臺灣博碩士論文加值系統

研究背景與目的：過去研究多採橫斷式的研究設計個別探討患者的害怕復發、因應策略、健康相關生活品質與創傷後成長等情形，及其相關因子。後續有學者提倡以慢性化的觀點探討癌症的疾病適應歷程，故本研究旨在參考共通信念模式之架構，瞭解在頭頸部癌症患者的適應歷程中，其害怕復發與因應型態如何影響健康相關生活品質與創傷後成長之情形。
研究方法：本研究採縱貫式設計，接續賴世華（2010）的研究，追蹤其研究之207位頭頸部癌症患者，在第二時間點（約間隔3年）邀請受試者完成基本資料表、簡明因應量表、害怕惡化量表、創傷後成長量表及癌症治療指標之功能性評估表等五份問卷。
研究結果：以相關、差異分析、變異數分析、多元迴歸及結構方程模式統計分析結果發現：（1）患者在經過約三年的追蹤期間，害怕復發的程度、趨近與逃避因應的使用均顯著減少，在健康相關生活品質各層面的變動則變化不大；（2）兩個時間點的害怕復發與健康相關生活品質皆達顯著負相關；（3）在第二時間點，害怕復發與創傷後成長間為負相關，但未達顯著；（4）在第二時間點，健康相關生活品質與創傷後成長呈顯著正相關；（5）第一次治療完成距今時間與第二時間點之教育程度、害怕復發、趨近因應可預測第二時間點之健康相關生活品質；（6）第二時間點之教育程度與物質使用可預測第二時間點之創傷後成長，第二時間點之害怕復發與逃避因應僅有邊緣顯著的預測力；（7）參考共通信念模式的架構來探討害怕復發、因應型態與健康相關生活品質/創傷後成長間的縱貫型關係是有助益的，影響後續適應結果的重要因素除了害怕復發的程度，更重要的是對應害怕復發所採取的因應策略。
結論：研究發現害怕復發、因應型態、健康相關生活品質與創傷後成長等因子對頭頸部癌症患者的疾病適應歷程具有影響性，藉由瞭解疾病適應的歷程，將有助於醫療人員及助人專業者提供更優質之後續處遇與介入。

Background and purpose：Most of past research is cross-sectional design, individually study patient's fear of recurrence, coping strategies, health-related quality of life, posttraumatic growth, and related factors. Recently, there are scholars advocate to explore the cancer adaptation process from the chronic view. The purpose of this study is to understand the adaptive process in patients with head and neck cancer, and how their fear of recurrence and coping styles affect their health-related quality of life and post-traumatic growth by the common sense model.
Methods：This study is prospective design. Research followed up 207 patients with head and neck cancer in Lai’s (2010) research. The follow- up assessment (after 3 years) included 122 subjects, each participant completed the questionnaires, including: (1) Personal Demographic Data; (2) Brief Coping Orientations to Problems Experienced Scale (Brief COPE); (3) Fear of Progression Questionnaire-Short Form (FoP-Q-SF); (4) Posttraumatic Growth Scale (PGS) and (5) Functional Assessment of Cancer Therapy Scale-Head and Neck (FACT-H & N).
Results：Analyzed through Pearson product-moment correlation, the analysis of difference, multiple regression analysis, and the structural equation modeling (SEM) found that: (1) after three years of follow-up period, patient’s degree of fear of recurrence, as well as the use of approach and avoidance coping, were significantly reduced, however, health-related quality of life changed little; (2) fear of recurrence has a significantly negative correlation with health- related quality of life; (3) fear of recurrence has a negative correlation with posttraumatic growth, but does not achieve significant level; (4) health-related quality of life has a significantly positive correlation with posttraumatic growth; (5) time since first treatment completed, level of education, fear of recurrence, and approach coping style could predict health-related quality of life at three-year follow-up; (6) level of education and substance use could predict posttraumatic growth at three-year follow-up, however, fear of recurrence and avoidance coping style has only borderline significant predictive power; (7) it’s helpful to explore the longitudinal relationship between fear of recurrence, coping styles and health-related quality of life/ posttraumatic growth by the common sense model. The extent of the fear of recurrence is important, more importantly, the coping strategies adopted corresponding fear of recurrence will affect the results of adaptation.
Conclisions：We found that fear of recurrence, coping style, health-related quality of life, and posttraumatic growth play an important role in the head and neck cancer adjustment process. By understanding this process, more information will be provided to health professionals for better consultation and intervention.

目錄
摘要 I
Abstract II
目錄 IV
表目錄 VI
圖目錄 VIII
第一章 緒論 1
第二章 文獻探討 3
第一節 頭頸部癌症簡介 3
第二節 癌症適應之慢性化與影響因素 5
一、害怕復發（fear of recurrence, FOR） 6
二、健康相關生活品質（health-related quality of life, HRQOL） 9
三、創傷後成長（posttraumatic growth, PTG） 12
第三節 參考共通信念模式於癌症長期適應之架構 15
一、共通信念模式（common sense model, CSM） 15
二、視害怕復發為疾病表徵 16
三、以因應型態作為中介因子 17
四、預測健康相關生活品質與創傷後成長等癌症適應結果的縱貫式研究 23
五、小結 24
第四節 研究架構與假設 24
第三章 研究方法 27
第一節 研究對象 27
第二節 研究工具 33
第三節 研究程序 35
第四節 資料分析 36
第四章 研究結果 38
第一節 人口變項、臨床變項與研究變項之相關及差異分析 38
第二節 研究變項的穩定與變動及相關分析 53
一、害怕復發、因應型態與健康相關生活品質的穩定與變動 53
二、害怕復發、因應型態、創傷後成長與健康相關生活品質的相關分析 54
第三節 整合的迴歸模式與路徑分析 58
一、預測第二時間點之健康相關生活品質的階層式迴歸模式 58
二、預測第二時間點之創傷後成長的階層式迴歸模式 60
三、害怕復發、因應型態與健康相關生活品質的路徑分析 62
四、害怕復發、因應型態與創傷後成長的路徑分析 63
五、對應研究假設之小結 65
第五章 討論與建議 66
第一節 研究結果討論 66
一、頭頸部癌患者適應因子的變化情況與相關因素 66
二、頭頸部癌症患者之縱貫式疾病適應模式 71
第二節 研究貢獻與臨床應用、研究限制及未來研究方向 80
一、研究貢獻與臨床應用 80
二、研究限制 81
三、未來研究方向 82
參考文獻 84
附錄一 受試者同意書 97
附錄二 研究問卷 101
第一部分 個人基本資料 101
第二部分 簡明因應量表 102
第三部分 害怕惡化量表 103
第四部分 創傷後成長量表 104
第五部分 癌症治療指標之功能性評估表─頭頸部癌（第四版） 105
附錄三 簡明因應量表（Brief COPE）各向度題目列表 107
附錄四 創傷後成長量表（PTGS）各向度題目列表 108
附錄五 創傷後成長量表（PTGS）授權同意書 109

表目錄
表2-3-1 趨近與逃避因應分類與定義 22
表3-1-1 病患之人口學變項特性 29
表3-1-2 病患之臨床變項特性 30
表3-1-3 追蹤成功組在兩個時間點之人口學變項特性的變化 32
表4-1-1 追蹤組基本人口因素暨臨床相關因素與各主要研究因素之相關（N=122） 38
表4-1-2 追蹤組第二時間點基本人口因素與害怕復發之平均數、標準差與差異檢定（N=122） 40
表4-1-3 追蹤組第二時間點基本人口因素與因應型態之平均數、標準差與差異檢定（N=122） 41
表4-1-4 追蹤組第二時間點基本人口因素與創傷後成長之平均數、標準差與差異檢定（N=122） 42
表4-1-5 追蹤組基本人口因素與第一時間點健康相關生活品質之平均數、標準差與差異檢定（N=122） 43
表4-1-6 追蹤組基本人口因素與第二時間點健康相關生活品質之平均數、標準差與差異檢定（N=122） 44
表4-1-7 追蹤組臨床相關因素與害怕復發之平均數、標準差、差異檢定與變異數分析（N=122） 46
表4-1-8 追蹤組臨床相關因素與因應型態之平均數、標準差、差異檢定與變異數分析（N=122） 47
表4-1-9 追蹤組臨床因素與第二時間點創傷後成長之平均數、標準差、差異檢定與變異數分析（N=122） 48
表4-1-10 追蹤組臨床相關因素與第一時間點健康相關生活品質之平均數、標準差、差異檢定與變異數分析（N=122） 49
表4-1-11 追蹤組臨床相關因素與第二時間點健康相關生活品質之平均數、標準差、差異檢定與變異數分析（N=122） 51
表4-2-1 各追蹤變項在兩測量時間點變化的差異檢定與相關分析（N=122） 54
表4-2-2 害怕復發、因應型態、創傷後成長與健康相關生活品質的相關分析 56
表4-3-1 第二時間點之頭頸部癌生活品質總分的階層式迴歸分析 59
表4-3-2 第二時間點之創傷後成長總分的階層式迴歸分析 61
表5-1-1 第二時間點的創傷後成長與兩個時間點的因應策略之相關分析 75
表5-1-2 以兩個時間點之因應策略預測第二時間點之創傷後成長總分的逐步式迴歸分析 76
表5-1-3 第一時間點因應策略間之相關分析 77
表5-1-4 兩個時間點因應策略間之相關分析 78
表5-1-5 第二時間點因應策略間之相關分析 79

圖目錄
圖2-4-1 研究架構圖 25
圖4-3-1 害怕復發、因應型態與健康相關生活品質的路徑分析 62
圖4-3-2 害怕復發、因應型態與創傷後成長的路徑分析 64

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