頭頸癌患者健康控制信念、因應方式與身心社會調適關聯之縱貫性研究

No Thumbnail Available

Date

2010

Journal Title

Journal ISSN

Volume Title

Publisher

Abstract

本研究旨在探討頭頸癌患者隨著不同病程階段其身心社會調適的變化情況,以及不同層次影響因素對其調適的初始狀態與後續成長率的影響效果;同時也探究患者處在不同病程階段,其因應方式、健康控制信念與身心社會調適的相關性變化。 本研究乃於北部及南部各一所醫學中心之放射腫瘤科,徵求經診斷為頭頸部惡性腫瘤且自願接受施測之患者為研究對象,分別在診斷後、治療中、治療後三個月及治療後六個月進行四次施測,研究受試者共計109人,收得有效問卷共257份。所使用的研究工具包括集體因應風格量表、健康控制信念量表、情緒狀態量表--焦慮與憂鬱分量表,及頭頸癌患者之生物-心理-社會症狀綜合量表。依據本研究問題與假設,本研究主要以描述統計及階層線性模式統計方法進行資料分析。主要研究結果如下: 一、頭頸癌患者的生活品質變化形式為先升後降的二次方曲線成長形式,亦即生活品質困擾呈現先遞增再遞減的倒U現象;影響診斷後生活品質的因素,在個人間層次的解釋因素包括年齡、癌症診斷與工作狀況,在個人內層次則主要為因應方式;隨著病程階段對於生活品質成長速率具有顯著影響的調節因子為癌症期數。 二、頭頸癌患者心理狀態變化形式為ㄧ次方線型成長形式,亦即心理狀態困擾會隨著時間呈現線性遞減的趨勢;影響診斷後心理狀態的因素,在個人間層次的解釋因素包括年齡、性別、信仰/靈性與工作狀況,在個人內層次的解釋變項則為因應方式,特別是抱持「接受、重構與奮鬥因應」的患者,其診斷後心理狀態調適的影響效果格外明顯;隨著病程階段對於心理狀態成長速率具有顯著影響的調節因子,主要是性別、癌症期數與教育程度。 三、病程階段對於因應方式影響生活品質之調節效果,根據本研究結果顯示,病程階段對於逃避否認疏離因應與生活品質的影響關係具有調節效果;病程階段對於尋求家庭支持因應與心理狀態的影響關係具有調節效果;病程階段對於私下情緒出口因應與心理狀態的影響關係,亦具有調節效果。此外,有關病程階段對於健康控制信念與因應方式之調節效果,根據本研究結果顯示,病程階段對於機運控制信念與尋求家庭支持因應結果的影響關係具有調節效果。 四、根據本研究結果顯示,患者在診斷後持「醫師強有力他人控制信念」,與治療中的「接受、重新架構與奮鬥因應」、「尋求家庭支持因應」與「信仰/靈性因應」具有正相關。在診斷後抱持「內在控制信念」,與治療中的「接受、重新架構與奮鬥因應」與「尋求家庭支持因應」、以及治療後六個月的「尋求家庭支持因應」呈現正相關。在診斷後抱持「機運控制信念」,則與治療中「逃避否認與疏離因應」呈現顯著正相關;並與治療後三個月的「尋求家庭支持因應」、「接受、重新架構與奮鬥因應」、「逃避否認與疏離因應」呈現正相關。此外,頭頸癌患者生活品質對於心理狀態的影響要遠高於反向的關係。 根據研究結果與限制,對於臨床實務應用與心理介入方案,以及未來癌症患者身心社會調適的相關研究提出若干建議。
The aim of this quantitative study contains three parts: Part I of the study is to examine growth pattern of the bio-psycho-social adaptation effect of head and neck cancer patients and examine the effects of variables on within-individual and between-individual level factors during their disease sessions; Part II of the study is to explore if the stages of the disease have a significant moderate effect. Part III of the study is to investigate an integral correlation among health locus of control, coping way, and bio-psycho-social adaptation effect for four different illness stages. The research subjects of this study have 109 head& neck cancer patients and with total 257 valid questionnaires. The research tools include: “Collectivist Coping Styles; CCS”, “Multidimensional Health Locus of Control; MHLC”, “Profile of Mood States; POMS--Tension-Anxiety & Depression-Dejection subscale” and “The Bio-psycho-social Symptoms of HNC patients After Treatments; BSHAT”. The questionnaires were filled 4 times by the clients when identified their disease diagnosis, period of treatment, 3 months after therapeutic course, and 6 months after therapeutic course respectively. Descriptive statistics and hierarchical linear models were used for data analysis. The main results were: I: The score of the quality of life of the growth model in each illness stage supports the curve of the growth pattern of increasing, followed by decreasing or slowing down. The variables in within-individual level (coping ways) and between-individual level(age, religion and job)have a significant effect on the initial status of clients’ adaptation effect; cancer stage has an effect on the growth rate of clients’ adaptation effect. II: The score of mood state in each illness stage of the growth model supports the linear growth pattern of decreasing or slowing down. The variables in within-individual level(coping ways)and between- individual level(age, gender, religion and job)have a significant effect on the initial status of clients’ adaptation effect; gender, cancer stage and educational degree has an effect on the growth rate of clients’ adaptation effect. III: The stages of disease plays the role of moderator effect between “Avoidance and detachment coping style” and “Quality of life”; And the stages of disease also plays the role of moderator effect between “Family support coping style” and “mood state ”; “Private emotional outlets coping style” and “mood state ”. IV: After identified diagnosis, for the patients with powerful others health locus of control (PHLC), the scores of the survey have positive correlation with the scores of the “Acceptance, reframing and striving coping style”, “Religion-spirituality coping style” and “Family support coping style” during therapeutic course; After identified diagnosis, for the patients with internal health locus of control (IHLC), the scores of the survey have positive correlation with “Acceptance, reframing and striving coping style” and “Family support coping style” during therapeutic course and “Family support coping style” after 6-month therapeutic course; After identified diagnosis, for the patients with chance health locus of control (CHLC), the scores of the survey have positive correlation with “Avoidance and detachment coping style” during therapeutic course, and “Acceptance, reframing and striving coping style”, “Family support coping style” and “Avoidance and detachment coping style” after 3-month therapeutic course. In addition, the degree of quality of life for head& neck patients affect the mood states is stronger than the mood sates affect patients’ quality of life. Based on research results and limitations, several suggestions were proposed for future research and concern for providing appropriate clinical psychological intervention and nursing care guidelines to improve the head and neck patients’ quality of lives.

Description

Keywords

頭頸癌, 健康控制信念, 集體因應風格, 身心社會調適, 階層線性模型, head and neck cancer patient, bio-psycho-social adjustment, way of coping, health locus of control, Hierarchical Linear modeling(HLM)

Citation

Collections