口腔癌術後病人對外觀羞恥與汙名化感受和社會互動的探討

The exploration of perceived of appearance shame and stigma and social interaction in patients with oral cancer after surgery

黃淑貞(Shu-Chen Huang)

指導教授 ： 林佑樺 ； 葉世安

義守大學/醫學院/護理學系/碩士(2018年)

摘要

目的：由於疾病特點和手術方式的不同，口腔癌病人容易造成臉部毀容或功能殘疾，導致羞恥感和汙名化，進而影響病人的社會互動。本研究旨在探討口腔癌病人手術後羞恥與汙名化感受和社會互動的相關因素。
方法：採用橫斷式相關研究設計，以南部某準醫學中心耳鼻喉科病房及門診診斷為口腔癌且接受手術治療的病人為收案對象，自2017年2月1日至11月30日以結構式問卷，包括病人基本資料、疾病特性、羞恥與汙名化量表和社會互動量表，以面對面訪談模式進行收案，共計383位。結果測量採用獨立t檢驗、變異素分析，Pearson相關分析和逐步迴歸分析進行統計分析。
結果：口腔癌術後病人羞恥與汙名化感受與社會互動呈顯著高度正相關，顯示羞恥與汙名化感受愈明顯，對其社會互動衝擊愈大。病人之職業、口腔嗜好與吸煙、飲酒、檳榔咀嚼、腫瘤位置、癌症分期和手術方式和羞恥與汙名化感受呈現顯著差異。病人的年齡、職業、癌症分期和手術方式與社會互動有顯著差異。以逐步迴歸分析，原發病兆切除及頸部淋巴廓清和併皮瓣重建、癌症分期第四期、職業、原發病兆切除及頸部淋巴廓清術和口腔嗜好抽菸、喝酒、嚼檳榔三類都有者，5項預測因子可解釋口腔癌術後病人羞恥與汙名化感受的總變異量之34.7%。而外表恥辱感、言語與社會關注、癌症分期第四期、婚姻狀況、汙名化感覺、和腫瘤位置在舌、口底、硬顎，此6項因子可解釋口腔癌術後病人社會互動的總變異量之55.2%。
結論和臨床應用：本研究結果顯示手術方式、癌症分期和職業會影響口腔癌術後病人因面部缺陷和功能障礙造成的汙名化與羞恥感和影響社會功能。因此，臨床護理人員照護口腔癌病人時，能提供合適的護理措施，幫助病人適應外觀改變，重新融入社會互動。

關鍵字

口腔癌 ； 羞恥與汙名化 ； 社會互動

並列摘要

Objective: The objective of this study was to investigate how the shame and the perceived social stigma of facial disfigurement or dysfunction caused by oral cancer surgery affect social interaction. Other factors related to shame, social stigma, and social interaction in oral cancer surgery patients were also investigated.
Methods: In this cross-sectional study, 383 patients diagnosed with oral cancer were recruited from a general hospital in southern Taiwan. Data were collected by face-to-face interviews and structured questionnaires administered from February 1 to November 30, 2017. Outcome measurements included Social Interaction Scale (SIS) score, Shame and Stigma Scale (SSS) score, personal characteristics, and medical related variables. Statistical analyses included independent t-test, one-way analysis of variance, Pearson correlation, and stepwise regression.
Results: The statistical analyses revealed a strong positive association between SIS score and SSS score. That is, the difficulty of social interaction increased as the shame and perceived social stigma of facial disfigurement and dysfunction after oral cancer surgery increased. Additionally, SSS scores significantly differed by occupation, cancer stage, tumor location, surgical procedure type, and consumption of tobacco, alcohol, and betel nut. The SIS scores significantly differed by age, occupation, cancer stage and surgical procedure. Stepwise regression analysis revealed that five factors accounted for 34.7% of the total variance in social interaction anxiety after oral cancer surgery: tumor resection with lymph node dissection plus reconstructive surgery (22 %), cancer stage IV (5.1%), occupation ( 3.8%), tumor resection plus lymph node dissection (2.3% ) and use of tobacco, alcohol, or betel nut (1.3 %). Six factors accounted for 55.2% of the total variance in social interaction anxiety after oral cancer surgery: shame of appearance (32.9%), social and speech concerns (18.8 %), , cancer stage IV (1.3%), marital status (1.0 %), perceived social stigma (6%), and tumor sites in the tongue, mouth floor and hard palate (5 %).
Conclusions and clinical applications: This study provides initial evidence that surgical procedure type, cancer stage, and occupation affect shame and stigma of facial disfigurement and social dysfunction after oral cancer surgery. Therefore, healthcare professionals responsible for treating these patients should consider these factors when planning interventions for social reintegration of these patients.

並列關鍵字

oral cancer ； shame and stigma ； social interaction

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