伴侶溝通模式、關係品質對頭頸部癌適應之影響歷程

The Process of Cancer-related Communication Patterns, Quality of Relationship, and Quality of Life among Couples Coping with Head and Neck Cancer.

周依亭(Yi-Ting Chou)

指導教授 ： 黃君瑜

中原大學/理學院/心理學研究所/碩士(2013年)

https://doi.org/10.6840/CYCU.2013.00341

摘要

研究背景與目的：癌症適應歷程中，溝通互動及關係調適對患者與其伴侶的生活品質具有影響力。然過去癌症相關的溝通研究多為各自探討病患及伴侶的心理適應狀態，而對於彼此間相互影響的歷程卻是未知。因此本研究考量伴侶之間的相互性，以對偶效果(dyadic effects)來瞭解頭頸部癌症患者與其伴侶在溝通模式、關係品質及生活品質的關聯性及影響歷程。
研究方法：採取橫斷式設計，研究對象包含治療後三個月以上的頭頸部癌症男性患者與其伴侶，共131對。其中伴侶雙方分別必須完成個人基本資料表、溝通模式調查問卷(Communication Pattern Questionnaire)、配偶調適量表(Dyadic Adjustment Scale)及台灣簡明版世界衛生組織生活品質問卷(WHOQOL-BREF, Taiwan version)。
研究結果：透過對偶資料分析(Dyadic data analysis)，以相關及差異分析、多元迴歸及結構方程模式統計分析結果發現：(1)病患及伴侶的溝通模式未隨著治療情境不同而有所差異；(2)能知覺到相互建設性溝通的病患及伴侶，能感受到的關係品質較好；而知覺到雙方採取要求-迴避、相互迴避溝通，則會報告較差的關係品質；(3)運用主-客體相依模式(Actor-Partner Interdependent Model, APIM)顯示，無論病患或伴侶，自身知覺到的溝通模式皆能顯著預測自己的關係品質，且病患的關係品質會受到伴侶所知覺到的溝通模式所影響；(4)無論病患或伴侶，關係品質能預測生活品質各範疇的表現；(5)關係品質在頭頸癌適應中為一重要機制。除生理健康外，病患知覺的溝通模式會透過關係品質，進而影響自身在心理、社會關係及環境品質；而對伴侶來說，知覺到的溝通模式亦會透過關係品質影響生活各範疇的品質；(6)根據APIM的影響歷程，發現伴侶所知覺到的溝通互動，會透過病患的關係品質而影響其環境品質，但在其他範疇則未見此效果。
結論：頭頸部癌症適應歷程中，伴侶之間的溝通及關係互動扮演一個重要的角色。因此未來臨床實務上除給予醫療協助之外，關注病患與伴侶的互動品質亦能促進彼此的心理及疾病適應，尤其瞭解頭頸癌患者之伴侶如何知覺彼此的溝通互動，可能同時改善病患及伴侶自身的關係及生活品質。

關鍵字

關係品質 ； 伴侶溝通模式 ； 頭頸部癌症 ； 生活品質

並列摘要

Background and Purpose In the cancer adjustment process, we found that interaction patterns and relationship adaptation of couples had an impact on quality of life (QOL) for both patient and partner. Although the study of cancer-related communication suggests that patient’s and partner’s perceptions of communication affects his/her own psychological adjustment, the degree to which each person’s perceptions of communication has an independent effects on their partner’s quality of relationship or QOL is unknown. Thus, this study aim to consider the reciprocity of couple, and examine the dyadic effects of communication pattern, quality of relationship on the QOL of couples dealing with head and neck cancer.
Methods This study is cross-sectional design, and subject were the male patients who completion of cancer treatment more than 3 months and their partners with head and neck cancer, included 131 patient-partner dyads. Each participant completed the basic information questionnaire, Communication Pattern Questionnaire, Dyadic Adjustment Scale and WHOQOL-BREF, Taiwan version.
Results Using dyadic data analysis, through correlation, the analysis of difference, multiple regression and the structural equation modeling (SEM) found that: (1)by treatment, there are no difference on cancer-related communication pattern for both patient and partner; (2)both patient and partner, their perception of mutual constructive communication was associated with more quality of relationship, Demand-withdraw communication and mutual avoidance and withholding was associated with less quality of relationship; (3)using the Actor-Partner interdependence model, result reveled that although each person’s cancer-related communication pattern is the strongest predictor of their own quality of relationship, partner’s perception of communication pattern also play significant role on patient’s quality of relationship; (4)both patient and partner, quality of relationship could predict their own QOL; (5)quality of relationship was an important mechanism on head and neck cancer, except for physiological health, patient perceived communication pattern and QOL could be accounted for by their influence on quality of relationship. For partner, quality of relationship were consistent with full mediated between the cancer-related communication patterns and all domain of QOL; (6) According to APIM, only the partner perceived communication pattern and environment of QOL could be accounted for by their influence on quality of relationship, but others domain were not.
Conclusions We found that cancer-related communication and interaction of relationship among couples play an important role in the head and neck adjustment process. Thus, except the medical care, clinicians concern with interaction between patient and partner can be enhance their psychological adjustment and illness, particularly the partner’s perception of communication pattern, which may improve the quality of relationship and life adaptation of both couples when they are dealing with head and neck cancer.

並列關鍵字

Quality of relationship ； Quality of life ； Cancer-related communication pattern ； Head and neck cancer

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