乳癌病人治療決策遺憾與生活品質之相關以及正念扮演的角色：以序列解釋型混合研究

Abstract

背景：乳癌治療選擇多元，病人在權衡治療效益與風險時，常產生治療決策遺憾。當病人面對後悔與遺憾的情緒時，可能會陷入負向自我責備。正念及自我疼惜可能成為保護因子，調節這些情緒對生活品質的影響。儘管已有研究探討這些保護因子在面對壓力時的中介調節作用，但針對乳癌病人及其治療決策遺憾感受的相關研究仍相對有限，這引發了本研究的動機。 目的：量性研究探討乳癌病人的治療決策遺憾與生活品質之關係，並分析正念與自我疼惜在其中所扮演的中介角色。質性研究探討瞭解病人在治療決策歷程中產生遺憾感受的脈絡與主觀經驗。 研究方法：本研究採用序列式解釋型混合研究設計（Sequential Explanatory Mixed-Methods Design），第一階段以量性研究探討乳癌病人的治療決策遺憾與生活品質之關係。第二階段以質性研究，進行主觀經驗的分析；此研究設計以量性分析了解主要變項的相關，再以質性分析了解變項相關的因果脈絡，期能全面理解病人在治療決策中的遺憾感受和想法，並提出具實證基礎的照護建議。本研究以北台灣某醫學中心及區域醫院之乳房外科及腫瘤科門診進行收案，研究對象為初次罹患乳癌第0、I、II期且已經完成手術治療、放射線治療、化學治療或標靶治療後36個月內且定期追蹤之女性病人。量性研究採立意取樣、問卷(基本資料表、治療決策角色量表、決策遺憾量表、生活品質量表、止觀覺察注意量表及自我疼惜量表等)收集資料及SPSS套裝軟體統計資料分析。質性研究採立意及滾雪球取樣；資料收集以基本資料表、決策遺憾量表及半結構式一對一訪談法並以主題分析方法進行資料分析。 研究結果：(一)量性研究：於2021年5月至12月收案138名，平均年齡為56.50歲； 17.39%病人表示沒有治療決策遺憾，55.80%屬於輕度遺憾(得分=1-25分)，26.81%屬於中重度遺憾(得分≥26分)。病人在治療決策中的實際參與角色與其偏好一致時，較不易產生遺憾。多元迴歸分析結果，較低的治療決策遺憾及較高的正念覺察與較高的EORTC QLQ-C30功能面向相關；較低的治療決策遺憾與較高的EORTC QLQ-BR45功能面向相關；乳癌病人的正念覺察在治療決策遺憾與整體健康狀況及EORTC QLQ-C30功能面向之間扮演部分中介作用，正念覺察在治療決策遺憾與EORTC QLQ-C30症狀面向之間扮演完全中介作用。 (二)質性研究：於2025年1月至3月收案16名，平均為54.83歲；在治療決策參與程度方面，「被動」有6位，「積極」有10位。根據治療決策遺憾量表（DRS）評分結果，共有7位(43.7%)表示沒有遺憾/後悔感受，另有9位（56.3%）表示遺憾/後悔。在治療決策影響因素中：共同的主題(themes)為信任醫療人員及經濟能力，另外，被動參與決策受訪者(n=6)的主題還有醫師權威、病人自認缺乏專業知識與家人支持；積極參與決策受訪者(n=10)的主題則是醫師專業建議、病人個人偏好(包含對身體心像的重視、對復發與死亡風險的擔憂、親密關係與子女的感受)、家人和朋友支持、過去家人治療的經驗及神明指示。治療決策遺憾/後悔的原因：沒有遺憾/後悔受訪者(n=7)的主題為生活未受影響、接受副作用及專注當下；有遺憾/後悔受訪者(n=9)的主題為生活功能受限、認知功能減退、外觀改變的心理影響、手術結果與預期有落差、藥物副作用影響、對未來病程的不確定感及自費治療費用高。治療後因應方式：主題有信念(次主題:命運、轉念、順其自然/放下、感恩、樂觀)、專注當下的生活、自我照顧(次主題: 健康生活型態、愛自己行動及積極圓夢)、利他以及外在支持(次主題:家庭、社會、醫療及宗教等支持)。 結論/實務應用：結合本研究之量化與質性結果，顯示專注在當下生活的正念扮演保護因子能協助乳癌病人調適治療決策遺憾、面對治療副作用、生活改變及面對未來復發的擔憂。建議臨床照護人員於治療決策歷程與治療後生存階段導入正念覺察介入策略，以增強病人之心理韌性與整體生活品質。

Background: Breast cancer is the most commonly diagnosed cancer among women worldwide. Given the variety of available treatments, patients often experience decision regret when weighing treatment benefits and risks. Mindfulness and self-compassion may serve as protective factors that help regulate the impact of these emotions on quality of life. Although existing studies have examined the mediating and moderating roles of these protective factors in stressful situations, research specifically addressing their relevance to decision regret among breast cancer patients remains limited. This gap in the literature forms the basis for this study. Objection: This study aimed to explore the relationship between treatment decision regret and quality of life in breast cancer patients and to examine the mediating roles of mindfulness and self-compassion. Methods: A sequential explanatory mixed-methods design was adopted. The quantitative phase investigated the relationships among treatment decision regret, mindfulness, self-compassion, and quality of life. The qualitative phase further explored the context and subjective experiences of decision regret during the treatment decision-making process. The study is designed to first use quantitative analysis to understand the relationships among the main variables, followed by qualitative analysis to explore the causal context behind these relationships. The goal is to gain a comprehensive understanding of patients' feelings and thoughts of treatment decision regret, and to propose evidence-based care recommendations. Participants were recruited from the breast surgery and oncology outpatient clinics of a medical center and regional hospital in northern Taiwan. Eligible participants were women diagnosed with stage 0, I, or II breast cancer who had completed surgery, radiation therapy, chemotherapy, or targeted therapy within the past 36 months and were undergoing regular follow-up. The quantitative study used purposive sampling and questionnaires (including demographic data, Control Preference Scale, Decision Regret Scale, EORTC QLQ-C30, EORTC QLQ-BR45, Mindful Attention Awareness Scale, and Self-Compassion Scale). Data were analyzed using SPSS. The qualitative study employed purposive and snowball sampling. Data were collected through demographic forms, the Decision Regret Scale, and one-on-one semi-structured interviews, and analyzed using thematic analysis. Results: 1. Quantitative Results: From May to December 2021, 138 participants were recruited with an average age of 56.5 years. The mean decision regret score was 20.94 (SD = 15.34; range = 0–75). Among them, 17.39% reported no decision regret, 55.80% reported mild regret (score = 1–25), and 26.81% reported moderate to strong regret (score ≥ 26). Patients whose actual decision-making role matched their preferred role were less likely to experience regret. Correlation analyses showed that decision regret was negatively associated with overall health status and functional domains of the EORTC QLQ-C30 and QLQ-BR45, and positively associated with symptom domains of the EORTC QLQ-C30. Multiple regression analyses revealed that lower regret and higher mindfulness were associated with higher QLQ-C30 functioning; lower regret was associated with higher QLQ-BR45 functioning. Further analyses demonstrated that mindfulness partially mediated the relationship between decision regret and both global health and functioning domains of the QLQ-C30, and fully mediated the relationship between decision regret and symptom domains of the QLQ-C30. 2. Qualitative Results: From January to March 2025, 16 participants were interviewed, with a mean age of 54.8 years. Among them, 6 had “passive” and 10 had “shared” decision-making roles. According to the Decision Regret Scale, 7 participants (43.7%) reported no regret, and 9 (56.3%) reported regret, including 7 with mild and 2 with moderate to strong regret—both of whom had passive decision-making roles. Factors influencing treatment decisions included trust in healthcare providers and financial considerations for all participants. Additional themes for passive participants (n = 6) included physician authority, perceived lack of medical knowledge, and family influence; for shared participants (n = 10), themes included medical advice, personal preference (concerns about body image, the risk of recurrence and death, and the feelings of intimate partners and children), support from family/friends, prior family experiences, and religious guidance. Themes related to reasons for no regret (n = 7) included: unaffected daily life, acceptance of side effects, and focus on the present. Themes for regretful participants (n = 9) included: physical limitations, cognitive decline, appearance-related distress, mismatch between surgical outcomes and expectations, medication side effects, uncertainty about future disease progression, and high out-of-pocket treatment costs. Post-treatment coping strategies were categorized into five themes: (1) personal beliefs (subthemes: fate, cognitive reframing, letting go, gratitude, optimism); (2) living in the present; (3) self-care (subthemes: healthy lifestyle, acts of self-compassion, goal pursuit); (4) altruism; and (5) external support (subthemes: family, social, medical, and religious support). Conclusion/ Implications: Integrating the quantitative and qualitative findings, the study demonstrates empirical support for the role of mindfulness as a protective factor in helping breast cancer patients cope with decision regret, treatment side effects, life changes, and concerns about recurrence. It is recommended that healthcare professionals incorporate mindfulness-based strategies into both the treatment decision-making process and survivorship care to enhance patients’ psychological resilience and overall quality of life. The findings of this study also provide theoretical and empirical foundations for future research and intervention development.