[[alternative]]The relationship between symptomatic distress, mood state, resilience and psychological well-being among the early stage of breast cancer woman after breast conservation surgery

[[abstract]]研究背景：乳癌長期排名台灣女性癌症發生率的第一名，死亡率為第二名，對於台灣女性來說有著莫大的衝擊。早期乳癌患者常因接受乳房保留手術（Breast Conservative Surgery）而造成乳房雙側不等大、乳房變形。因不同程度之心理衝擊而產生負面情緒等，如又合併接受其他治療造成不等程度之症狀困擾，即產生不同程度之情緒狀態進而影響幸福感。研究目的：本研究目的在探討早期乳癌女性在接受乳房保留手術後之幸福感，並瞭解人口學屬性、疾病治療屬性、復原力、症狀困擾、情緒狀態與幸福感之相關性。研究方法：本研究採橫斷式研究設計，以方便取樣，於某台北地區醫學中心血液腫瘤科門診進行收案。採結構式問卷進行資料收集，量表包含基本人口學屬性量表、症狀困擾量表、情緒狀態量表、中文版 Connor-Davidson 復原力量表及中國人幸福感量表。以獨立樣本T檢定（T-test）、單因子變異數分析（One way ANOVA）、皮爾森相關係數（Pearson correction）及線性複回歸（Multiple liner regression）等統計方法進行資料分析。研究結果：共收案120位乳癌女性，平均年齡為48.6歲。幸福感平均得分為30.34分。單變量分析中，乳癌女性的症狀困擾越高(r = - 0.323，p < 0.001)、情緒狀態越差(r = - 0.601，p < 0.001)、復原力越低(r = 0.673，p < 0.001)，其幸福感越低。另外，相較於教育程度為國小/國中/高中者，教育程度在大學以上的乳癌女性，有比較高的幸福感。相較於家庭月收入在25,001-60,000者，家庭月收入大於10萬的乳癌女性，有比較高的幸福感。將這些變項放入複迴歸分析中得知復原力及情緒狀態是預測乳癌病人幸福感的顯著預測因子，共可解釋54.2%的變異量。當乳癌女性的症狀困擾越少，情緒狀態越好，其復原力越高，幸福越高，顯示復原力是症狀困擾及情緒狀態與幸福感關係的中介因子。結論與實務應用：乳癌女性的症狀困擾及情緒狀態是影響其幸福感的重要因子。建議於入院時做相關護理評估，並適時提供護理處置介入，以改善其症狀困擾及情緒狀態，並增進幸福感。而復原力是影響乳癌女性之症狀困擾及情緒狀態與幸福感間關係的中介因子，故提升病患之復原力，可進而提升其幸福感。[[abstract]]Study Background：Breast cancer has been listed as number one in cancer occurrence, number 4 in death rate and results in huge impact for females in Taiwan. Early stage breast cancer patients results in unequal sizes on both breast sides and breast deformation because of accepting Breast Conservative surgery (BCS). Due to different level mental impact, it results in negative emotions affecting psychological well-being, such as combining accepting other therapies to induce different syndrome disturbance and emotional states.Study Objective： This study mainly investigates the psychological well-being from early stage breast cancer women after accept BCS and understand the correlation among psychological well-being, basic demographic attributes, disease treatment attributes, recovery, syndrome distress, emotional states.Study Methods： This study adopts cross-sectional research design with convenience sampling and samples recruited from hematology oncology clinic at a medical center in Taiwan. Structural questionnaire was adapted to data collection, including basic demographic attributes scale, symptoms distress scale, emotional status scale, Connor-Davidson resilience scale and Chinese happiness scale. Statistics using independent T-test, One way ANOVA, Pearson correctio and Multiple liner regression were applied for data analysis.Study result：Totally 120 breast cancer women were received to join this study, with an average age of 48.6 years. The average score of the Chinese Happiness Index is 30.34. In univariate analysis, women with the worse symptoms distress (r = -0.323，p < 0.001), the worse the emotional state (r = -0.601, p < 0.001), and the lower the resilience (r - 0.673, p < 0.001), experienced lower the psychological well-being. In addition, compared with women with breast cancer who have a higher level of education than those with a national education level of elementary school/junior high school/senior high school, women with a higher level of education have a higher level of psychological well-being. Compared to those with a monthly household income of 25,001-60,000, breast cancer women with a monthly household income of more than 100,000 had a higher level of psychological well-being. These variables were found in regression analysis to know that resilience and emotional state were significant predictors of psychological well-being in breast cancer patients, which explained a total of 54.2%. When breast cancer women have fewer symptoms, the better the emotional state, the higher their resilience, the higher the psychological well-being. The resilience is mediator which effect the relationships between the symptom distress and emotional state and psychological well-being.Conclusions and practical applications：Symptom distress and emotional state of breast cancer women are important factors affecting their psychological well-being.It is recommended to conduct an assessment at the time of admission and provide adequate interventions in due course to improve symptom distress and emotional state and improve psychological well-being. Resilience is the mediator that affects the relationship between symptom distress and emotional state and psychological well-being in women with breast cancer, so it enhances the patient's resilience and thus their psychological well-being