乳癌患者因應策略、社會支持與創傷後成長之關聯探討

本研究旨在探討乳癌患者之因應策略、社會支持與創傷後成長之間的關聯，並以因應策略、社會支持作為預測指標，探討其對創傷後成長的影響。本研究屬橫斷面問卷調查，採立意取樣，以中部某醫學中心乳房甲狀腺外科門診之乳癌患者為施測對象，收納102份有效樣本。年齡分佈由27至70歲，平均年齡為50.56 ± 9.09歲。研究工具包含「創傷後成長量表（PTGI）」、「簡明因應量表（Brief COPE）」、「社會支持量表（SSS）」。以皮爾森積差相關、單因子獨立樣本（ANOVA）、階層多元迴歸進行統計分析，結果顯示：（一）在簡單相關的檢定中，（1）乳癌患者各向度的因應策略（問題取向因應、情緒取向因應、逃避因應）、整體及部分向度（資訊性、評價性、工具性）的社會支持與創傷後成長呈正相關；（2）創傷後成長與罹癌時間正相關；（3）問題取向因應與年齡負相關、與教育程度正相關；（4）情緒取向因應與年齡負相關、與教育程度正相關；（5）逃避因應與年齡負相關、與罹癌期別正相關；（6）社會支持與年齡、教育程度、罹癌期別、罹癌時間、復發與否、轉移與否等背景變項皆無關；（二）在單因子變異數分析檢定中，（1）月收入五萬至八萬者的創傷後成長顯著大於無收入者；（2）40-49歲乳癌患者使用問題取向因應顯著多於60歲以上乳癌患者，最高大學以上者使用問題取向因應顯著多於最高學歷國中以下者，月收入二至五萬者使用問題取向因應顯著多於無收入者；（3）20-39歲者使用情緒取向因應顯著多於50歲以上者；（4）40-49歲者使用逃避因應顯著多於60歲以上者，已婚不同住者使用逃避因應顯著多於喪偶者；（5）社會支持在年齡、教育程度、宗教信仰、收入、婚姻狀態、罹癌期別、罹癌時間、更年期與否、復發與否、轉移與否等背景變項等背景變項皆無顯著差異；（三）在調節效果的檢定中，因應策略與社會支持的交互作用對創傷後成長無顯著效果；（四）在多元迴歸的檢定中，乳癌患者愈常使用問題取向因應、情緒取向因應，接收愈多整體社會支持、工具性支持，可預測其創傷後成長程度愈高；接收愈多情緒性支持，則可預測其創傷後成長程度愈低；（五）在簡單中介效果的檢定中，乳癌患者的社會支持會影響創傷後成長，問題與情緒取向因應在兩者之間皆可扮演完全中介角色。最後，提出結果討論、研究限制與未來研究相關建議。

關鍵字

乳癌患者；創傷後成長；社會支持；因應策略

並列摘要

This research is aimed to the patients with breast cancer, exploring the relationship between their coping strategies, social support and posttraumatic growth. This cross-sectional questionnaire survey study was conducted in a sample of 102 women with breast cancer. The age distribution ranges from 27 to 70 years old, with an average age of 50.56 ± 9.09 years old. The questionnaire included Posttraumatic Growth Inventory (PTGI), Brief COPE, and Social Support Scale (SSS). The collected data were analyzed by Pearson’s product-moment correlation, one-way ANOVA and hierarchical multiple regression analysis, and the results show: (1) In correlation analysis, (a) The coping strategies of breast cancer patients in all dimensions (problem-focused coping, emotion-focused coping, and avoidance coping), social support in whole and partial dimensions (informational, appraisal, and tangible) are positively correlated with posttraumatic growth; (b) Posttraumatic growth is positively correlated to the time since diagnose; (c) Problem-focused coping is negatively correlated with age and positively correlated with education level; (d) Emotion-focused coping is negatively correlated to age and education level; (e) Avoidance coping was negatively correlated with age and positively correlated with cancer stage; (f) Social support did not correlated with any demographic factor such as age, education level, cancer stage, time since diagnose, recurrence and metastasis of cancer; (2) In one-way ANOVA, (a) The posttraumatic growth of those with a monthly income of 50,000 to 80,000 is significantly greater than that of those without income; (b) Women with breast cancer aged 40-49 use problem-focused coping significantly more than those over 60; women with master's degree use problem-focused coping significantly more than those with primary school education, and furthermore, those with a monthly income of 20,000 to 50,000 use problem-focused coping significantly more than those with no income; (c) Women with breast cancer aged 20-39 use emotion-focused coping significantly more than those over 50; (d) Women with breast cancer aged 40-49 use emotion-focused coping significantly more than those over 60; married separated women use avoidance coping significantly more than women widowed; (e) Social support did not show significant difference in any demographic factor such as education level, religious, income, marriage status, cancer stage, time since diagnose, menopause, recurrence and metastasis of cancer; (3) The interaction between coping strategies and social support has no significant effect on posttraumatic growth; (4) Multiple regression analyses showed that the more use of problem- and emotion-focused coping, more received overall and tangible support, and received emotional support significantly predicted greater posttraumatic growth; (5) Problem- and emotion-focused coping can play the role as mediators between social support and posttraumatic growth. Finally, discussions, limitations, and recommendations for future research are proposed.