接受合併化學及放射線治療之食道癌患者調適影響之研究-
復原力作用的綜合探討

本研究採質性研究法，探討食道癌患者接受合併化學及放射線治療調適影響與復原力作用的改變歷程。研究對象為中部某醫學中心胸腔外科首次接受合併化學及放射線治療療程的食道癌病患，採立意取樣選取10位受訪者者進行深入訪談。資料收集以半結構式訪談大綱為指引，訪談內容採用內容分析法加以分析歸納。研究結果顯示食道癌患者的背景中，1.個人信念；2.家庭支持；3.醫療團隊的信賴與經濟影響復原力的萌發、成形與展現。復原力的初次萌發點在患者接受了罹癌的事實，決心積極參與治療的契機，家庭支持使患者想要活下來的信念是走向復原力的主軸。食道癌患者接受合併化學及放射線治療生活之衝擊生理、情緒、社會、經濟、主要照顧者等五方面，以生理衝擊包括的體重減輕、吞嚥困難、灌食管的照護和合併化學及放射線治療的副作用最為困擾；在內在歸類罹癌原因後，採取1.正向信念的因應策略；2.家庭支持系統；3.經濟；4.對專業醫療團隊的信賴是調適的復原因子，而復原力的展現則為飲食的適應、個人生活的正面態度、週遭的社會參與和推己及人的社會幫助四大方向。食道癌患者的社會支持網絡與與復原力的展現成正相關，即社會支持網絡愈強患者的復原力及適應越好，當中又以配偶為最主要的社會支持來源，其次為醫療團隊；患者的經濟能力間接影響的復原歷程，有負擔者，僅管家庭支持系統強大，但經濟的困境阻撓了復原歷程的展現，長久下來家庭成員負荷的重擔亦形成危機。本研究結果可做為臨床醫療人員，了解食道癌患者接受合併化學及放射線治療之復原調適的影響與生活面臨的窘況，包含症狀不適、飲食問題、經濟困境和主要照顧者的負荷四大面向，並推論應用於口腔癌、頭頸部腫瘤、胃癌等上消化道系統之癌症，提供必要的介入措施與諮詢轉介。

關鍵字

食道癌、復原力、合併化學及放射線治療、社會支持、質性研究

並列摘要

Drawing on method of qualitative research, this study has focused on the suffering from esophageal cancer patients receiving concurrent chemoradiotherapy impact and adaptation process of change: discussion of resilience. The participants were selected by thoracic surgery department of medical center located at the central Taiwan, for the first time received concurrent chemoradiotherapy course. Following the purposive sampling, 10 esophageal cancer patients were invited to join in the in-depth qualitative interviewing. With regard to the data collection and analysis, qualitative interviewing was designed as semi-structured, and analysis was conducted as the data from of inductive content analysis. The results showed that esophageal cancer patients’ self beliefs, family support, the trust of the medical team and economic influence resilience sprout, forming and progressing. The onset time of the resilience located at the period was the fact that with patients received, determined to actively participate in treatment. The center of the sprout were family support and the belief of “ keeping living”. The impact of patients received treatment were physical, emotional, social, economic, and other primary caregivers in five areas, including in the physiological impact of weight loss, dysphagia, feeding tube care and concurrent chemoradiotherapy side effects most troubled; including the classification with cancer cause, to take positive coping strategies, beliefs, and family support systems, economic and trust for professional medical team is the adaptation of the recovery factor, while the resilience of the show was adapted diet, personal life positive attitudes, social participation and benefit the people around the community to help the four directions. Esophageal cancer patients and social support networks and resilience demonstrated a positive correlation, ie, the stronger the patient's social support network resilience and adapt better, which spouse as the most important sources of social support, followed by the medical team; patients indirectly affect the economic recovery process capabilities, who have the burden, only the tube strong family support system, but the economic plight of the recovery process to obstruct the show, a long time down load the burden of family members also formed the crisis. Therefore, the research result can be used as medical staff, to understand esophageal cancer patients receiving concurrent chemoradiotherapy rehabilitation adaptation of the predicament faced with life, including symptoms of discomfort, eating problems, economic difficulties and primary caregiver's burden to assist the four dimensions, and inference applied to oral cancer , head and neck cancer, gastric carcinoma and other cancers of the upper gastrointestinal system, to providing the necessary intervention measures and counseling referrals.

並列關鍵字

esophageal cancer, resilience, concurrent chemoradiotherapy, social support, qualitative research

參考文獻

王子葳(2013)•性別家務分工、家庭決策與災難適應與復原之關係•台北：臺灣大學社會工作學研究所。

王紹穎(2007)•自我感、復原力與創傷後症狀之關聯性研究:以燒傷病人為例•

朱月英、郭碧照(2006)•食道癌患者生活品質及其相關因素研究•實證護理，2

行政院衛生署(2012)•統計公佈欄•取自:

李妙純、張華庭 (2011)•社經地位與健康路徑關係之性別差異•台灣衛誌，30 (5) , 453-467。

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接受合併化學及放射線治療之食道癌患者調適影響之研究- 復原力作用的綜合探討

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