對偶因應量表結構及其與生活品質之關係初探－以乳癌患者與伴侶為例

研究背景與目的:現今癌症病程雖然已經呈現慢性化的趨勢，但罹癌所帶來的重大壓力衝擊，不僅會影響患者，也會連帶影響伴侶。Bodenmann（1995）提出系統互動模式的對偶觀點，認為患者及其伴侶在因應罹癌壓力及調適過程中，會相互依賴與相互影響，並主張對偶因應能降低另一方或是雙方的壓力程度，促進個人及其伴侶之間的關係功能。Bodenmann依照系統互動模式的理論概念發展對偶因應量表，評估患者及其伴侶提供給對方與感知的壓力溝通、個人對偶因應行為，及共同對偶因應行為。目前對偶因應量表已經在許多國家被廣泛使用並顯現不錯的信效度，然其因素結構上仍有分歧，有鑑於目前少有研究將立基於理論架構中的兩種因素結構（個人對偶因應的五因素或四因素；共同對偶因應的二因素或一因素）進行模式比對，本研究將以乳癌患者與其伴侶為樣本，檢驗對偶因應量表在國內的心理計量特性。再者，從乳癌具有高存活性的特性來看，本研究認為探究生活品質的面向能夠使研究者較全面的瞭解罹癌診斷與治療對於癌症患者及其伴侶的影響，也能有助於釐清過去研究中還未能探討到的對偶因應行為與生活品質之關係。因此，本研究之研究目的如下:（1）藉由驗證式因素分析及模式比對建立臺灣版對偶因應量表之信、效度；（2）以行動者－夥伴相依模式探討壓力溝通、正負向對偶因應行為對乳癌患者及其伴侶生活品質之影響。研究方法:本研究為橫斷式研究，採用科技部計畫（MOST 109-2635-H-033-001-）之部分樣本進行研究分析，共有186對乳癌患者及其伴侶為研究對象。主要的研究工具為自陳式量表，包含臺灣版對偶因應量表與臺灣簡明版世界衛生組織生活品質問卷。研究分析將以驗證性因素分析檢驗臺灣版對偶因應量表之因素結構與模式比對，並依據行動者－夥伴相依模式探討患者及其伴侶提供及感知的壓力溝通、正負向對偶因應行為對個人或/及其伴侶生活品質的影響。研究結果：（1）驗證性因素分析與模式比對的結果顯示臺灣版對偶因應量表較支持五因素-一因素的因素結構，即壓力溝通、問題為焦及情緒為焦支持對偶因應、承擔對偶因應與負面對偶因應（五因素），以及共同對偶因應（一因素）。（2）患者提供壓力溝通、問題為焦及情緒為焦支持、承擔對偶因應對其社會關係、環境有顯著正向影響；感知問題為焦及情緒為焦支持則對其所有範疇的生活品質有顯著正向影響。伴侶無論是提供或感知正向對偶因應，其壓力溝通、問題為焦/情緒為焦支持、承擔對偶因應均對其自身所有範疇的生活品質（生理健康、心理健康、社會關係、環境）有顯著正向影響。（3）患者提供負面對偶因應會對自身的社會關係及環境有負面影響；感知負面對偶因應則負向影響其所有範疇的生活品質。伴侶提供負面對偶因應僅對其自身的生理健康有顯著負向影響；感知負向對偶因應則會負向影響其生理健康與環境。（4）患者的共同對偶因應會正向影響自己的社會關係及環境，並正向影響其伴侶的環境生活品質；伴侶則會正向影響自己所有範疇的生活品質。（5）提供及感知正負向對偶因應僅在社會關係及環境生活品質有夥伴效應。結論：本研究發現臺灣版對偶因應量表較符合Bodenmann理論概念的五因素－一因素模式，並支持對偶因應對伴侶雙方具相互影響性，其中正向對偶因應對生活品質有利，負面對偶因應行為則有害。本研究提供臨床工作者瞭解伴侶雙方對偶因應類型的測驗工具，並可運用於協助罹癌患者及其伴侶進行壓力溝通及正向對偶因應行為，以作為提升彼此生活適應的參考方向。

關鍵字

乳癌；病患；伴侶；對偶因應量表；生活品質

並列摘要

Background and purpose: The course of cancer today has shown a trend of chronicity, the significant stress from cancer will not only affect patients, but also affect their partners. Bodenmann（1995）proposed the Systemic-Transactional Model（STM）, that emphasizes the interdependence and mutuality between patients and their partners in the process of coping with stress from cancer.The STM model advocated that dyadic coping can reduce the stress of patients and their partners, and promote the relationship function between patients and their partners. Bodenmann developed the Dyadic Coping Inventory based on the theoretical concept of the STM model, which evaluates the stress communication, individual dyadic coping behaviors, and common dyadic coping behaviors between patients and their partners. So far the DCI has been widely used in many countries and has shown good reliability and validity. However, current evidence are still inconsistent in the factor structures. In view of the fact that few studies compared two factor structures based on the theoretical framework, this study would taked breast cancer patients and their partners as samples to caculate the psychometric characteristics of the DCI in Taiwan. Furthermore, considering the high survivability of breast cancer, this study believes that the quality of life can enable researchers to understand how diagnosis and treatment of cancer has impact on cancer patients and their partners. Simultaneously, this study can also help to clarify the relationship between dyadic coping and quality of life, that has not been explored in previous studies. Therefore, the purposes of this study are as follows: (1) Establish the reliability and validity of the Taiwanese version of the DCI through confirmatory factor analysis and pattern comparison; (2) explore the influence of stress communication, positive and negative dyadic coping behaviors on the quality of life of breast cancer patients and their partners through the actor-partner interdependence model. Methods: This study is a cross-sectional study, using part of samples from the Ministry of Science and Technology Project (MOST 109-2635-H-033-001-). Including 186 pairs of breast cancer patients and their partners. The main research tool including the DCI（Taiwanese version） and WHOQOL-BREF. As methods of analysis, we applied confirmatory factor analysis and APIM-MM. Results: (1) The results of confirmatory factor analysis and model comparison showed that the DCI（Taiwanese version）support the five factors-one factor structure model, including stress communication, problem-focused, emotional-focused supportive dyadic coping, delegated dyadic coping , negative dyadic coping（five factors）, and common dyadic coping（one factor）; (2)The patients have provided stress communication, problem-focused, emotional-focused supportive dyadic coping, delegated dyadic coping could significantly positively influence patients’ social relationship and environmental quality. The patients have perceived problem-focused, emotional-focused supportive dyadic coping could significantly positively influence patients’ quality of life in all domains. The partners have provided and perceived positive dyadic coping（stress communication, problem-focused, emotional-focused supportive dyadic coping, delegated dyadic coping ）could significantly positively influence partners’ quality of life in all domains;(3) The patients have provided negative dyadic coping could significantly negatively influence patients’ social relationship and environmental quality；The patients have perceived negative dyadic coping could significantly negatively influence patients’ quality of life in all domains. The partners have provided negative dyadic coping could significantly negatively influence partners’ physical health. The partners have perceived negative dyadic coping could significantly negatively influence partners’ physical health and environmental quality; (4) The patients have provided common dyadic coping could significantly positively influence their social relationship and environmental quality. The partners have provided common dyadic coping could significantly positively influence partners’ quality of life in all domains;(5) Providing and perceiving positive, negative dyadic coping have partner effect in social relationship and environmental quality. Conclusion: This study found that the DCI（Taiwanese version）fits the five factors-one factor model of Bodenmann's theoretical concept, and supports that dyadic coping with the mutual influence of both partners. The positive dyadic coping is beneficial to the quality of life, and the negative dyadic coping is harmful to the quality of life. This study provides a tool for clinicians to understand the types of dyadic coping of patients and their partners.On the other hand, this study can be used to enhance stress communication and positive dyadic coping behaviors by patients with cancer and their partners, and as a recommend direction for improving each other's life adaptation.