臺灣博碩士論文加值系統

頭頸癌為台灣男性中常見之癌症，癌症本身與治療過程帶給頭頸癌存活者許多治療副作用與相關適應障礙，癌症所帶來之生命威脅對於患者亦可視為一創傷性壓力。
然而，面對癌症時，除了產生心理痛苦與創傷後壓力症狀之外，亦有部分患者體驗到正向的改變，Tesdechi與 Calhoun (2004) 將個體與具挑戰性的生活環境奮鬥之後，所體驗到的心理上正向改變稱之為「創傷後成長 (posttraumatic growth, PTG)」。本研究旨在調查台灣頭頸癌患者中創傷後成長之現況，並檢驗Tesdechi與 Calhoun (2004)提出之認知歷程模式在此群患者中之適用性。
本研究共招募196位頭頸癌患者，分別測量其壓力感受、侵入性芻思、精緻化芻思、核心信念改變、創傷後成長及創傷後壓力症狀。
研究發現在台灣頭頸癌患者中，壓力感受、芻思、核心信念改變、創傷後成長、創傷後壓力症狀程度均較低，性別、年齡、教育程度會造成患者創傷後成長之差異，而年齡與教育程度亦會影響患者思考癌症所帶來之意義與改變、與檢視自身核心信念之程度。
在模式適用上，台灣頭頸癌患者之認知歷程模式符合理論模式，患者罹癌後心理壓力上升，進入侵入性芻思、轉向精緻化芻思，並造成核心信念改變後，體驗到癌症所帶來之正向成長。如若個體未進入精緻化芻思，則將造成創傷後壓力症狀之感受上升。
研究結果可提供臨床實務工作者了解台灣頭頸癌患者創傷後成長現況及其產生之認知歷程，並建議未來以縱貫性研究收集治療完成後各時間點之患者，以探究當癌症威脅降低時，認知歷程隨時間演進所產生之改變，並以質性研究法探究自侵入性芻思轉換至精緻化芻思、產生核心信念改變、體驗創傷後成長之改變機制，用以促進患者之創傷後成長。

Head and neck cancer is a common type of cancer amongst Taiwanese males. The cancer itself and the treatment process come with many side effects and other related adjustment difficulties, and the life threat brought by the cancer to patients is sometimes seen as a traumatic stress. Apart from psychological distress and symptoms of PTSD, some patients however, also experience positive changes when facing cancers.
Tesdechi and Calhoun (2004) coined the term “Posttraumatic Growth, PTG” to refer to the psychological positive changes one experiences after battling with a challenging environment. The current study aims to investigate the post traumatic growth of Taiwanese head and neck cancer patients, as well as to test the suitability of the cognitive process model proposed by Tesdechi and Calhoun (2004) in these patients.
The current study includes 196 patients with head and neck cancer, testing their feelings of stress, intrusive rumination, deliberate rumination, changes in core beliefs, post-traumatic grow, symptoms of post-traumatic stress. The result shows that(1) stress feeling, rumination, changes in core beliefs, post-traumatic growth, and post traumatic stress are lower in Taiwanese head and neck patients; (2) gender, age and level of education will contribute to the difference of patients’ post traumatic growth; (3) age and level of education have an impact on the degree to which patients think about the meaning and changes brought by the cancer and check their own core beliefs.
In terms of the suitability of the model, Taiwanese head and neck patients’ cognitive process matches with the theoretical one, in that patients’ psychological stress increases first, followed by intrusive rumination, deliberate rumination, changes in core beliefs, then experience the positive growth brought by the cancer. On the other hand, an individual’s post traumatic stress symptoms will increase if he/she does not enter the deliberate rumination phase.
Findings of the current study can improve clinical workers’ understanding of Taiwanese head and neck cancer patients’ post traumatic growth and its underlying cognitive process. For future studies, It is suggested to take a longitudinal approach to collect data from patients who are at different time points after treatment to investigate the changes from intrusive rumination to deliberate rumination, changes in core beliefs, and the change mechanism of post traumatic growth.

指導教授推書………………………………………………………………………-i-
口試委員審定書…………………………………………………………………-ii-
授權書…………………………………………………………………………………-iii-
致謝………………………………………………………………………………………-iv-
中文摘要………………………………………………………………………………-vi-
英文摘要……………………………………………………………………………-viii-
目錄…………………………………………………………………………………………-x-
表次………………………………………………………………………………………-xii-
圖次………………………………………………………………………………………-xiii-
第一章 緒論………………………………………………………………………- 1 -
第一節 研究背景……………………………………………………………- 1 -
第二節 文獻探討……………………………………………………………- 3 -
第三節 研究假設與架構………………………………………………- 26 -
第二章 研究方法……………………………………………………………- 29 -
第一節 研究對象與來源………………………………………………- 29 -
第二節 研究工具……………………………………………………………- 34 -
第三節 資料分析……………………………………………………………- 39 -
第三章 研究結果……………………………………………………………- 43 -
第一節 各變項之描述性統計………………………………………- 43 -
第二節 各變項於人口學變項間之差異……………………- 60 -
第三節 各變項間相關……………………………………………………- 66 -
第四節 創傷後成長認知歷程之路徑分析…………………- 71 -
第四章 討論……………………………………………………………………- 80 -
第一節 各變項之描述性統計與各變項於人口學變項之差異……- 80 -
第二節 各變項間相關之檢定 ……………………………- 88 -
第三節 創傷後成長模式檢定結果……………………………- 96 -
第五章 結論與建議………………………………………………………- 100 -
第一節 研究總結與建議………………………………………………- 100 -
第二節 研究限制與待研究方向…………………………………- 101 -
參考文獻……………………………………………………………………………-104-
附錄一 正式施測量表……………………………………………………-113-
附錄二 人口學變項與各研究變項之關係…………………-123-

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