治療期和治療後存活期的表現和三階段的改變與乳癌局部復發率和存活率之相關。研究方法. 本研究計畫為期五年追蹤是採用前瞻縱貫性研究設計(a prospectivelongitudinal study) ，整合性持續照顧模式介入的成效是以隨機控制試驗(therandomized controlled trial, RCT)之設計，將邀請年齡介於18 至40 歲年輕婦女於醫院外科門診確認為乳癌診斷的病患參與本研究計畫，預期134 位參與者將經由隨機選擇的方式分別至實驗組或是控制組。實驗組的參與者將接受包含3 個階段的照護：1.診斷期:診斷後兩週內4 個小時的個別衛教諮詢包含乳癌和治療過程的資訊以降低診斷期的不確定感；2.癌症積極治療期: 診斷後一個月每週一次衛教暨身心靈心理治療團體共四次，主要目標為處理治療時所產生的身心困擾；3.治療後存活期:於診斷後十個月，每週一次衛教暨身心靈心理治療團體共四次，主要目標為處理於癌症治療後生活適應的身心困擾。控制組的參與者將於診斷兩週內獲得疾病認識和症狀處置之衛教手冊；於診斷後一個月提供半天密集衛教團體課程共一次；診斷後十個月提供關於如何適應癌症治療後存活期生活改變的衛教手冊。結果測量工具包含唾液可體松（收集於睡醒、睡醒後30 和45 分鐘、12:00, 17:00 及21:00 的樣本）、EORTC 歐洲癌症治療與研究組織生活品質核心問卷以及乳癌生活品質問卷、HWS 整體安適量表、BDI-II 憂鬱量表、STAI 焦慮狀態量表、ECR-R 親密關係修正版量表、SAQ 性功能量表及MLQ 生命意義問卷。測量時間包含獲知乳癌診斷一週內為測量之基準點(T0)，以及之後八個追蹤測量時間：診斷後第2 個月，完成癌症積極治療期的介入措施(T1)、診斷後第9 個月(T2)、診斷後第11 個月，完成治療後存活期的介入措施(T3)、診斷後第18 個月(T4)、診斷後第二年(T5)、診斷後第三年(T6)、診斷後第四年(T7)、診斷後第五年(T8)。預期貢獻：本五年追蹤研究計劃的預期貢獻是說明整合性持續照顧模式介入對於年輕乳癌病患於診斷期、治療期、和存活期之成效以及發展適用於臨床人員的照護手冊,並且認識長期壓力對年輕乳癌病患的影響。<br> Abstract: The title of the research project: Local recurrence and survival following integrated care and cortisolresponses in young breast cancer patientsBackground. The impacts of nursing-led continuing care and cortisol responses on breast cancer survivalsare neglected. Moreover, the current nursing-led continuing care failed to effectively manage psychologicaldistress. Therefore, we aim to develop an integrated continuing care model which combined health educationwith psychotherapy together to meet young breast cancer women’s holistic caring needs.Aims and objectives. This five-year follow up study aims to explore 1. the effects of the integratedcontinuing care model on cortisol responses, self-report well-being status, recurrence and survival amongyoung breast cancer patients aged between 18 and 40 years old; 2. the associations of diurnal cortiosl patternsat diagnostic, active cancer treatment, and post-treatment survivorship stages and the changes across threestages with the subsequent local recurrence and survival.Methods. This five-year follow up study adopts a prospective longitudinal design. The randomizedcontrolled trial (RCT) design will be chosen for explore the effects of an integrated continuing care model.Total 134 women, who are aged between 18 and 40 years old and are recruited at the time of receivingdiagnosis of breast cancer at outpatient department, will be randomly assigned into an experimental or acontrol group. The participants in an experimental group will receive an integrated continuing care whichconsists of three stages of care: 1. Diagnostic stage: 4-hour individual educational consultation providedwithin two weeks of post diagnosis for managing uncertainty of breast cancer diagnosis and treatmentprocedure, 2. Acute cancer treatment stage: 4-session weekly education combined with body-mind-spirit(BMS) psychotherapy provided at the 1st month post diagnosis helping patients for symptom managementand 3. Post-treatment survivorship stage: 4-session weekly education combined with body-mind-spirit (BMS)psychotherapy offered at the 10th month post diagnosis for adjustment of living with cancer. Those in acontrol group will receive a booklet for understanding disease and symptom management within two weeksof post diagnosis followed by a half-day intensive psychoeducation group program at the 1st month of postdiagnosis and providing a booklet for living with cancer at post-treatment survivorship.The outcome measures include salivary cortisol (collected at time of waking, 30 and 45 minutes post waking,12:00, 17:00 and 21:00 in their home), self-report well-being status (European Organization for Research andTreatment of Cancer Core Cancer Quality of Life Questionnaire and its breast cancer specific complementarymeasure, Holistic Well-being Scale, Beck Depression Inventory, State-Trait Anxiety Inventory, Experiencesin Close Relationships-Revised scale, Sexual Activity Questionnaire, and Meaning in life questionnaire).Measurement time-points include within a week of receiving diagnosis as the baseline assessment (T0), andT1 (in the 2nd month post diagnosis, end of intervention at active cancer treatment stage), T2 (in the 9thmonth), T3 (in the 11th month, end of intervention at post-treatment survivorship stage), T4 (in the 18thmonth), T5 (in the 2nd year), T6 (in the 3rd year), T7 (in the 4th year), and T8 (in the 5th year).The contribution. This five-year follow up study aims to demonstrate the effects of an integrated continuingcare model for young breast cancer patients at diagnostic, active cancer treatment, and post-treatmentsurvivorship stages and to compile a care manual for health professionals, as well as understanding theimpacts of long-term stress hormone (cortisol) on breast cancer progression.年輕乳癌病患整合性持續照顧模式健康衛教身心靈心理治療憂鬱焦 慮生活品質生命意義唾液可體松濃度可體松晝夜型態Young breast cancer patientsan integrated continuing care modelhealth educationbody-mind-spirit psychotherapydepressionanxietyquality of lifemeaning in lifesalivary cortisol levelsdiurnal cortisol patterns