希望感與無望感對癌症患者憂鬱及癌因性疲憊之影響

The Effect of Hope and Hopelessness on Cancer patient’s depression and Cancer-related fatigue

李海華(Hai-Hua Li)

指導教授 ： 黃君瑜

中原大學/理學院/心理學研究所/碩士(2016年)

https://doi.org/10.6840/cycu201600255

摘要

研究背景與目的：癌因性疲憊是癌症患者最常出現的副作用之一，亦是近期心理腫瘤學中備受關注的議題，且已知與憂鬱有著緊密的關係。此外，從文獻回顧中發現癌症患者在抗癌過程中會不斷於希望感與無望感的認知中來回擺盪。故本研究想探討希望感與無望感對於癌症患者憂鬱及癌因性疲憊的影響，包含無望感對於患者癌因性疲憊、憂鬱的關聯性，以及希望感在此關係中所扮演的角色，以利未來在臨床場域中可給予適時的心理介入，提升患者的生活品質。

研究方法：研究採取橫斷式設計，以癌症患者為研究對象，共計150位。研究工具為個人基本資料、希望感量表、貝克絕望感量表、流行病學研究中心憂鬱量表，以及癌症疲勞量表。資料分析以相關分析與階層迴歸分析進行假設考驗。

研究結果：(1)患者無望感程度越高，憂鬱的程度亦越高；(2)患者希望感(動力、路徑思考)程度越高，憂鬱程度則越低；(3)患者無望感程度越高，癌因性疲憊(生理、認知、情感)的程度亦越高；(4)患者希望感(動力、路徑思考)程度越高，癌因性疲憊(生理、認知、情感)的程度則越低；(5)無望感與希望感中的動力思考之交互作用，可以顯著預測憂鬱；(6)無望感與希望感之交互作用、無望感與希望感中動力思考之交互作用，以及無望感與希望感中路徑思考之交互作用，皆可顯著預測癌因性疲憊中的生理面向。

討論：當癌症患者在因應過程中，因為無望感而造成憂鬱時，動力思考在過程中扮演了重要的角色。此外，若患者是因無望感而產生生理疲憊時，除動力思考外，路徑思考亦會進而產生調節效果。因此本研究建議，未來於臨床場域中，若能適時協助提升患者相對應的希望感成分，就能進而預防憂鬱及生理疲憊的發生，提升患者的生活品質。

關鍵字

癌因性疲憊 ； 憂鬱 ； 希望感 ； 無望感

並列摘要

Background and purpose：Cancer-related fatigue is one of the most common side effects of patient with cancer. It is also one of concern issue on recent psycho-oncology, and is known to highly correlate with depression. From the literature review, Cancer patient in the process of fighting cancer may both feel hopeful and hopeless. Therefore, the purpose of this study is to explore the effect of hope and hopelessness on depression and cancer-related fatigue in patient with cancer, including the relationship between hopelessness on patient’s depression and fatigue, and the role of hope in this relationship. By understanding this, more information will be provided to health professionals for better intervention, and it also can be provided to improve patient’s quality of life.

Methods：This study is based on cross-sectional design. A total of 150 patients with cancer were included. The tools we used in this study including the Personal Basic Information, The Trait Hope Scale, The Beck Hopelessness Scale(BHS), Center for Epidemiologic Studies-Depression Scale (CES-D) and Cancer Fatigue Scale(CFS). Correlation analysis and hierarchical regression analysis were used to analyses the statistics.

Result：(1) Patients who reported having higher level of hopelessness would feel more depressed. (2) Patients who reported having higher level of hope (agency and pathway thinking) would feel lower depressed. (3) Patients who reported having higher level of hopelessness would have higher level of cancer-related fatigue. (4) Patients who reported having higher level of hope (agency and pathway thinking) would have lower level of cancer-related fatigue. (5) The interaction between hopelessness and agency thinking of hope significantly predicted depressive symptoms. (6) The interaction between hopelessness and hope, hopelessness and agency thinking of hope, and hopelessness and pathway thinking of hope significantly predicted physical fatigue.

Discussion：Agency thinking plays an important role in coping process of patient with cancer, when they are struggling with depression by feeling hopeless. In addition, if a patient’s physical fatigue is caused by hopelessness, not only agency thinking, but also pathway thinking has moderating effects on physical fatigue. Therefore, in order to prevent depression and physical fatigue and to improve the quality of life of these patients, we suggest that clinicians can timely help the patients to enhance corresponding component of hope.

並列關鍵字

Cancer-related fatigue ； Depression ； Hope ； Hopelessness

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