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  • 學位論文

癌症晚期病人及家屬的智謀與預期性哀傷之變化

The change of resourcefulness and anticipatory grief in patients with advanced cancer and their families

指導教授 : 賴倩瑜

摘要


本研究目的在探討癌症晚期病人與家屬之智謀及預期性哀傷的程度,並了解其智謀與預期性哀傷程度隨時間之變化。本研究採縱貫性研究設計,以立意取樣方式,於台灣南部某教學醫院內科病房及門診收案,研究對象是診斷為癌症第四期者及其主要照顧者家屬,收案人數病人及家屬各40人,總共80人,並以結構式問卷進行相關資料收集。研究工具包含「個人基本資料」、「智謀量表」與「預期性哀傷量表」,施測時間分別是病人獲知癌症晚期診斷後的一個月內以及第一次施測後一個月,共施測兩次。以描述性及推論性統計方法進行資料的分析。 研究結果顯示,癌症晚期病人之第一次及第二次施測智謀平均分數分別為91.95 (IS=65.67)及90.82 (IS=64.87)分,而癌症晚期病人之家屬其之第一次及第二次施測智謀平均分數分別為94.65 (IS=67.60)及94.35分 (IS=67.39),癌症晚期病人及家屬無論在第一次或第二次施測皆有中等程度的智謀;而癌症晚期病人之第一次及第二次施測預期性哀傷平均分數分別為85.60 (IS=63.40)、90.58(IS=67.10)分,癌症晚期病人家屬之第一次及第二次施測預期性哀傷平均分數分別為89.03(IS=65.95)及90.98(IS=67.39)分,癌症晚期病人及家屬無論在第一次或第二次施測皆有中等程度的預期性哀傷。再者,癌症晚期病人與家屬在初獲知疾病診斷及獲知罹病一個月後,其智謀無顯著改變。然而,癌症晚期病人與家屬在初獲知診斷後一個月後,其預期性哀傷則顯著高於剛獲知診斷時。本研究結果可提供醫療專業人員做參考,以利臨床醫療人員能提早評估服務對象之智謀及哀傷程度,並進一步設計智謀或哀傷輔導介入措施,以協助病人與家屬度過哀傷危機。

關鍵字

癌症晚期 智謀 預期性哀傷

並列摘要


The purpose of this study was to explore the levels and changes of resourcefulness and anticipatory grief in patients with advanced cancer and their families. A longitudinal study design with purposive sampling was applied to explore how the levels of resourcefulness and anticipatory grief of cancer patients and their families change by time. Subjects were recruited from outpatient department and medical wards in a teaching hospital in southern Taiwan. All patients who were diagnosed with cancer stage 4th and their family caregivers were eligible to be invited into this study; totally, 40 patients and their family caregivers were recruited. Structured questionnaires such as "basic personal information", "Resourcefulness Scale" and "Anticipatory Grief Scale" were used to collect data. There were two points of time to collect data: the first one was the time no later than one month while patients were first diagnosed with advanced cancer (stage 4th); the second time was one month after the subjects finished the first measurement. Descriptive statistics and inferential statistics were applied to analysis the data in this study. The results showed that the mean score of resourcefulness in patients with advanced cancer at the first and the second time were 91.95 (IS = 65.67) and 90.82 (IS = 64.87) respectively. The mean score of resourcefulness of their family caregivers at the first and the second time were 94.65 (IS = 67.60) and 94.35 (IS = 67.39). Overall, patients and their family caregivers have a moderate degree of resourcefulness. On the other hand, the mean score of anticipatory grief in patients with advanced cancer at the first and the second survey were 85.60 (IS = 63.40) and 90.58 (IS = 67.10). For their family caregivers, the mean score of anticipatory grief at the first and second time were 89.03 (IS = 65.95) and 90.98 (IS = 67.39) respectively. Generally, patients with advanced cancer and their family caregivers have a moderate degree of anticipatory grief. Regarding the change of resourcefulness in patients with advanced cancer and their family caregivers, no statistical significances were found between the first time when patients and their families were told their diagnosis (T1) and one month later (T2). However, patients’ and their family caregivers’ anticipatory grief at one month later when they were told the diagnosis were found significantly higher than the time while they were just informed. The results can provide medical professionals the reference to assess the levels of resourcefulness and anticipatory grief of patients with advanced cancer and their family caregivers in advance. Further nursing interventions constructing with resourcefulness skills or grieving counseling could be designed to help patients and their families overcome their grieving crisis.

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