臺灣博碩士論文加值系統

為瞭解南部三大醫學中心癌症患者症狀困擾、生命意義、健康控握信念和死亡焦慮之概況，以及探討癌症患者個人基本屬性、症狀困擾、生命意義、健康控握信念與死亡焦慮的關係。本研究採採相關性研究設計，便利取樣選取高雄地區三所醫院的癌症放射治療的病患，共219位個案，以結構性問卷進行資料蒐集。研究工具包括：個人基本屬性、症狀困擾量表、生命意義量表、健康控握信念量表及死亡焦慮量表。研究結果發現：（1）癌症病患死亡焦慮指標分數為49.65分，屬中等程度；症狀困擾的指標分數為15.65分，屬輕度困擾程度；生命意義部分只有33.8 %的人有明確的生活目標與意義；故多數癌症病患生活目標與意義屬不確定；本研究對象內控組有137 人（62.6％）顯示以內控型人格特質為主，自己會積極尋求醫療照護。（2）本研究結果發現不同自覺疾病嚴重度與害怕復發程度之病患在死亡焦慮得分上達顯著差異；而其他社會人口學特徵、疾病狀況、治療方式與自覺健康狀況方面無顯著差異。（3）症狀困擾、機運健康控握信念與死亡焦慮的關係呈顯著相關，而生命意義與死亡焦慮的關係呈顯著相關。（4）生命意義及害怕疾病復發程度是癌症病患死亡焦慮的顯著預測因子，可解釋變異量為42﹪。研究結果可提供醫護人員對病患死亡焦慮的瞭解，有助於協助病患解決死亡焦慮的影響因素，進而減輕病患的死亡焦慮，使其有尊嚴的面對死亡以達正向的生命態度。協助病患生命意義的提升，建議推展與研究有關促進生命意義相關的教育訓練課程，期能引導病友再度發現或肯定其生命意義，進而超越生死困頓。

The objectives of this study are to understand the symptom distress, purpose in life, multidimensional health locus of control, and the level of death anxiety in the cancer patients, and to investigate the association between personal characteristics, symptom distress, purpose in life, multidimensional health locus of control and the level of death anxiety. Two hundred and nineteen cancer patients are purposively sampled from three medical centers in southern Taiwan. Subjects are interviewed with a structured questionnaire, which includes personal characteristics, symptom distress scale, purpose in life test, multidimensional health locus of control, and death anxiety inventory. The experimental results are listed as the followings: (1) The average death anxiety score is 49.65, which is ranked as moderately severe. The average symptom distress is 15.65, a mild level. Only 33.8% of the cancer patients have definite purpose of life and confirm the meaning of life. In other words, it is implied that the aim of life is uncertain for cancer patients. One hundred thirty-seven patients (62.6%) who are characterized as health-internal could aggressively seek for medical care by themselves. (2) Severity of disease and fear for disease recurrence are both significantly associated with death anxiety. Personal characteristics, disease status, management methods, and subjective health status are not significantly associated with death anxiety. (3) Symptom distress and opportunistic health locus of control are positively associated with death anxiety, while the score of purpose of life is negatively associated with the level of death anxiety. (4) Purpose of life and fear for disease recurrence are significant predictors for death anxiety among cancer patients, explaining 42% of the total variance.
This investigation provides the information about the death anxiety among cancer patients. Health care providers are encouraged to relieve patients’ death anxiety so that they can face the death with dignity and live their lives with positive attitude. Future studies and training programs can focus on promoting the purpose of life among cancer patients. Health care providers can bring positive attitude to cancer patients and guide them to re-discover the meaning of life and pass beyond the confusion of death.

誌謝…………………………………………………… i
中文摘要…………………………………………………… iii
英文摘要……………………………………………… v
目錄…………………………………………………… vii
表目錄…………………………………………………… x
圖目錄…………………………………………………… xi
第一章緒論……………………………………………… 1
第一節研究動機及重要性……………………………… 1
第二節研究目的………………………………………… 3
第二章文獻探討………………………………………… 4
第一節癌症病患死亡焦慮……………………………… 4
一 死亡焦慮的概念………………………………… 4
二 癌症病患死亡焦慮……………………………… 7
三 死亡焦慮的相關研究…………………………… 9
第二節社會人口學特質、疾病狀況、治療情形與死亡
焦慮的關係……………………………………… 10
一 社會人口學特質與死亡焦慮的關係…………… 10
二 自覺健康與死亡焦慮的關係…………………… 12
三 疾病狀況與死亡焦慮的關係…………………… 13
四 治療情形與死亡焦慮的關係…………………… 15
第三節症狀困擾與死亡焦慮…………………………… 16
一 症狀困擾的概念及評估………………………… 16
二 症狀困擾之相關研究…………………………… 19
三 症狀困擾與死亡焦慮之關係…………………… 21
第四節生命意義與死亡焦慮…………………………… 22
一 生命意義的概念………………………………… 22
二 癌症病患的生命意義探討……………………… 25
三 生命意義之相關研究…………………………… 26
四 生命意義與死亡焦慮之關係…………………… 27
第五節健康控握信念與死亡焦慮……………………… 28
一 健康控握信念的概念…………………………… 28
二 癌症病患的健康控握信念……………………… 30
三 健康控握信念與死亡焦慮之關係……………… 32
第六節研究概念架構…………………………………… 33
第三章研究方法………………………………………… 34
第一節研究設計………………………………………… 34
第二節研究假設………………………………………… 34
第三節名詞界定………………………………………… 35
第四節研究對象及場所………………………………… 36
第五節資料蒐集………………………………………… 37
第六節研究工具………………………………………… 39
第七節資料處理及統計分析…………………………… 46
第八節研究倫理………………………………………… 47
第四章研究結果………………………………………… 49
第一節癌症病患之社會人口學特質與自覺健康狀況… 49
第二節癌症病患之症狀困擾、生命意義、健康控握信
念與死亡焦慮程度……………………………… 54
第三節社會人口特質與自覺健康狀況、症狀困擾、生
命意義、健康控握信念與死亡焦慮之關係…… 61
第四節癌症病患死亡焦慮的預測因子………………… 65
第五章討論……………………………………………… 67
第一節社會人口學特質、自覺健康狀況、症狀困擾、
生命意義、健康控握信念、死亡焦慮…………… 67
第二節社會人口學特質、自覺健康狀況、症狀困擾、
生命意義、健康控握信念與死亡焦慮之關係… 71
第三節死亡焦慮的預測因子…………………………… 75
第六章總結……………………………………………… 78
第一節結論……………………………………………… 78
第二節建議……………………………………………… 79
第三節限制……………………………………………… 83
參考文獻………………………………………………… 85
附錄一研究同意書……………………………………… 100
附錄二研究工具………………………………………… 101
附錄三研究工具使用同意書…………………………… 108
附錄四專家效度檢定名單……………………………… 111
表一社會人口學特質…………………………………………… 52
表二癌症病患之自覺健康狀況之得分與分佈………………… 54
表三癌症病患之症狀困擾量表之得分與分佈………………… 56
表四癌症病患之生命意義量表之得分與分佈………………… 58
表五癌症病患之健康握控信念之得分情形…………………… 60
表六癌症病患之健康控握信念之分佈情形…………………… 60
表七癌症病患之死亡焦慮量表之得分與分佈………………… 61
表八癌症病患的社會人口特質之類別變項與死亡焦慮之關係 63
表九癌症病患之連續變項與死亡焦慮之相關性……………… 65
圖一研究概念架構圖…………………………………………… 34

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