台灣乳癌患者疾病表徵樣態與疾病適應歷程之關聯

The Relationships of Illness Representation Profile and Adaptation in Taiwanese Breast Cancer Patients

陳俞霈(Chen Yu-Pei)

指導教授 ： 吳治勳

國立政治大學/理學院/心理學系/碩士(2021年)

https://doi.org/10.6814/NCCU202100789

摘要

緒論：乳癌是具高度生命威脅性的慢性病，乳癌患者對乳癌的「疾病表徵」建構，應是協助理解其疾病自我調節歷程的有效方式。然而過去研究常將疾病表徵拆解為各個獨立變項進行探討，可能忽略了疾病表徵的整體性。本研究希望回歸「疾病表徵常識模式」的原始概念，探討台灣乳癌患者在疾病治療初期的「疾病表徵樣態」，並探索不同「疾病表徵樣態」的患者在疾病適應歷程上的差異。

研究方法：本研究以台灣北部某醫學中心之108位女性乳癌患者為研究對象，在患者術後一個月時進行收案。研究工具將使用「短版疾病知覺量表」測量患者的「疾病表徵」，以「癌症自我效能」、「因應策略」、「情緒壓力」、「癌症憂慮」及「生活品質」作為疾病適應歷程的指標。透過「判別分析」生成「分組判別函數」，並進行「疾病表徵樣態」的分組，而後再檢驗「疾病表徵樣態」在「癌症自我效能」、「因應策略」、「情緒壓力」、「癌症憂慮」及「生活品質」上是否具有差異。

研究結果：本研究分出3組「疾病表徵樣態」，3組「疾病表徵樣態」在「影響」、「時間性」、「本質」、「在意度」、及「情緒反應」5個題項上，組1顯著大於組2又顯著大於組3，此概念命名為「威脅感」，意即個體感受到的健康威脅程度。而在「個人控制」、「治療控制」及「連貫性」3個題項上並無差異，此概念命名為「控制感」，意即個體感受到對疾病的控制程度。本研究將組1命名為「高威脅感－高控制感」組，組2命名為「中威脅感－高控制感」組，組3命名為「低威脅感－高控制感」組。在疾病適應歷程上，「高威脅感－高控制感」組之「社會支持因應」顯著高於其他兩組，「逃避因應」顯著高於而「癌症自我效能」則顯著低於「低威脅感－高控制感」組，3組在「個人因應」上無顯著差異。在疾病適應結果上，「高威脅感－高控制感」組之「情緒壓力」與「癌症憂慮」皆為顯著高於「中威脅感－高控制感」組，又顯著高於「低威脅感－高控制感」組。「低威脅感－高控制感」組的「心理生活品質」與「環境生活品質」顯著高於其他兩組，而「生理生活品質」與「社會生活品質」則顯著高於「高威脅感－高控制感」組。

討論：乳癌患者在疾病治療初期，有不同的「疾病表徵樣態」及其相應之疾病適應歷程，樣態間的差異來自「威脅感」的程度高低，此研究結果呈現患者對於疾病整體性的主觀建構，及其與後續適應歷程之關聯。本研究中的「高威脅感－高控制感」組，可能是臨床上最需要關注的族群，此組的患者感受到較高的疾病威脅，且在疾病適應歷程上為3組之中適應最差的組別。未來透過本研究之「分組判別函數」，可即時得知患者所屬組別，並判斷患者可能的疾病適應歷程，進而能夠將患者分流，為分屬「高威脅感－高控制感」組的患者提供進一步的身心狀態評估與介入。研究限制為目前「疾病表徵樣態」的研究仍少，因此對於乳癌患者的「疾病表徵樣態」難有較穩定的推論，尚待未來更多的相關研究。此外，本研究在「控制感」無組間差異，除了可能與疾病特性相關，也可能是受樣本特性的影響，未來研究建議可以納入不同醫療場域、不同地區、不同治療階段的乳癌患者進行研究。

關鍵字

疾病表徵 ； 疾病表徵常識模式 ； 疾病適應 ； 威脅 ； 控制 ； 乳癌

並列摘要

Background: Breast cancer is a chronic disease but is life-threatening. Therefore, the illness representation constructs introduced by the Common-Sense Model could be a valuable concept to clarify breast cancer patients’ self-regulation process throughout the illness. However, previous research often analyzed the illness representations variable-by-variable, yet illness representations should be comprehensive for the patients. Thus, the current study proposed to use an “illness representation profile” to represent more comprehensive illness representation constructs of the Taiwanese breast cancer patients and further explored the relationships of the illness representation profiles and illness adaptation.

Methods: A total of 108 breast cancer patients were recruited from a medical center in northern Taiwan. They completed questionnaires on demographics, beliefs about breast cancer (Brief Illness Perception Questionnaire, BIPQ), and illness adaption (emotional distress, cancer-related worry, cancer self-efficacy, coping, and quality of life) at 1-month post-surgery. Cluster analysis was used to identify the number of “illness representation profile” groups, and discriminant analysis was used to sort respondents into groups by their illness perception scores. In addition, independent sample t-tests or one-way analyses of variance (ANOVA) were used to explore the differences in illness adaption among groups.

Results: Results showed that 3 different illness representation profiles could be identified. Significant differences among profiles were found in consequence, timeline, identity, concern, and emotional response scales of the BIPQ. These scales could reflect “threat,” as how much the individual felt threatened about illness. No significant differences were found in personal control, treatment control, and coherence scales. These scales could represent “control,” as how much the individual felt she could control the illness. Thus, the 3 illness representation profiles were named as the “High threat-High control” profile, the “Medium threat-High control” profile, and the “Low threat-High control” profile. Patients with the “Low threat-High control” profile had a higher cancer-related self-efficacy, using less socially-supported coping and avoidant coping, better QoL, less distress, and less cancer-related worry. However, patients with the “High threat-High control” profile had less cancer-related self-efficacy, using more socially-supported coping and avoidant coping, poorer QoL, higher distress, and more cancer-related worry.

Discussion: The current study supported that illness representation profiles could be identified and could reflect different statuses of illness adaptation among Taiwanese breast cancer patients. The results showed that “threat” is the primary difference among profiles. Patients with the “High threat-High control” profile were more threatened about the illness, and their adaptation was worse than the other 2 groups. Therefore, they should receive more clinical attention, and referring to clinical psychologists is recommended. The main clinical contribution of the current study is that the discriminant function could use to sort new patients into the 3 profiles mentioned above simply by key in their BIPQ scores. If the patients fit the “High threat-High control” profile, they may need further assessment and intervention. Differences in “control” were not found among profiles might due to illness characteristics, but it was also possibly due to a limitation of the study, the selection bias. Future research should recruit patients in various settings (e.g., hospitals and communities) to further explore the illness representation profiles and their influences on illness adaption.

並列關鍵字

Illness representation ； Common-Sense Model ； illness adataption ； threat ； control ； breast cancer

參考文獻

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