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| Title: | 以認知行為為基礎之睡眠衛教方案於預防乳癌患者癌症相關失眠之成效
The effect of cognitive-behavioral based sleep education program in preventing breast cancer patients from cancer-related insomnia |
| Authors: | 許筱筠 |
| Contributors: | 楊建銘
許筱筠 |
| Keywords: | 乳癌
癌症相關失眠
睡眠衛教方案
Breast cancer
Cancer-related insomnia
Sleep education program |
| Date: | 2018 |
| Issue Date: | 2018-07-23 16:51:20 (UTC+8) |
| Abstract: | 研究背景與目的：失眠困擾是乳癌患者最常見的困擾之一，與癌症相關的失眠在乳癌患者中不但盛行率高、在診斷初期就可能出現、多重促發因子容易在治療當中反覆出現、且延續為慢性失眠的比例高、容易造成後續多重的負面影響。本研究針對乳癌患者失眠困擾特性，以認知行為為基礎設計適合在手術後預備進行輔助治療的乳癌患者進行的睡眠衛教方案，並檢視此一睡眠衛教方案對於降低乳癌患者於治療期間發展出失眠問題或是降低失眠嚴重度是否有效。
研究方法：本研究共招募43位介於20-65歲，初次罹癌，預備手術治療與進行輔助治療的乳癌患者為對象，以隨機分派之方式，實驗組（n = 22）進行以針對乳癌的特殊性，以認知行為為基礎架構的睡眠衛生教育方案做為介入，對照組（n = 21）則進行過去研究證實有效但非為乳癌患者設計之睡眠衛教；兩組分別進行單次個人睡眠衛教與兩次（兩週、一個月）電話聯絡回顧衛教內容，在兩次的電話聯繫中，實驗組包含了睡眠問題解答與協助睡眠時間規劃，對照組則提供社會支持。兩組在第一次衛教介入後兩週、一個月與三個月追蹤失眠嚴重程度與助眠藥物使用狀況，焦慮與憂鬱情緒的追蹤則以在一個月時貝克焦慮量表、貝克憂鬱量表第二版作為測量。
研究結果：兩組在前測的人口學變項、睡眠變項皆無顯著差異，在經過了衛教介入後，兩組在兩週時的睡眠困擾都是顯著下降的（p = .02），而到三個月時，從失眠嚴重度平均數的趨勢上來看，對照組的失眠困擾有增加的趨勢，實驗組則是維持，兩組間的失眠嚴重度差異呈顯著邊緣（p = .06）。若以8分作為是否有失眠困擾的切分點，比較實驗組與對照組在各時間點達臨床失眠困擾比例，在一個月追蹤時兩組失眠困擾比例達顯著差異（p = .01）。在助眠藥物使用上，實驗組兩週時用藥比例顯著減少（p < .001），三個月與前測相較則是不顯著（p = .83）。對照組兩週時用藥比例顯著增加（p = .01），在三個月時則是達顯著邊緣（p = .06），用藥人數有增加的趨勢。在焦慮與憂鬱情緒的變化上，由二因子混合設計變異數分析中可以看到，一個月後測與前測相較，在主觀焦慮症狀分量表得分上，在時間主要效果上顯著（p < .01），有下降的趨勢；憂鬱在時間主要效果達顯著（ p < .001），效果來自認知情感分量表上分數的下降（ p < .001）。
結論：此一結果顯示出本研究實驗組專門為仍在進行治療中的乳癌患者設計的睡眠衛教方案，對於協助乳癌患者減緩失眠困擾有相當程度之效果。此外在焦慮與憂鬱情緒方面，提供睡眠衛教方案對於兩組降低主觀焦慮症狀與改善認知情感向度上的憂鬱症狀也有成效。在臨床上提供以認知行為為基礎之睡眠衛教方案對於預防或是減緩失眠嚴重度是有其價值的。
Purpose: Insomnia is one of the most common complaints in breast cancer patients. Cancer-related insomnia is not only highly prevalent in breast cancer patients, but also can occur in the early stage after diagnosis. The insomnia might be precipitated by factors associated with cancer treatment, and can be perpetuated and become chronic in course without proper intervention. The sleep disturbance can further impact negatively to the quality of life of the patients. In this study, we developed a cognitive-behavioral based sleep education program (CBSE), which was designed for breast cancer patients who were under adjuvant therapy after surgery. The purpose of this study is to evaluate the efficacy of this program to prevent the patients to develop insomnia or to reduce insomnia symptoms in breast patients during the earlier stages of treatment.
Methods: A total of 43 breast cancer patients between the ages of 20-65 years old, who were prepared for surgery and/or adjuvant therapy were enrolled in this study. They were randomly assigned into an experimental group (n = 22) and a control group (n = 21). Both groups received a one face-to-face sleep education session and two phone consultation sessions at two weeks and one month after the first session. For experimental group, the CBSE session was designed and the telephone consultations were to assist the patients to solve sleep problems and to set their best sleep schedule. For the control group, the sleep education program consisted of sleep hygiene education with information mentioned in the previous studies that was effective however not designed for breast cancer patients. During phone consultations, only social support was provided sessions. The severity of insomnia and the use of sleep aids were evaluated in two weeks, one month and three months after the first intervention, and the levels of anxiety and depression were measured at a one-month follow-up by phone.
Results: The results showed that there were no significant differences in demographic variables and sleep-related variables between the two groups prior to the intervention. The sleep disturbances of the two groups were significantly decreased at two weeks after the intervention (p = .02). At the time of the three-month follow-up, there was a near-significant trend of the mean insomnia severity to increase in the control group, but not in the experimental group. The difference in insomnia severity between the two groups was marginally significant (p = .06). Using a cut-off score of 8 on the Insomnia Severity Index to indicate clinically significant insomnia symptom, the number of patients with significant insomnia symptom were significantly different between the two groups at one-month follow-up (p = .01). In addition, the number of patients using sleep aids in the experimental group was significantly reduced at two weeks after intervention (p < .001), but was not significantly different compared with the pretest at three-month follow-up (p = .83). In the control group, the proportion of patients using sleep aids was significantly increased at two-week follow-up (p = .01), and was marginally significant at three-month follow-up (p = .06). In the change of anxiety and depression mood, the results from two-factor mixed design ANOVAs at one month after intervention showed that the time main effect of the subjective anxiety dimension is significantly reduced (p < . 01); time main effect of depression is significant for the total score (p < .001) and for the score on the cognitive-affective sub-scale of the BDI-II (p < .001).
Conclusion: This study shows that our CBSE program designed specifically for breast cancer patients during the early stage of treatment can benefit the patients by alleviating their insomnia symptoms and reducing symptoms of subjective anxiety and depression. The findings suggest the implementation of a CBSE program can prevent chronic insomnia in patients with cancer or other medical conditions. |
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| Description: | 碩士
國立政治大學
心理學系
102752019 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0102752019 |
| Data Type: | thesis |
| DOI: | 10.6814/THE.NCCU.PSY.009.2018.C01 |
| Appears in Collections: | [心理學系] 學位論文
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| 201901.pdf | | 1650Kb | Adobe PDF2 | 19 | View/Open |
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