探討乳癌育齡婦女接受生育力保留術之決策過程

Abstract

在乳癌診斷的育齡婦女面對行生育保留術之決策歷程，如何在有限的時間內，提供完整的資訊，讓個案能對生育保留術有所瞭解並能接續後續癌症治療，對醫療團隊是一項大挑戰。本文在於研究了解乳癌診斷的育齡婦女面及對行生育保留術之決策歷程，相關的影響因子和經驗內容，及所面臨的困境和未來可改善之處。本研究採取質性研究，以開放式的問句與個案深入訪談，進行資料統整和收集。採取立意取樣法，共訪談十位乳癌育齡婦女，持續在北部某醫學中心乳房外科追蹤，共五位行凍卵生育保存術，另五位行凍胚胎生育保留術，訪談內容採質性研究內容分析。本文研究發現乳癌診斷育齡婦女面對行生育保留術之決策歷程，會經過決策前、決策中、執行決策，這兩種族群面臨的歷程各有其相同及相異之處，過程中從情緒反應到收集生育相關資料，到求診內分泌生殖專科醫師，這一路面臨的心理壓力，生育和生命間如何取得平衡。在決策歷程的困境上，需在短短一個月倉促做決定，收集的資訊太雜太多，無法有效正確判斷，如果能訂定一套標準育齡婦女罹癌的治療及生育保留術之過程，並設立單獨專一窗口諮詢，成立相關病友團體，互相鼓勵度過此過渡期。 此研究內容可以供描述乳癌育齡婦女行生育保存術之決策歷程相關的影響因子，研究結果可提供於醫療人員於照護乳癌育齡婦女行生育保存術之過程的知識、問題及困境探討，加強醫護人員們的照護品質，使病人能落實病人共享決策於其中，研究結果可提供未來乳癌育齡婦女行生育保存術上照護之參考。

This study aimed to understand the decision-making of fertility preservation in diagnostic breast cancer women of child-bearing age. A qualitative design with open-ended, recorded the interviews with the breast cancer women of child-bearing age. A total of 10 participants who had followed breast surgery OPD in National Taiwan university medical hospital, including 5 frozen oocyte group and 5 frozen embryo group, were invited via purposively sampling and completed face-to-face in-depth interviews. Data was analyzed by using qualitative content analysis. The result indicated that breast cancer women of child-bearing age were in the face of the decision-making process of reproductive retention, through before decision-making, in decision-making, and doing decision-making. The two groups faced the same problem from their emotional response in the process. In order to collect fertility-related information, they had to seek out endocrinology and reproductive specialists. How to balance the psychological pressure between fertility and life was the major problem. However, in the dilemma of the decision-making process, it was necessary to make a decision in a short period of one month. The information collected is too much and cannot be effectively judged correctly. The results showed that we should establish the standard treatments and the process of fertility preservation, set up a separate window consultation and set up relevant patient groups for women of child-bearing age, creating the opportunity to encourage them each other to pass this transition period. If the procedure could be constructed completely, it might give the breast cancer women of child-bearing age effective assistance when they do the decision-making process of reproductive retention.