肺癌病人與家屬照顧者之憂鬱探究：肺癌病人憂鬱處置成效統合分析與家屬照顧者壓力與憂鬱之間調節因子分析

憂鬱是肺癌病人及其家屬照顧者常見的心理困擾，本論文包含兩個研究：改善肺癌病人憂鬱症狀的支持性介入之成效，以及緩衝家屬照顧者壓力和憂鬱症狀間的調節因子。研究一透過系統性文獻查證與統合分析的研究方法，探討改善肺癌病人憂鬱的支持性介入處置之成效，共納入12 篇研究進行分析，結果顯示兩種支持性介入方案（心理教育合併心理治療與運動方案）可有效緩解肺癌病人的憂鬱症狀。然而，多數研究多以肺癌病人為主要研究對象，忽略了疾病對家屬照顧者的心理衝擊與影響。因此，研究二以病人—家屬照顧者的配對模式探討家屬照顧者的憂鬱現況，並分析來自家屬照顧者本身的保護因子（家屬照顧者的正念特質、自我疼惜能力、接受他人疼惜能力）與來自病人的保護因子（病人的正念特質）於照顧壓力與憂鬱症狀間的緩衝效應。將72 位病人與其家屬照顧者的資料納入分析，結果發現病人和家屬的憂鬱症狀程度有顯著相關。家屬照顧者的憂鬱症狀與病人的治療狀態、症狀困擾、憂鬱症狀、以及照顧者自覺的健康狀況有關。家屬照顧者的正念覺察特質與自我疼惜的行動可緩衝照顧壓力對其憂鬱的影響。而肺癌病人的正念特質雖然與照顧壓力有關，但與照顧者的憂鬱症狀則不具相關性。根據研究結果與限制，建議未來以病人—家屬照顧者配對模式的研究設計，檢視正念特質與疼惜能力的個人效應與相互影響的效應。臨床應用上，肺癌病人的憂鬱處置可根據其症狀嚴重程度、功能限制、憂鬱原因、及個人偏好等面向提供個人化的有效介入方案。發展肺癌家屬照顧者正念合併疼惜介入措施以強化其自我疼惜的行動能力與正念覺察的技巧來減緩憂鬱症狀。由於肺癌病人與其家屬照顧者憂鬱症狀具互相影響的相關性，建議未來發展病人—家屬照顧者共同參與的憂鬱介入模式。

關鍵字

肺癌；家屬照顧者；憂鬱症狀；正念特質；自我疼惜；病人—家屬照顧者配對模式

並列摘要

Patients with lung cancer and their family caregivers often suffer from psychological distress, particularly depression. This thesis composes of two studies: the effects of supportive care interventions on improving depression in patients with lung cancer and moderators of the impacts of stress on caregivers’ depression. Study one adopts the meta-analysis method to explore the effects of the supportive care interventions on improving depressive symptoms for lung cancer patients. The data based on a total of 12 studies were analyzed. The results conclude that two types of supportive care interventions (psychoeducation combined with psychotherapy and exercise) effectively reduce depressive symptoms of patients with lung cancer. However, the current effective interventions mainly focus on the patients’ depression. Very few studies examine the psychological impact of patients’ lung cancer on caregivers’ depression. Therefore, the study two with the caregiver-patient dyadic approach aimed to understand the depressive symptoms among family caregivers of lung cancer patients. Moreover, this study also explored the protective factors from both patients’ and caregivers’ trait mindfulness and caregivers’ compassionate behaviors (self-compassion and compassion from others) in buffering the impact of stress on caregivers’ depressive symptoms. A total of 72 lung cancer outpatients and their family caregivers are included in this study. The results indicate that there are correlations of depressive symptoms between lung cancer patients and their family caregivers. Caregivers’ depression is associated with patient’s treatment status, symptom distress, depressive symptoms, and caregivers’ self-reported health status. The results also show that caregivers’ mindful awareness of the present moment, and self-compassionate action are the protective factors mitigating the impact of caregiving stress on their depressive symptoms. Patients’ trait mindfulness is only related to levels of caregivers’ stress but not associated with caregivers’ depressive symptoms. Based on the findings and the limitations of this study, future research with the dyadic patient-caregiver approach can examine the individual and interaction effects of trait mindfulness and compassion on depression of lung cancer patients and their caregivers. The implications for clinical practice are providing the personalized supportive care (psychoeducation with psychotherapy or exercise program) for patients with lung cancer according to different levels of symptoms, functional impairment, causes of depressive symptoms, and patient preference; and developing mindfulness with compassion program aiming to enhancing the caregivers’ competencies of self-compassionate action with mindful awareness in order to reduce their depression A patient-caregiver dyadic depression program is also suggested based on findings of the correlations of depression between patients and caregivers.

並列關鍵字

lung cancer ； family caregiver ； depressive symptoms ； dispositional mindfulness ； self-compassion ； dyadic patient-caregiver approach

參考文獻

Walker, J., Sawhney, A., Hansen, C. H., Symeonides, S., Martin, P., Murray, G., & Sharpe, M. (2013). Treatment of depression in people with lung cancer: A systematic review. Lung Cancer, 79(1), 46-53. doi: 10.1016/j.lungcan.2012.09.014

References

Google Scholar

Aaronson, N. K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., . . . et al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85(5), 365-376.

Google Scholar

Akechi, T., Okuyama, T., Onishi, J., Morita, T., & Furukawa, T. A. (2008). Psychotherapy for depression among incurable cancer patients. The Cochrane database of systematic reviews(2), CD005537.

Google Scholar

Allen, A. B., & Leary, M. R. (2010). Self-Compassion, Stress, and Coping. Social and Personality Psychology Compass, 4(2), 107-118. doi: 10.1111/j.1751-9004.2009.00246.x

Google Scholar

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