透過您的圖書館登入
IP:54.144.81.21
  • 學位論文

頭頸部癌患者的害怕復發、因應型態與健康相關生活品質、創傷後成長間關係之追蹤研究

The Prospective Study of Fear of Recurrence, Coping Style, Health-Related Quality of Life, and Posttraumatic Growth in Patients with Head and Neck Cancer

指導教授 : 洪福建

摘要


研究背景與目的:過去研究多採橫斷式的研究設計個別探討患者的害怕復發、因應策略、健康相關生活品質與創傷後成長等情形,及其相關因子。後續有學者提倡以慢性化的觀點探討癌症的疾病適應歷程,故本研究旨在參考共通信念模式之架構,瞭解在頭頸部癌症患者的適應歷程中,其害怕復發與因應型態如何影響健康相關生活品質與創傷後成長之情形。 研究方法:本研究採縱貫式設計,接續賴世華(2010)的研究,追蹤其研究之207位頭頸部癌症患者,在第二時間點(約間隔3年)邀請受試者完成基本資料表、簡明因應量表、害怕惡化量表、創傷後成長量表及癌症治療指標之功能性評估表等五份問卷。 研究結果:以相關、差異分析、變異數分析、多元迴歸及結構方程模式統計分析結果發現:(1)患者在經過約三年的追蹤期間,害怕復發的程度、趨近與逃避因應的使用均顯著減少,在健康相關生活品質各層面的變動則變化不大;(2)兩個時間點的害怕復發與健康相關生活品質皆達顯著負相關;(3)在第二時間點,害怕復發與創傷後成長間為負相關,但未達顯著;(4)在第二時間點,健康相關生活品質與創傷後成長呈顯著正相關;(5)第一次治療完成距今時間與第二時間點之教育程度、害怕復發、趨近因應可預測第二時間點之健康相關生活品質;(6)第二時間點之教育程度與物質使用可預測第二時間點之創傷後成長,第二時間點之害怕復發與逃避因應僅有邊緣顯著的預測力;(7)參考共通信念模式的架構來探討害怕復發、因應型態與健康相關生活品質/創傷後成長間的縱貫型關係是有助益的,影響後續適應結果的重要因素除了害怕復發的程度,更重要的是對應害怕復發所採取的因應策略。 結論:研究發現害怕復發、因應型態、健康相關生活品質與創傷後成長等因子對頭頸部癌症患者的疾病適應歷程具有影響性,藉由瞭解疾病適應的歷程,將有助於醫療人員及助人專業者提供更優質之後續處遇與介入。

並列摘要


Background and purpose:Most of past research is cross-sectional design, individually study patient's fear of recurrence, coping strategies, health-related quality of life, posttraumatic growth, and related factors. Recently, there are scholars advocate to explore the cancer adaptation process from the chronic view. The purpose of this study is to understand the adaptive process in patients with head and neck cancer, and how their fear of recurrence and coping styles affect their health-related quality of life and post-traumatic growth by the common sense model. Methods:This study is prospective design. Research followed up 207 patients with head and neck cancer in Lai’s (2010) research. The follow- up assessment (after 3 years) included 122 subjects, each participant completed the questionnaires, including: (1) Personal Demographic Data; (2) Brief Coping Orientations to Problems Experienced Scale (Brief COPE); (3) Fear of Progression Questionnaire-Short Form (FoP-Q-SF); (4) Posttraumatic Growth Scale (PGS) and (5) Functional Assessment of Cancer Therapy Scale-Head and Neck (FACT-H & N). Results:Analyzed through Pearson product-moment correlation, the analysis of difference, multiple regression analysis, and the structural equation modeling (SEM) found that: (1) after three years of follow-up period, patient’s degree of fear of recurrence, as well as the use of approach and avoidance coping, were significantly reduced, however, health-related quality of life changed little; (2) fear of recurrence has a significantly negative correlation with health- related quality of life; (3) fear of recurrence has a negative correlation with posttraumatic growth, but does not achieve significant level; (4) health-related quality of life has a significantly positive correlation with posttraumatic growth; (5) time since first treatment completed, level of education, fear of recurrence, and approach coping style could predict health-related quality of life at three-year follow-up; (6) level of education and substance use could predict posttraumatic growth at three-year follow-up, however, fear of recurrence and avoidance coping style has only borderline significant predictive power; (7) it’s helpful to explore the longitudinal relationship between fear of recurrence, coping styles and health-related quality of life/ posttraumatic growth by the common sense model. The extent of the fear of recurrence is important, more importantly, the coping strategies adopted corresponding fear of recurrence will affect the results of adaptation. Conclisions:We found that fear of recurrence, coping style, health-related quality of life, and posttraumatic growth play an important role in the head and neck cancer adjustment process. By understanding this process, more information will be provided to health professionals for better consultation and intervention.

參考文獻


楊于婷(2012)。自我效能與壓力相關疲勞:直接心理生理反應路徑與間接因應行為路徑的影響(未出版之碩士論文)。中原大學,桃園縣。
劉文山(2007)。鼻咽癌以耳下腺保護放射治療的唾液腺功能評估之研究(未出版之博士論文)。中山醫學大學,台中市。
葉秀宇(2007)。乳癌存活者的壓力因應歷程之探索性研究(未出版之碩士論文)。臺灣大學,台北市。
胡欣怡(2005)。創傷後成長的內涵與機制初探:以九二一震災為例(未出版之碩士論文)。台灣大學,台北市。
王藝陵(2010)。乳癌婦女的創傷後成長對其安適感之影響:手術距今時間、診斷期數及人格特質可能的調節角色(未出版之碩士論文)。臺灣大學,台北市。

被引用紀錄


曾心怡(2016)。頭頸癌患者之復發擔憂、關係焦點因應對關係品質的影響歷程〔碩士論文,中原大學〕。華藝線上圖書館。https://doi.org/10.6840%2fcycu201600251
薛惠文(2016)。乳癌患者睡眠困擾對心理幸福感的影響:以失志為中介〔碩士論文,中山醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0003-1801201622562200

延伸閱讀