探討習得智謀與疼痛意義對癌因性疼痛控制的影響

背景癌症病人對疼痛處置方式認知不清楚導致無法有效的控制疼痛，控制不良的疼痛可能會直接讓病人產生負面的情緒，癌症疼痛的病人可能會期望增強正向的自我信念，以建立信心和技能來克服障礙，疼痛的經歷可能會引發病人思考對癌症疼痛相關的意義生存問題，病人對疼痛表示疾病進展的擔憂，可能會延遲病人與醫護人員進行溝通，進而影響到疼痛的控制，擁有高度習得智謀的病人更能尋求資源，並確立解決問題的策略，但近年來較少研究探討癌症病人與疼痛意義、習得智謀與疼痛控制的相關性。研究目的本研究目的為探討影響癌症病人控制疼痛的相關性。材料與方法在人體試驗倫理委員會核准後，本探索性研究採用橫斷式研究設計(cross-sectional design)以隨機取樣，於台中某醫學中心之腫瘤科門診與血液腫瘤科病房，使用問卷填寫收集資料進行收案，問卷內容含「基本屬性問卷」、「支持憑藉資源量表」及「自覺癌症疼痛意義量表」。收案期間為2020年11月起至2021年11月，共100人，結果＆討論單因子多變項分析顯示(1)不同癌症分類在習得智謀上沒有顯著差異(F= 0.43~3.62, p>.05)；在疼痛意義的挑戰向度上有顯著差異(F＝5.57, p=.02）。挑戰是一種積極正向的思維，與病人應對及調整情緒有關，病人對疼痛所感受到意義可幫助臨床護理人員了解病人對疼痛的反應。(2) 習得智謀與挑戰有顯著正相關（Pearson’s r =.35, p=.00），病人擁有越高的習得智謀，表更具有正向積極的思考能力來解決問題和控制較大壓力情況的能力。(3)迴歸分析結果顯示癌症分期越高和疼痛部位總數越多，病人賦予挑戰上的意義就會較少，自變項有性別、年齡、刺痛、悶痛、大部分疼痛分數、兩階止痛藥物、疼痛部位總數、癌症種類及習得智謀，依變項為挑戰，共解釋34％總變異量(R2=.34,p=.00)，有統計顯著意義的自變項為兩階止痛藥物、RS z乘以二階止痛、疼痛部位總數和大部分疼痛分數((t=-2.62~2.90, p≤.05)。結論本研究結果可提供未來相關研究進行參考與比較，建議未來研究可加入介入性措施來進行前後比較病人的疼痛嚴重程度與疼痛控制。

關鍵字

癌因性疼痛；疼痛控制；疼痛意義；習得智謀

並列摘要

Background Lack of knowledge about how to manage ofeten leads to ineffectively control pain in paients with cancer. Poorly controlled pain tends to result in negative emotions in patients. Literature has suggested that an successful pain management in patients with cancer enhances their positive self-belief to the extesst which builds confidence, improves self-esteem, and skills to overcome barriers from cancer pain. However, how the pain experience relates to the meaning of cancer pain has various concerns, particularily in survival issues. They are consists of patients’ perceptions on their disease progression , and the ineffective communication with the health care providers. In addition, patients with a high degree of resourcefulness are more able to seek resources to develop problem-solving strategies in ones’ pain management. However, in recent years, few studies have discussed the meaning of pain, learned resourcefulness and pain control. Among patients diagnosed with cancer. Purpose Therefore, the purpose of this study was to investigate the factors influencing pain control in cancer patients.Method and Materials After the study was approved by the Intitutue of Review Board, this exploratory study adopted a cross-sectional design with random sampling. Participants were recruided from the oncology clinics and ward at a medical center in Middle Taiwan. The questionnaires were employed to collect data. The content of the questionnaires included demogrpahic questionnaires, the traditional Chinese version of Resourcefulness Scale and the Perceived Meanings of Cancer Pain Inventory. From November 20, 2020 to November 20, 2021, a total of 100 patients with cancer experiencing pain were recruided in this present study. Results Discussion Various Staastic Methods were performed to yield results as follow, (1) The one way analyses with multiple mean comparison indicate there is no significant difference in acquired resourcefulness among different cancer diagnoses (F= 0.43~3.62, p>.05); however there are significant differences in the challenge dimension of pain significantly(F＝5.57, p=.02). Challenge as a positive thinking relates to patients' coping and emotional adjustment for cancer pain. Understandint patients’ perceived meaning of pain helps clinical nurses how patients response to their pain experience in developing effect protocal for pain control. (2) There is a significant positive correlation between learned resourcefulness and challenges (Pearson’s r=.35, p=.00). The higher the patient's learned resourcefulness, the more positive thinking ability, the ability to solve problems and control more stressful situations. (3) The results of the regression analysis showed that the higher the cancer stage and the higher the total number of pain sites, the less significance the patient assigned to the challenge, Independent variables are gender, age, tingling, dull pain, most pain scores, two-tier pain medication, total number of pain sites, type of cancer, and learned resourcefulness, and the dependent variable is challenge,explained total of 34% variances(R2=.34,p=0.00). The significant predicrots were two-stage pain reliever, RS z multiplied by two-stage pain reliever, total number of pain sites, and most pain scores (t=-2.62~2.90, p≤.05). Conclusion The results of this study suggested that future studies can add interventional measures to compare the pain severity and pain control of patients before and after.