癌症兒童因應量表之發展和測試

Development and Testing of the Pediatric Cancer Coping Scale

吳麗敏(Li-Min Wu)

指導教授 ： 陳彰惠

共同指導教授 ： 金繼春(Chi-Chun Chin)

高雄醫學大學/護理學院/護理學系研究所/博士(2009年)

https://doi.org/10.6832/KMU.2009.00017

摘要

背景：因應是壓力和適應的中介變相，亦是預測適應結果的重要因子，因此評估癌症兒童的因應措施不僅可以了解癌症兒童如何面對疾病，亦可發展介入措施協助癌症兒童調適疾病。然而，國內唯一的癌症兒童因應量表卻無法確切的評估和了解癌症兒童的因應策略，因此發展一份具信度和效度且能預測適應結果的兒童癌症因應量表是非常迫切的。
研究目的：本研究的目的是發展和測試癌症兒童因應量表(Pediatric Cancer Coping Scale, PCCS)。
方法：本研究採橫斷式研究，樣本來自中、南部三家醫學中心，以病童自填問卷方式收集資料，共收案229位7 至18歲的兒童癌症病患，進行癌症兒童因應量表(PCCS)之信效度檢測，包含內在一致性、再測信度、內容效度、建構效度、聚合和區辨效度、已知群組效度(Known-group validity)。
結果：癌症兒童因應量表(PCCS)共有33題，具有很好的內在一致性（α＝.91），各題和總量表的相關性（item-to-total correlation）位於 .3至 .6且2週的再測信度(intraclass coefficient, ICC)為.86。癌症兒童因應量表(PCCS)運用探索式因素分析（exploratory factor analysis）總共萃取3個因素，即認知因應、問題導向因應、防禦性因應；各因素負荷量位於.31至.71，可以解釋40% 總變異量；驗證性因素分析（confirmatory factor analysis）亦證實各項度具有良好的適配指數(χ2/d.f <3, RMSEA< .08, GFI, AGFI, and NFI > .87 )。在聚合和區辨效度，認知因應和問題導向因應均與復原力呈現顯著性正相關；防禦性因應和焦慮呈現顯著性正相關。已知群組效度：青春期兒童使用認知因應和防禦性因應顯著性高於學齡期癌症兒童且治療中的癌症兒童使用防禦性因應行為顯著高於停藥的病童。
結論和建議：癌症兒童因應量表(PCCS)具有良好的信度和效度，此量表可以用來評估7至18歲罹患癌症兒童的因應策略，且能區辨不同年齡層和治療/停藥中的病童所使用的因應策略；量表可以提供醫護人員評估癌症兒童在面對疾病後的因應策略和發展介入措施計畫。

關鍵字

兒童癌症 ； 因應 ； 復原力 ； 焦慮

並列摘要

Background. Coping is a mediator between stressful events and adaptation. Also coping is an important predictor for adjusting outcomes. Hence, assessing coping strategies for children with cancer not only understand how they cope with disease but also can develop intervention programs to help them adaptation. However, there is only one coping tool in Taiwan and it can not truly assess and understand coping strategies in children and adolescents with cancer. Hence, it is urgent to develop a reliable and valid scale to predict outcomes on children and adolescents with cancer.
Purpose. This study was to develop and test the pediatric cancer coping scale (PCCS) on children and adolescents with cancer.
Methods. This was a cross-sectional study. The study recruited 229 subjects who had cancer at the age between 7 and 18 and came from three medical centers. The PCCS was tested internal consistent reliability, test-retest, content validity, construct validity, convergent and discriminate validity, and known-group validity.
Results. The PCCS with 33 items had satisfactory evidences of internal consistency (α＝.91); and its 2-week test-retest reliability (intraclass coefficient [ICC] = .86) was provided, with item-to-total correlation ranging from .3 to .6. The PCCS was extracted three subscales including cognitive coping, problem-oriented coping, and defensive coping that explained 40% of the total variance with factor loadings ranging from .31 to .71 using exploratory analysis. That was supported by the confirmatory factor analysis with indices, indicating a good of fit (χ2/d.f <3, RMSEA< .08, GFI, AGFI, and NFI > .87). Using convergent and discriminate validity, cognitive coping and problem-oriented coping had a significant positive relationship with resilience. Defensive coping had a significant positive relationship with anxiety. Testing known-group validity, adolescents used more cognitive coping and defensive coping than school-age children; children and adolescents were in treatment used more defensive coping than those who were off treatments.
Conclusions and suggestions. The PCCS is a reliable and valid scale to measure coping. The PCCS can appropriately be used to assess coping strategies in pediatric cancer patients who are at the age from 7 to 18 and discriminate coping strategies between groups (in/off treatments, and school-age children and adolescents). The results can help health providers to assess children and adolescents with cancer in clinical settings and develop interventions programs.

並列關鍵字

childhood cancer ； coping ； resilience ； anxiety

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