摘要
研究目的:
癌症為國人最主要的死亡原因，其中乳癌有日益遽增的現象。研究指出癌症除了影響患者之身心健康外，也可能會損害家屬的睡眠品質及生活品質。因研究也指出一般大眾或長期病患的健康內、外控與睡眠品質及生活品質呈正相關；但也有研究指出年紀、收入、性別，及配偶身份可能影響照顧者的生活品質及睡眠品質，所以此研究納入及控制這些因子。因此，本研究主要目的為探討：乳癌患者的主要照顧者，在得知診斷後之生活品質及睡眠品質狀況，進一步控制年紀、收入、性別，及配偶身份後，檢驗健康內、外控與其生活品質及睡眠品質的相關。

研究方法:
本研究採取橫斷式研究設計；受試者為診斷初發18個月內的乳癌期0到3期之主要照顧者，共有65位參與本研究。研究流程：在取得收案醫院研究倫理委員會同意後，在外科門診及化療室外接觸受試者，告知研究目的並取得同意後開始施測。研究工具包括健康內外控、生活品質，及睡覺品質等自陳式量表。研究方法：依本研究目的使用描述性統計、t檢定、皮爾遜相關，及多元回歸分析資料。

結果：
研究中共有88.89%的參與者有不良睡眠品質。皮爾遜相關分析結果顯示，健康內控與日常生活不良功能有負相關；健康外控與社會關係範疇、環境範疇，及整體生活品質呈負相關。健康內控與自覺睡眠品質呈正相關。多元迴歸分析顯示在控制年齡、收入、性別，及配偶身份後，健康內控可預測整體睡眠品質，健康外控則可預測社會關係範疇及整體生活品質。收入與健康內控在環境範疇上有交互作用，進一步分析結果顯示在低收入及高健康內控組，健康內控與環境範疇呈正相關。

討論：
本研究中，約九成的乳癌照顧者可能有睡眠障礙。高健康內控與良好睡眠品質呈正相關，高健康外控與生活品質與睡眠品質呈負相關，迴歸結果顯示健康內、外控對照顧者的睡眠與生活品質皆有影響。醫療工作人員協助照顧者時可針對降低其健康外控。

Abstract
Research background/goal:
Increasing occurrences of breast cancer in Taiwan suggests that more and more people will be affected by this disease. Several lines of evidence suggest that caregiving is a tremendously stressful task. Moreover, caregiving may lead to lower quality of life and sleep quality for caregivers. Studies have indicated that Health Locus of Control (HLOC) is beneficial for healthy people and chronic patients. Moreover, studies have illustrated that age, income, gender, and spousal status may affect the impact of caregiving. Thus this study included and controlled these variables. This study observes the quality of life and sleep quality of caregivers; this study examines the correlations among Heath Locus of Control, sleep quality and quality of life of caregivers.

Research Design:
This study employed a cross-sectional and correlational design. The measurements used for quality of life and sleep quality were Quality of Life (WHOQOL-BREF-TAIWAN) and Chinese Pittsburgh Sleep Quality Index (CPSQI). Sixty-five primary caregivers of breast cancer patients in stage 0-3, who had been diagnosed within the period of 18-month participated in this study. Approvals from board of ethics were obtained. Participants were contacted at the surgery and chemotherapy clinics. Informed-consent was obtained before data collection. Descriptive analyses, t-tests, Pearson’s Correlations, and multiple regressions were used to sort and analyze data.

Result:
There were 88.89% of the participants who may have had poor sleep quality. Pearson’s correlation was used to examine the correlations between HLOC, CPSQI, and WHOQOL-BREF-TAIWAN. The internal HLOC was negatively correlated with Daytime Dysfunction. External HLOC was negatively correlated with Social Relationship Domain, Environmental Domain, and overall quality of life. External HLOC was positively correlated with Subjective Sleep Quality. Multiple Regressions indicated that when age, income, gender, and spousal status were controlled, internal HLOC positively predicted Global Sleep Quality. External HLOC negatively predicted of Social Relationship Domain and overall quality of life. Interaction between income and internal HLOC on Environmental Domain was significant, in which, the low-income-and-high-internal-HLOC group revealed a positive correlation between internal HLOC and Environmental Domain.

Discussion:
Majority of caregivers of breast cancer patients may have sleep difficulties. Overall, higher Internal HLOC was correlated with better sleep quality; higher External HLOC was correlated with poor sleep quality and worse quality of life. Health Locus of Control is an important issue for caregivers. Clinical professionals may aim to reduce external HLOC when assisting caregivers.

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