[[alternative]]The Relationship between symptom-management self-efficacy、Demoralization and Emotional status in Breast Cancer Patients.

[[abstract]]惡性腫瘤為國人死因第一位，焦慮、憂鬱情緒困擾更是好發在癌症診斷及治療過程中，而影響癌症的治療與生活品質，近幾年來許多研究發現，失志症候群和焦慮、憂鬱情緒息息相關。而自我效能是影響病人健康行為的重要因素，自我效能是病人對其本身執行某些特定健康照護行為的能力信念或判斷，在個人朝向既定健康照護目標努力的過程中自我效能扮演一個重要的自我調節角色，因而病人具備較高的症狀處理自我效能，可能對乳癌病人的情緒狀態產生正向影響。故本研究目的在探討乳癌住院病人人口學特徵、疾病特性、化療期間症狀處理自我效能、失志與情緒狀況的相關性。 本研究是以橫斷相關性設計，採方便取樣方式，以北部某醫學中心化療集中病房為收案地點，共收集71位化學治療中的乳癌病人，利用結構式問卷收集包括『基本資料人口學』人口學特質資料表、『症狀處理自我效能』量表(symptom management self-efficacy scale)、『中文版失志量表』 (Demoralization Scale- Mandarin Version, DS-MV)、『醫院焦慮憂鬱量表』 (Hospital Anxiety and Depression Scale, HADS)為研究工具。 研究資料將以SPSS 19.0 for windows統計套裝軟體進行資料分析，各項假設所設定之統計顯著水準α值0.05為標準，描述性統計以百分比、平均數、標準差，推論性統計則以ANOVA、t-test、pearson correlation相關檢訂分析，探討乳癌病人症狀處理自我效能、失志與情緒狀態相關性。結果顯示在焦慮程度方面，「目前職業」及「手術」的統計量達顯著水準（p < .05），在憂鬱方面，而「服藥數量」與「憂鬱」的相關係數達顯著正值（r = .25，p < .05），表示當個案服用藥物的數量越多時，所展現出來的憂鬱程度也會越高。在整體症狀處理自我效能與情緒狀況方面，「整體症狀處理自我效能」（r = -.36，p < .01）與「焦慮」和「憂鬱」的相關係數皆達顯著負值，表示當病人在各方面的症狀處理自我效能知覺程度越良好時，所展現出來的焦慮憂鬱程度則會越低。在失志與焦慮憂鬱方面，「整體失志」與「焦慮」（r = .25，p < .05）和「憂鬱」（r = .47，p < .001）的相關係數皆達顯著正相關，表示當個案在這些方面的所展現出來的失志程度越高時，所展現出來的焦慮與憂鬱程度也會越高。本研究中探討症狀處理自我效能、失志對焦慮憂鬱的相關預測，結果發現，症狀處理自我效能中的次變項「處理化學治療相關症狀」、手術（有 vs 無）、失志中的次項目「沮喪感」能有效影響依變項「焦慮程度」，且解釋力為23.0%；失志中的次項目「沮喪感」與症狀處理自我效能中的次變項「處理情緒及人際困擾」能有效影響依變項「憂鬱程度」，且解釋力為34.2%。罹患癌症病人從診斷到治療期間，癌症病人容易發生失志情形，失志也許是憂鬱症之前兆或預兆，本研究結果預期將可提供醫護人員進一步了解乳癌病人化療期間症狀處理自我照護及了解乳癌病人失志及情緒相關影響因素，提供未來照護之實証參考，改善病人對於疾病所衍生的情緒問題。[[abstract]]Malignant tumors rank first in the causes of death of Taiwanese people. When receiving a cancer diagnosis and treatment, most people tend to develop emotional disturbances, such as anxiety and depression, which will have an adverse impact on the cancer treatment, as well as patients' quality of life. According to the research conducted in recent years, demoralization syndrome has a high correlation with anxiety and depression. Self-efficacy is another crucial factor related to patients' healthcare results, as well as their faith and judgment with regard to specific healthcare behaviors. Endeavoring to fulfill a preset healthcare target helps an individual with self-adjustment. As a result, breast cancer patients with relatively high symptom management self-efficacy may develop a positive mental status. This research aims to explore the correlation between the symptom management self-efficacy, demoralization, and mental status of inpatients with breast cancer.This research benefits from a cross-sectional design and a convenience sampling method, with all cases collected from a number of wards located close together in a medical center in northern Taiwan. In total, this study included 71 breast cancer patients undergoing chemotherapy. Structured questionnaire collection, including a basic demographic data sheet, symptom management self-efficacy scale, Demoralization Scale - Mandarin Version (DS-MV), and Hospital Anxiety and Depression Scale (HADS), was used in this research.All research data are analyzed using SPSS 19.0 for Windows. To explore the correlation between the symptom management self-efficacy, demoralization, and mental status of breast cancer patients, the standard statistical significance α under various assumptions shall be 0.05. Descriptive statistics are based on the percentage, mean value, and standard deviation, while inferential statistics are analyzed by means of ANOVA, t-test, Pearson’s correlation, and multiple regression. As shown by the results, there is a significant difference in the anxiety for individual’s &quot;current occupations&quot;(p < .05) and &quot;operations&quot; (p < .05); the correlation coefficients of &quot;dosage&quot; and &quot;depression&quot; result in a significantly positive value (r = .25, p < .05), which means that the higher dosage administered to an individual, the more severe the level of depression. Furthermore, the correlation coefficients of &quot;overall symptom management self-efficacy&quot; (r = -.36, p < .01), &quot;anxiety&quot;, and &quot;depression&quot; are significantly negative, which means that a better awareness of symptom management self-efficacy in various respects will help alleviate patients’ anxiety and depression. In contrast, the correlation coefficients of &quot;overall demoralization&quot;, &quot;anxiety&quot; (r = .25, p < .05), and &quot;depression&quot; (r = .47, p < .001) are significantly positive, meaning that an individual with a higher level of demoralization will be more anxious and depressed.This research involves exploring patients' symptom management self-efficacy and making predictions about the correlation between demoralization, anxiety, and depression. Based on the results, we found that &quot;symptoms concerning chemotherapy management&quot; (a secondary variable of symptom management self-efficacy), operations (Yes vs. No), and &quot;discouragement&quot; (a secondary variable of demoralization) have an effective influence on the &quot;anxiety level&quot; (a dependent variable), with an explanatory power of 23.0%; while &quot;depression&quot; (a secondary variable of demoralization) and &quot;emotional management and interpersonal disturbance&quot; (a secondary variable of symptom management self-efficacy) have an effective influence on the &quot;depression level&quot; (a dependent variable), with an explanatory power of 34.2%.Cancer patients tend to develop demoralization upon receiving a definite diagnosis and when undergoing medical treatment. Demoralization may be an aura of depression, while self-efficacy can help improve patients’emotional state. These research results can help medical personnel further recognize the symptom management self-care ability of patients with breast cancer when undergoing chemotherapy and better understand the impact of demoralization on the emotions of patients. What's more, it can provide a practical reference for future healthcare and help alleviate unhealthy emotions arising from various diseases