臺灣博碩士論文加值系統

本研究目的在探討正向思考日誌及疾病相關資訊對疑似頭頸部腫瘤患者疾病診斷期情緒反應之影響。本研究採類實驗法之兩組前後測研究設計。以立意取樣，於北部某醫學中心耳鼻喉科門診及口腔外科門診，選取疑似口腔癌或鼻咽癌但未進行切片確立診斷者為研究對象。個案於切片當天及一星期後返診看切片報告且醫師告知切片結果後，接受追蹤調查。自民國96年3月至96年7月止，共收81位個案(實驗組28位；對照組53位)。評估工具有「基本屬性」、「疾病不確定感量表」、「癌症憂慮量表」、「情境焦慮量表」、「希望狀態量表」及「評價表」。所得資料採電腦軟體SPSS10.0版進行描述性及推論性統計分析。
結果顯示:實驗組及對照組確立診斷前的情緒狀態均屬中度疾病不確定感、中度癌症憂慮及高度焦慮。僅在希望狀態上有差異，實驗組希望狀態為104.75分。對照組希望狀態為98.87分。撰寫正向思考日誌及提供疾病相關資訊後，實驗組疾病不確定感及焦慮下降、希望狀態提升。提供疾病相關資訊後，對照組疾病不確定感下降及希望狀態提升。檢測有無撰寫正向思考日誌後之成效，實驗組較對照組疾之病不確定感明顯下降許多及希望狀態明顯提升許多。整體而言兩組均覺得本介入措施是有幫助的且可繼續施行於門診。實驗組經過撰寫正向思考日誌及疾病相關資訊提供後擔心害怕指數下降，撰寫正向思考日誌後自覺較能正面看事情，給予提供疾病相關資訊後則更瞭解病情及澄清自己對病情的疑問。對照組則在經過疾病相關資訊提供後自覺更瞭解病情及澄清自己對病情的疑問，但少部分人仍覺得反而更擔心害怕。
整體而言正向思考日誌及疾病相關資訊可降低疾病不確定感、焦慮及提升希望狀態。且正向思考日誌可解釋確立診斷後疾病不確定感的變異量5.2%。正向思考日誌可解釋確立診斷後希望狀態的變異量7.9%。切片結果可解釋確立診斷後希望狀態的變異量5.6%。期能將此介入措施運用於臨床照護上，以緩解個案疾病診斷期之負向情緒反應。

Abstract
This research aims to explore the influence of positive thinking journals and disease-related information on the emotional reaction of the patients suspected to have neck tumors at the stage of disease diagnosis. This research adopts pretest and posttest of two groups in quasi-design and selects the patients suspected to have oral cavity cancer or nasopharyngeal carcinoma, but haven’t had section diagnosis in the E.N.T. department and oral surgery outpatient service of certain medical center in Northern Taiwan as the research targets by purposive sampling. The targets read the section report on the day of section diagnosis and after one week. They receive tracking investigation after the doctors inform them of the results. From March, 2007 to July, 2007, there were 81 cases collected (28 targets in experiment group; 53 targets in control group). The assessment tools included “basic attributes”, “disease uncertainty scale”, “cancer worry scale”, “situational anxiety scale”, “expectation state scale” and “evaluation”. Data acquired was managed by descriptive and inferential statistics analysis by computer software SPSS10.0.
The result shows: the emotional state of experiment group and control group before diagnosis refers to medium disease uncertainty, medium cancer anxiety and high anxiety. Only expectation state reveals difference. Expectation state of experiment group is 104.75 points and that of control group is 98.87 points. After writing positive thinking journals and providing disease-related information, disease uncertainty and anxiety are eased and expectation state is increased in experiment group. After providing disease-related information, disease uncertainty is reduced and expectation state is increased in control group. When we examine the result of writing positive thinking journals, we find that comparing with control group, disease uncertainty significantly reduces and expectation state significantly increases in experiment group. Generally speaking, two groups indicate that this intervention measure is helpful and it can be further implemented in outpatient service. After writing positive thinking journals and providing disease-related information, the anxiety in experiment group is reduced. After writing positive thinking journals, they find themselves to treat things more positively and after providing disease-related information, they can understand their own situations and clarify their questions. After providing disease-related information, control group can understand their own situations and clarify their questions. However, few of them still feel worried.
Generally speaking, positive thinking journals and disease-related information can reduce disease uncertainty, anxiety and increase expectation state. Besides, positive thinking journals can explain 5.2% variance of disease uncertainty after diagnosis. Positive thinking journals can explain 7.9% variance of expectation state after diagnosis. Section result can explain 5.6% variance of expectation state after diagnosis. We expect to apply this intervention measure to clinical care to ease the negative emotional reaction of the targets at the stage of disease diagnosis.

目錄
頁碼
誌謝-------------------------------------------------------------------------------I
中文摘要-------------------------------------------------------------------------II
英文摘要-------------------------------------------------------------------------IV
目錄-------------------------------------------------------------------------------VI
圖表目錄-------------------------------------------------------------------------IX
附錄目錄-------------------------------------------------------------------------X
第一章 緒論--------------------------------------------------------------------01
第一節 研究動機與重要性-----------------------------------------------01
第二節 研究目的-----------------------------------------------------------02
第三節 研究問題-----------------------------------------------------------03
第四節 研究假設-----------------------------------------------------------04
第五節 名詞解釋-----------------------------------------------------------04
第二章 文獻查證--------------------------------------------------------------07
第一節 頭頸部腫瘤的發生原因、癌前病變、症狀、診斷分期及治
療-------------------------------------------------------------------------------07
第二節 癌症患者疾病診斷期常見之情緒反應及其相關因素-----17
第三節 正向思考日誌及疾病相關資訊對癌症患者情緒反應之影響
--------------------------------------------------------------------------------- 34
第三章 研究方法--------------------------------------------------------------37
第一節 概念架構-----------------------------------------------------------37
第二節 研究設計-----------------------------------------------------------39
第三節 研究場所與對象--------------------------------------------------40
第四節 研究工具-----------------------------------------------------------42
第五節 研究工具之效度檢測--------------------------------------------47
第六節 資料收集過程-----------------------------------------------------49
第七節 資料處理與分析方法--------------------------------------------56
第四章 研究結果--------------------------------------------------------------60
第一節 實驗組及對照組研究對象基本資料--------------------------60
第二節 實驗組撰寫正向思考之內容-----------------------------------67
第三節 實驗組及對照組確立診斷前疾病不確定感、癌症憂慮、焦
慮、希望狀態之現況與各別接受介入措施後之成效----------------68
第四節 影響疑似頭頸部腫瘤患者未確立診斷前疾病不確定感、癌
症憂慮、焦慮及希望狀態之相關因素----------------------------------77
第五節 疑似頭頸部腫瘤患者對於疾病診斷期接受撰寫正向思考日
誌及提供疾病相關資訊的評價-------------------------------------------83
第六節 確立診斷前疑似頭頸部腫瘤患者疾病不確定感、癌症憂
慮、焦慮及希望狀態之預測因子----------------------------------------85
第七節 確立診斷後疑似頭頸部腫瘤患者疾病不確定感、癌症憂
慮、焦慮及希望狀態之預測因子----------------------------------------88
第五章 討論--------------------------------------------------------------------91
第一節 實驗組及對照組研究對象基本資料--------------------------91
第二節 實驗組及對照組接受撰寫正向思考日誌及提供疾病相關資
訊後疾病不確定感、癌症憂慮、焦慮及希望狀態改變的成效---92
第三節 影響疑似疑似頭頸部腫瘤患者確立診斷前疾病不確定感、
癌症憂慮、焦慮及希望狀態的相關影響因素-------------------------94
第四節 疑似頭頸部腫瘤患者的基本屬性對確立診斷前之疾病不確
定感、癌症憂慮、焦慮及希望狀態的預測因子---------------------100
第五節 疑似頭頸部腫瘤患者的基本屬性、切片報告及撰寫正向思
考日誌對確立診斷後之疾病不確定感、癌症憂慮、焦慮及希望狀態
的預測因子------------------------------------------------------------------101
第六章 結論與建議-----------------------------------------------------------102
第一節 結論-----------------------------------------------------------------102
第二節 研究結果於護理上之應用--------------------------------------104
第三節 研究限制及未來研究之建議-----------------------------------105
參考資料------------------------------------------------------------------------106
中文部份---------------------------------------------------------------------106
英文部份---------------------------------------------------------------------110

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