年輕成人罹癌康復後生命經驗之詮釋

Abstract

前言：年輕癌症病人族群長久以來未受到研究或實務工作者足夠之關注，年輕人相對而言預後較佳，許多人在罹癌康復後仍需回歸原本的生活。儘管癌症已經緩解，但年輕人的生命往往再也不同了。為了提供年輕癌症病人適當的協助，臨床工作者必須對其生命經驗有深入足夠的了解。

研究目的：以詮釋現象心理學為立基，理解曾經罹患癌症的年輕成人在康復後如何詮釋生病經驗以及後續對人生造成的影響。

方法：研究參與者包含五位介於24至35歲之年輕成人，其中3位診斷為淋巴癌、另外兩位則分別為血癌與乳癌。他們在19到26歲之間確診為癌症並接受治療，受訪時距離治療結束的時間約為5至10年間，每位參與者均接受兩次深度訪談，述說有關癌症之生命經驗，包含確診、治療、以及治療結束後之心路歷程。本研究以視框之破裂與新視框的形成作為理解之基礎，分別針對各文本進行文本分析與理解，文本分析方法包含（1）受訪者的生病故事（2）對子分析與普遍視框之辨識（3）詮釋主題 （4）整體性詮釋（5）透過對先前文本的理解來拓展理解。(6)綜合詮釋等六步驟。

結果：本研究除了深入詮釋每一位受訪者所理解之癌症生命經驗與意義之外，亦統整所有的文本以進行綜合詮釋，結果包含「癌症作為邊界經驗」、「人生的中斷與銜接」、「罹患癌症對親密關係與婚姻的阻礙」、「罹患癌症與自我認同的建立」、「網路社群的幫助」、「內在語言的力量」，以及「創造屬於自己的生病意義」等七大主題，並在結論處總結年輕癌症病人的特殊性，提出研究與實務工作層面之建議。

結論：本研究有助於人們深入地理解年輕人生病經驗中的苦、欣賞其堅強與韌性，並認識到其身為人之主體性，將所遭逢之事予以組織、形成意義，並化整為人生的一部分。Young adulthood is a transitional time in life circle when crucial decisions are made that could influence a person’s future, and having cancer makes the tasks even more challenging. Although increasing literatures have identified the unique psychological issues and the late effects of young cancer survivors, the attention to young people’s survivorship in Taiwan is still limited. The objective of this qualitative research is using hermeneutic phenomenology to understand young adults experience as cancer survivors in Taiwan. Five participants were recruited from a cancer bulletin board. They were diagnosed and treated during age 19 to 26, and were interviewed 5 to 10 years after their treatments. Three of them were diagnosed with lymphoma, the rest were diagnosed with leukemia and breast cancer. We conduct a qualitative analysis to explore the understanding of the meaning in the text and to identify the main themes. Seven main themes were identified that reflected survivors’ understanding of the impact of cancer in young adulthood: (1) having cancer as a boundary situation, (2) the interruption and resumption of life, (3) the impact on intimate relationship and marriage, (4) survivorship and self-identity, (5) the help from the cancer bulletin billboard, (6) the strength of inner speech, and (7) young adults create their own meaning of life with cancer. This research helps us to recognize the challenge of the young cancer survivors, to appreciate their strength and resilience, and to understand their subjectivity as their own meaning makers.