探討癌症病人疼痛與失志狀態之關聯

The Relationship Between Pain and Demoralization in Cancer Patients

林家惠(Chia-Hui Lin) ； 王枝燦(Chih-Tsan Wang)

《護理雜誌》 64卷1期 (2017/02) Pp. 51-60

https://doi.org/10.6224/JN.000008

摘要

背景　癌症病人普遍有疼痛經驗，然對疼痛認知存在著差異。當持續存在痛苦，會產生無望、悲觀、人際疏遠等「失志症候群」，台灣癌症病人失志盛行率遠高於他國。目的　以癌症疼痛意義為中介變項，探討癌症病人的疼痛與失志之關聯。方法　本研究採方便取樣60位癌症病人，以「臺灣版的簡易疼痛量表」、「中文版失志量表」及「自覺癌症疼痛意義量表」收集資料，使用徑路分析法探討變項間之關聯。結果　本研究顯示：(1)疼痛干擾生活程度對失志與疼痛意義有直接影響；(2)最輕分數組的疼痛干擾生活程度，經由疼痛意義「威脅」增加失志分數；(3)最痛分數組會透過疼痛干擾生活程度與疼痛意義「挑戰」間接影響失志。結論／實務應用　癌症照護除了緩解病人的疼痛外，更需關注疼痛干擾生活程度對病人失志狀態的影響，及早發現失志個案。再者，可從關注疼痛意義層面進行照護，若病人認為疼痛為挑戰時，失志不容易發生；反之，當視疼痛是種威脅時，要特別注意病人的失志狀態。

關鍵字

癌症疼痛 ； 失志 ； 癌症疼痛意義

並列摘要

Background: While patients with cancer commonly experience bodily pain, their perceptions of this pain may differ. Continually experiencing pain elicits a sense of helplessness and pessimism in these patients and exacerbates their perception of interpersonal alienation, which may cause the demoralization syndrome. In Taiwan, the rate of demoralization among patients with cancer is substantially higher than that in other countries. Purpose: The meaning of cancer pain is used as the mediating variable to investigate the relationship between the pain that is experienced by patients with cancer and their demoralization. Methods: Sixty cancer patients were surveyed using convenience sampling. Data were collected using the Taiwanese version of the Brief Pain Inventory, the Mandarin version of the Demoralization Scale, and the Perceived Meanings of Cancer Pain Inventory. The primary statistical analysis method used was path analysis. Results: (1) The extent to which pain disrupted the daily life of the participants directly affected their demoralization and perceived meanings of pain. (2) For the patient group that experienced the least pain, the extent to which pain disrupted daily life increased their demoralization scores, with this increase mediated by their perceived meaning of pain as ＂being threatened.＂ (3) For the patient group that experienced the most pain, the extent to which pain disrupted daily life and to which they perceived the meaning of pain as ＂a challenge＂ indirectly affected their demoralization scores. Conclusions / Implications for Practice: Cancer care should not only alleviate patient pain but also emphasize the effect of pain on disrupting the daily life of patients and eliciting their sense of demoralization. This enables the early diagnosis of the demoralization syndrome. Care may be provided in accordance with the various meanings of pain that are perceived by cancer patients. When patients perceive pain as a challenge, they are unlikely to be demoralized. However, when patients perceive pain as a threat, attention should be paid to their sense of demoralization.

並列關鍵字

cancer pain ； demoralization ； meanings of cancer pain

參考文獻

方俊凱（2011）．概述失志症候群．安寧療護雜誌，16（3），371–379。[Fang, C. K. (2011). Demoralization syndrome. Taiwan Journal of Hospice Palliative Care, 16(3), 371–379.] doi:10.6537/TJHPC.2011.16(3).8

陳麗糸（2010）．疼痛的認知層面評估：信念與態度．腫瘤護理雜誌，10（1），1–11。[Chen, L. M. (2010). Cognitive dimension of pain assessment: Beliefs and attitudes. The Journal of Oncology Nursing, 10(1), 1–11.]

賴虹均（2008）．癌症患者的憂鬱症．腫瘤護理雜誌，8（1），1–11。[Lai, H. C. (2008). Depression in patients with cancer. The Journal of Oncology Nursing, 8(1), 1–11.]

謝孟芸、蔡兆勳、陳慶餘、邱泰源（2011）．癌症末期患者群集性症狀診治的新進展．台灣醫學，15（1），62–69。[Hsieh, M. Y., Tsai, J. S., Chen, C. Y., & Chiu, T. Y. (2011). Therapeutic update on symptom clusters in advanced cancer patients. Formosan Journal of Medicine, 15(1), 62–69.] doi:10.6320/FJM.2011.15(1).10

洪曉琪、陳虹汶、張義芳、楊育正、劉建良、謝瑞坤…方俊凱（2010）．癌症病人失志量表中文版之信效度檢測．內科學誌，21（6），427–435。[Hung, H. C., Chen, H. W., Chang, Y. F., Yang, Y. C., Liu, C. L., Hsieh, R. K., ... Fang, C. K. (2010). Evaluation of the reliability and validity of the mandarin version of demoralization scale for cancer patients. Journal of Internal Medicine of Taiwan, 21(6), 427–435.] doi:10.6314/JIMT.2010.21(6).06