背景：
　　乳癌是目前台灣女性好發的癌症之一，其中約33%為育齡期女性。相較於年長女性，年輕的乳癌患者因為活得久而必須面對許多次復發的可能。年輕且正值育齡期的乳癌女性因社會的變遷，出現晚婚及高齡初產的狀況。乳癌輔助治療準則是在接受外科手術後一個月即需確定，選擇生育或是接受乳癌輔助治療，以啟動下一個計畫。乳癌的輔助性治療對於生殖系統的傷害尚無定論，其副作用或治療後生殖能力回復的時間長短，皆將致育齡期乳癌婦女不孕的可能性提高。因此育齡期乳癌女性常因伴侶狀況、生殖顧慮、乳癌復發擔憂間複雜的關係，導致選擇困難。過去相關缺乏非第一胎生產經驗的育齡期乳癌女性，在伴侶關係與育齡期母職壓力的研究也多以訪談為主，欠缺數據化的研究資料突顯育齡期乳癌女性的困境，使後續醫療照護品質的提升陷入困境。
目的：
　　研究目的旨在探討育齡期乳癌女性罹病後的母職需求，以確認生殖顧慮、乳癌復發擔憂、乳癌治療與保留生殖決策衝突對於育齡期乳癌女性母職計畫壓力的影響。
方法：
　　本研究為橫斷式，採方便取樣及相關性研究設計，採單一中心、收案地點於乳房外科門診進行收案；自人體研究倫理審查委員會審查通過後執行收案。納入條件涵蓋：1. 初診斷乳癌，符合輔助性治療條件，其輔助性治療具生殖細胞毒性可能之女性；2. 20至49歲；3. 具國語或閩南語溝通能力；排除條件有：1. 尚有其他初診斷癌症；2. 具慢性病史；3. 具身心症病史，如：憂鬱症；4. 具其他生殖系統病症。，研究者將先說明研究收案流程與受試者保護的措施，取得此些符合收案條件的育齡期乳癌女性知情同意，所有參與研究的育齡期乳癌女性須完成研究問卷計六部分，含：基本資料調查、艾氏人格特質量表(EPQ)、罹癌後生殖顧慮量表(RCACS)、癌症復發恐懼―疾病嚴重量表(FCRI-SF)、決策衝突量表(DCS)和多面向不孕症心理社會壓力量表(COMPI-FPSS)；此些研究問卷用以瞭解此些女性的人口學資料、人格特質、生殖顧慮、乳癌復發擔憂、決策衝突與母職計畫壓力。敘述性統計與推論性統計將以SPSS分析，使用AMOS進行結構方程式模型分析，以驗證伴侶關係、疾病嚴重程度、產次、生殖顧慮、乳癌復發擔憂和決策衝突對育齡期乳癌女性母職計畫壓力的影響。
結果：
　　本次執行期間為2022年9月18日至2023年11月14日，共收入100位符合納入條件之育齡期乳癌女性個案。研究過程並未有任何受試者遭受不良反應或傷害。經由結構方程式分析，顯示本研究針對伴侶關係、生殖顧慮、乳癌復發擔憂、決策衝突對育齡期乳癌婦女的母職計畫壓力將造成影響的假設模型是可接受的；除了乳癌復發擔憂、生殖顧慮、決策衝突確實可依序對育齡期乳癌婦女的母職計畫壓力造成直接影響外，偏神經質傾性的人格相較於伴侶關係，對於育齡期乳癌婦女的母職計畫能造成較大的影響；伴侶關係雖然其影響不若人格特質來得強，但較好的伴侶關係將可能緩解乳癌復發擔憂、生殖顧慮和決策衝突對育齡期乳癌婦女造成的母職計畫壓力。
結論：
　　本研究發現，擔憂、顧慮及衝突甚至壓力這些負向的感受，可能與源於病人本身的人格特質有極大關聯。由此更加凸顯醫療人員應尊重病人的個別性，提供個別性照護的重要性。建議未來於照護育齡期乳癌女性時，除了瞭解她們對於生兒育女上未滿足的需求，給予同理心的照護，在提供醫療資訊時，也能考量此時期乳癌女性對於疾病擔憂、生殖顧慮上的困境，以緩解她們面對疾病治療或是母職計畫決策上的衝突；此些應給予系統性的照護並兼顧個別性的需求，讓育齡期乳癌女性也能被成全人生的計畫，於未來發展更多照護策略能夠妥善考量此些女性對於母職計畫上的困境及個別狀態，以提升其生活品質。

Background
Breast cancer is a common cancer among reproductive women. According to the late marriage and first childbearing age, most of these women had not yet completed their family plan. The gonadal impairment of the breast cancer treatments induced the distress of infertility among these reproductive women with breast cancer. The decision-making between receiving breast cancer treatment or retaining the fertility potential for later childbearing is the dilemma for these women within a short period of time during surgery and adjuvant therapies. Partner-relationship, childbirth, and fear of recurrent cancer are the specific concerns among these breast cancer reproductive women. However, the health care professions focused only on the physical illness of these women, and neglected the unmet needs of their psychological and social aspects. Despite the qualitative studies of infertility issues on reproductive breast cancer women, little quantitative data was available on these women and associated with the determined effects on their partner-relationship and parity. Therefore, the recent study is focused on determining the causal effect of the factors related to planned motherhood distress among reproductive women with breast cancer.
Purpose
To determine the effects of the partner relationship, severity of illness, parity, fertility concern, fear of cancer recurrence, and decision conflict on the distress of reproductive women with breast cancer planned motherhood.
Methods
The study employed a cross-sectional design with convenience sampling. The inclusion criteria are: 1. The new diagnosis is breast cancer, and women request to receive adjuvant or neoadjuvant treatments; 2. Age between 20–49 years old; 3. Available in Mandarin or Taiwanese. And the exclusive criteria are: 1. No double primary malignancies; 2. No chronic disease; 3. No mental disorders or major depression, and 4. No reproductive system disease. The data collecting process started after IRB approval and recruited the eligible participants in a medical center in south Taiwan. All the participants received informed consent and were required to complete six questionnaires: the survey of demographic data, all the questionnaires on personality (EPQ), fertility concern (RCACS), planned motherhood distress (COMPI-FPSS), fear of cancer recurrence (FCRI-SF), and decision conflict (DCS). SPSS version 22.0 and Amos 21.0 were used to analyze the data.
Results
One hundred reproductive women with breast cancer were enrolled in our study. the SEM results of the model are an acceptable fit (χ2 =67.03, df = 64, and p = 0.37,SRMR = 0.07, CFI =0.99 , TLI=0.99). Neuroticism was significantly associated with fear of breast cancer recurrence (β =0.41, P<0.01), and the partner relationship also had a significant association with fear of breast cancer recurrence (β =-0.20, P<0.05). Fear of breast cancer recurrence was significantly associated with decision conflict (β =0.29, P<0.05), and decision conflict was significantly associated with fertility concern (β =0.22, P<0.05). Furthermore, fertility concern was significantly associated with planned motherhood distress (β =0.71, P<0.01).
Conclusions
These findings can highlight the importance of healthcare providers respecting individuality and providing individualized care. In the future, it is necessary to provide care strategies for these women to fulfilled their unmet needs in planning motherhood. Integrated health care among multidisciplinary disciplines, considering the individual needs and providing professions including oncology, reproductive medicine, nursing, and psychological counseling, should be considered to develop the appropriate strategies in future care plans. The study will expect to enhance crucial factors of the dilemma among reproductive breast cancer women in planned motherhood, and help healthcare professionals further develop adequately and individualized strategies to deal with the distress of planned motherhood distress among reproductive women with breast cancer. Hence, these women could meet their needs in their life plan and achieve a better quality of life.

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