癌症患者的疼痛因應：控制源與情緒狀態之影響

Role of Locus of Control and Emotional State on Cancer-Related Pain Coping

田欣珊(Shin-Shan Tien)

指導教授 ： 洪福建

中原大學/理學院/心理學研究所/碩士(2007年)

https://doi.org/10.6840/CYCU.2007.00007

摘要

摘要
與癌症相關的疼痛是癌症患者經常遭遇到的困擾問題。過去研究焦點多著眼於疼痛與生活品質的關係，或人格特質對因應策略的影響。未曾考量患者在疼痛當下所產生之正、負向情緒對疼痛因應策略的影響，以及人格特質與疼痛因應策略間的適配性如何影響生活品質。因此，本研究試圖探討患者的人格特性（控制源）與情緒狀態如何影響癌症患者的疼痛適應歷程。

本研究分為兩個階段進行資料之收集，第一階段以半結構式問卷進行部分量表之預試，並根據結果編製「疼痛因應策略檢核表」。第二階段為正式研究，以問卷調查方式收集37名病房以及33名門診癌症疼痛患者之資料。所使用的研究工具包含「簡式-簡易疼痛量表」、「正負向情感量表」、「內外控量表」、「疼痛因應策略檢核表」、「台灣版世界衛生組織生活品質問卷」。

研究結果發現問題因應策略在疼痛強度預測生活品質中，具有部分中介效果，但情緒因應不具中介效果。正、負向情緒狀態對因應策略有主要效果，但無法在疼痛強度與因應策略間形成中介效果。而控制源雖無法調節疼痛強度與因應策略間的關係，但能調節因應策略與生活品質間的關係。結果說明傾向內控的患者若使用問題因應則生活品質較好，但傾向外控的患者若使用問題因應則生活品質並不會有所提升。而傾向外控的患者若使用情緒因應則生活品質較好，但傾向內控的患者若使用情緒因應則生活品質越差。

研究指出癌症疼痛患者的生活品質，明顯的比一般人差。從情緒狀態與因應策略間的關係，雖能發現情緒狀態對因應策略的影響力，然而在疼痛因應歷程，
並非影響生活適應結果的關鍵因素。生活品質的提升與否取決於控制源與因應策略間交互作用後所產生的影響。研究結果雖證明控制源與因應策略間的關係，但此部分仍有許多值得研究與澄清之處。故本研究依據上述各項結果提出臨床介入之建議與未來研究方向。

關鍵字

正向情緒 ； 負向情緒 ； 控制源 ； 生活品質 ； 癌症疼痛

並列摘要

Abstract
The cancer-related pain is a distressing problem for cancer patients. In the past, the most fundamental research issue was to investigate the relationship between the pain intensity and the quality of life or the effect by personality on coping processes. The effect of the patients' emotional state on pain coping processes and how the “good fit” between personality and cancer-related pain coping processes affecting the quality of life have never been identified. Therefore, the purpose of the study was to explore that how the personality（locus of control） and the emotional state affect the pain coping process for cancer patients.

The study was divided into two stages. Firstly, the checklist of pain coping strategies was derived from semistructure questionnaires done by cancer patients. Secondly, the formal questionnaires including Taiwanese version of the Brief Pain Inventory, the Positive-Negative Affect schedule, Internal/external locus of control scale, the checklist of pain coping strategies and WHOQOL-BREF Taiwan version were done by 37 inpatients and 33 outpatients with cancer-related pain.

The results were as following： Regression analysis showed that problem-focused coping strategies demonstrate partial mediating effect when using pain intensity predicts quality of life. However, emotional-focused coping strategies couldn’t have mediating effect within the relationships. Positive and negative
affectivity could appear main effect at coping strategies, but it couldn’t mediate the relationships among the pain intensity and coping strategies. While locus of control couldn’t moderate the pain intensity and coping strategies, it could moderate the relationships among coping strategies and the quality of life. While the cancer patient who has a disposition for internal control uses problem-focused coping strategies, the quality of life would be improved. The patient who has a disposition for external control uses the same coping strategies, the quality of life wouldn’t become better. The patient who has a disposition for external control uses emotional-focused coping strategies, the quality of life would have a great improvement. But the patient who has a disposition for internal control uses emotional-focused coping strategies, the quality of life would become worse.

The present study suggested that patients with cancer-related pain had suffered from poor quality of life than general population had. Although positive and negative affectivity could affect coping strategies, it was not a critical factor for the quality of life in whole coping process. This finding implied that the interaction of coping strategies and locus co control is a considerable factor for the quality of life. Though evidences support these linkages between locos of control and coping strategies, there is much room for clarification and substantiation. Based on these results, implications for clinical intervention and future researches are discussed.

並列關鍵字

Locus of control ； Negative affectivity ； Quality of life ； Cancer-related pain ； Positive affectivity

參考文獻

何京鰲、王復維、杜明勳（2003）。癌症病人之神經病變性疼痛。「基層醫學」，18卷，2期，42-49頁。

洪福建（1998）。癌末患者之焦慮、憂鬱評估。「安寧療護雜誌」，10期，45-51頁。

廖國盟、陳建仁（1997）。肺癌之流行病學特徵、危險因子及防治策略。「中華衛誌」，16卷，5期，375-395頁。

行政院衛生署（2005）。中華民國公共衛生年報。臺北市：行政院衛生署。

林玲華、陳景彥、劉嘉逸、陳美伶（2002）。癌症住院患者憂鬱狀態的盛行率及預測因素。「臺灣醫學」，6卷，4期，535-545頁。