中文摘要
過去研究發現即使非常少量的室內植栽或自然景觀接觸，都有助於人們的身心健康與福祉。但過去的研究鮮少利用自然景觀及園藝活動對乳癌病患進行實證。很多人癌症病人因為心理與生理因素導致無法回到正常生活，而乳癌患者卻可以透過治療而恢復正常生活。
本研究主要目的在探討自然景觀及園藝活動對乳癌患者生理健康(唾液皮質醇)及心理健康(焦慮、憂鬱及失志)相關因素之影響。共18名自願參與研究之乳癌患者，經過正確的刪選，最後選擇13名乳癌患者作為本次研究分析討論對象，其中實驗組6名、對照組7名。實驗組接受2週自然處方(自然景觀接觸及園藝活動)；對照組不接受任何自然處方。檢驗受測者於自然景觀接觸及園藝活動前後壓力(皮質醇)、焦慮憂鬱及失志等生理心理指標的變化。自變項為乳癌病患從事自然景觀接觸及園藝活動，依變項為乳癌患者的壓力、焦慮憂鬱和失志變化。研究工具為醫院焦慮憂鬱量表、失志量表及病患唾液以檢測壓力荷爾蒙。研究方法以量化分析為主，即以SPSS Statistics 20統計軟體進行相依樣本t檢定、獨立樣本t檢定及多元迴歸分析；質性分析為輔。
研究結果為透過多元迴歸分析「家裡看到綠色量」及「窗戶綠色量」自變數的迴歸係數分別為-5.00、-3.64，其顯著性皆0.00<0.05，表示住家綠色景觀越多失志則越低。相依樣本t檢定，唾液皮質醇實驗組前測生理指標及後測心理指標達顯著差異(t=-5.06，p≦0.01)。醫院焦慮憂鬱量表部分，後測及前測分數達顯著差異(t=-3.53，p≦0.05)。獨立樣本t檢定，失志量表總分改變量(t=2.16，p≦0.05)及醫院焦慮憂鬱量表總分改變量(t=4.36，p≦0.01)皆達顯著性差異。
研究結論為自然景觀接觸及園藝活動對於乳癌患者具有心理層面正向調節作用，然而壓力、焦慮憂鬱及失志除藥物治療外，自然處方可作為協助康復方法之一。本研究結果也可提供醫護人員增加生、心理效益為目標，視為衛教之重點。

Abstract
Previous studies have found that very few indoor plants or green natural environment have been associated with people’s psychological, physical health and well-being. Over the past years, few studies have focused on the effects of the natural environment and horticultural therapy for cancer patient’s benefits, especially for breast cancer patients. Cancer cure often have psychological and physical medical challenges. Many patients experience some difficulty in returning to normal daily life. However, breast cancer patients can be curative treatment and get back to a normal life again.
The purpose of this study is to investigate the effect of the natural environment and horticultural therapy on physiological (cortisol) and psychological indicators (anxiety, depression and demoralization) in breast cancer patients.
A total of 18 volunteers of breast cancer patients, after I correct to select the samples. There were 13 volunteers divided into experimental group (6 persons) and control group (7 persons). The experimental group received natural prescription (the natural environment and horticultural therapy) for two weeks. The control group was without any natural prescription. All tests of the participants were compared before and after the natural environment and horticultural therapy treatment within two weeks activities, changing physiological (cortisol) and psychological indicators (anxiety, depression and demoralization). The independent variables are the breast cancer patients contacting with the natural environment and horticultural therapy, and the dependent variables are the variation of pressure, anxiety, depression, and demoralization of breast cancer patients. Research tools including the Hospital Anxiety and Depression Scale, Demoralization Scale, and salivary cortisol. In this study lies in the major method used to quantify with SPSS statistical software 20 including dependent sample t test, independent samples t-test, and multiple regression analysis. A qualitative analysis is a supplement.
The research results through multiple regression analysis, the regression coefficients of the independent variables for "to see the amount of green view at house" and "the amount of green view at window" were -5.00 and -3.64, respectively. There were improve significantly (0.00≦0.05), and it represents the more green landscape around the house the more demoralization decreased. The experimental group measured salivary cortisol for physiological and psychological indicators by dependent sample t test, and there were significant difference between before and after test (t=-5.06, p≦0.01).There were significant differences between before and after test scores by the Hospital Anxiety and Depression Scale (t=-3.53, p≦0.05). Following independent sample t test, the amount of change total score by Demoralization Scale (t=2.16, p≦0.05) and the amount of change total score by the Hospital Anxiety and Depression Scale (t=4.36, p≦0.01) are reached significant.
The conclusion of this study that the natural landscape contacts and horticultural activities for breast cancer patients have a positive emotions of psychological regulation. In addition to medical treatment for stress, anxiety, depression, and demoralized, natural prescription can be used as one of rehabilitation methods.It also can provide medical staff some ways to focus on the basis of increasing the patient’s physiological and psychological benefit in the future.

致謝....................... I
中文摘要.................. II
英文摘要.................. III
目錄...................... V
表目錄.................... VIII
圖目錄.................... IX
第一章 緒論
第一節 研究緣起與問題陳述.... 1
第二節 研究目的.............. 3
第三節 研究內容............. 3
第四節 研究名詞定義......... 4
第二章 文獻回顧
第一節 癌症病患之生心理狀態... 8
一、 壓力(stress)........... 8
二、 失志(demoralization)... 12
三、 焦慮和憂鬱(anxiety and depression)..... 13
四、 小結.................. 16
第二節 乳癌的治療方式........ 18
一、 乳癌的治癒性及症狀緩和性治療...... 18
二、 輔助及另類療法......... 18
三、 小結.................. 20
第三節 自然景觀及園藝活動對病患健康效益之相關理論....20
一、 觀看自然景觀或處於自然.....21
二、 在自然中活動..............22
三、 園藝體驗活動..............23
四、 小結.....................30
第三章 研究方法
第一節 研究架構與假設...........31
第二節 研究實作................35
一、 研究樣本..................35
二、 研究流程..................35
三、 實驗時間與地點.............37
四、 自然處方內容...............37
五、 實驗流程..................38
六、 研究工具及材料.............40
七、 統計分析..................45
第四章 結果與討論
第一節 樣本描述.................47
第二節 住家綠色景觀對受測者的前測檢定....51
第三節 參與自然處方對受測者的前後檢定....54
第四節 有無參與自然處方對受測者組別之差異性檢定....58
第五章 結論與研究建議
第一節 結論.....................65
第二節 建議與限制................66
一、 針對促進乳癌患者健康.........66
二、 針對後續研究建議.............66
參考文獻.........................68

附錄一 研究問卷(前測)............88
附錄二 研究問卷(後測)............93
附錄三 中文版失志量表(DS-MV)使用同意書.......96
附錄四 醫院焦慮憂鬱量表(HADS)使用同意書......97
附錄五 人體研究對象(或受試者)同意書..........98
附錄六 研究檢體(加密檢體及衍生物)採集及使用(含基因及非基因檢測)同意書.............................99

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