口腔癌手術病人於住院期間身體心像改變及其因應行為探討

An Investigation of Body Image Changes and Coping Behaviors in Oral Cancer Patients Following Surgery

崔宛玉(Wan‐Yu Tsui) ； 林寬佳(Kuan‐Chia Lin) ； 黃惠璣(Hui‐Chi Huang)

《護理暨健康照護研究》 9卷2期 (2013/06) Pp. 127-138

https://doi.org/10.6225/JNHR.09.2.127

摘要

背景：手術是口腔癌病人主要治療方式之一，雖不同的癌症分期手術傷口大小不一，都會造成顏面外觀改變或功能的缺損。若病人無法有效應用策略面對，將會出現身體心像改變之適應問題，然國內相關的研究相當少見。目的：探討口腔癌手術病人住院期間身體心像改變與因應行為的相關性，並進一步了解影響因應行為之重要預測因子。方法：本研究是橫斷式設計，採結構式問卷，以北部二家醫學中心第一次口腔癌手術病人為收案對象，共收85位。問卷內容有基本資料、身體心像量表及因應行為量表，描述性資料分析以百分比、平均數及標準差呈現，推論性資料分析以Pearson積差相關、迴歸分析進行。結果：口腔癌手術病人年齡越輕者越在乎身體心像的改變，癌症分期愈高者手術切除範圍越大，對外觀的影響也就越大，病人使用情緒因應行為的頻率越高。影響口腔癌手術病人情緒因應之預測因子為「身體心像」，其可解釋的變異量為21.4%。結論／實務應用：本研究顯示，口腔癌病人在接受手術治療後，身體心像改變與情緒因應行為呈現顯著相關。結果可提供護理人員在臨床照護時依病人手術分期，預先說明身體心像可能之變化以協助病人表達負向情緒之因應行為。

關鍵字

口腔癌 ； 身體心像 ； 因應行為 ； 負向情緒

並列摘要

Background: Surgery is a main treatment for oral cancer. Although the magnitude of such surgery varies according to cancer stage, nearly all surgical interventions for oral cancer result in some degree of facial deformity or functional disability. Patients unable to effectively employ coping strategies experience difficulty adjusting to their altered body image. Studies of this topic have seldom been conducted in Taiwan. Purpose: The aim of this study was to explore the coping behaviors that affect body image adjustment in postoperative oral cancer patients. We also analyzed the related and predictive factors that influence such behaviors. Methods: This study used a cross‐sectional design and structured questionnaire. A total of 85 oral cancer patients from two medical centers in Northern Taiwan who had recently undergone oral cancer surgery for the first time were recruited as participants. The questionnaire comprised a basic information sheet, body image scale, and coping behavior scale. Descriptive and inferential statistics were used for data analysis. Results: Younger oral cancer patients were found to be more concerned with their post‐operative appearance than their older peers. Advanced stage patients who received surgery to remove large tumors were more affected than their peers in earlier cancer stages. Emotional coping strategies were the most prevalent strategy category used by participants. The predictive factor that most influenced participant emotional coping strategies was ”coping” in the body image scale, which explained 21.4% of variance. Conclusion / Practical Implications: This study shows a significant correlation between body image and the emotional coping performance of post‐operative oral cancer patients. Results suggest that medical staff should advise patients in advance of surgery regarding the physical changes likely to occur based on cancer stage in order to enhance patient coping behaviors, specifically in the realm of negative emotional reaction.

並列關鍵字

oral cancer ； body image ； coping behaviors ； negative emotions

參考文獻

陳佩英、郭素青、張惠甄、徐一瑱，林麗玉，楊桂美（2004）• 口腔癌術後病患之身心症狀與調適•安寧療護雜誌， 9(2)，153−164。[Chen, P. Y., Kuo, S. C., Chang, H. C., Hsu. I. C., Lin. L. Y., & Yang, K. M. (2004). Physio– psychological symptoms and adaptation in post-surgical oral cancer patients. Taiwan Journal of Hospice Palliative Care, 9(2), 153−164.]

詹慧珠、宋琇鈺、林麗英、朱淑媛、劉波兒（2008）•中 部地區護理長工作壓力與因應策略之探討•實證護理， 4(3)，200−211。doi:10.6225/JEBN.4.3.200 [Chan, H. C., Sung, H. Y., Lin, L. Y., Chu, S. Y., & Liu, P. E. (2008). A study on job stress and coping strategies among head nurses in central Taiwan. Journal of Evidence-Based Nursing, 4(3), 200−211.]

蔡紫暄、周繡玲、陳麗糸（2011）•口腔癌患者術後症狀 困擾及其相關因素探討•腫瘤護理雜誌，11(2)，23−34。 [Tsai, C. H., Chou, H. L., & Chen, L. M. (2011). Symptom distress and associated factors with inpatients of postoperated oral cancer. The Journal of Oncology Nursing, 11(2), 23−34.]

王宏銘、廖俊達、范綱行、吳樹鏗、詹勝傑、閻紫宸（2009）• 頭頸部鱗狀細胞癌治療的新進展•腫瘤護理雜誌， 9(Suppl.)，51−67。[Wan, H. M., Liao, C. T., Fan, K. H., Wu, S. H., Chan, S. C., & Yen, T. C. (2009). Recent advances and new standards of care for patients with head and neck squamous cell carcinoma. The Journal of Oncology Nursing, 9(Suppl.), 51−67.]

陳淑卿（2007）•口腔癌病患手術後之生活經驗•腫瘤護 理雜誌，7(2)，13−22。[Chen, S. C. (2007). Oral cancer patient's life experiences after surgery. The Journal of Oncology Nursing, 7(2), 13−22.]