跳到主要內容

臺灣博碩士論文加值系統

(44.192.94.177) 您好!臺灣時間:2024/07/21 17:27
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:鄭鈺
研究生(外文):CHENG, YUH
論文名稱:乳癌患者對癌症的認知評估與因應之組型的區辨效度
論文名稱(外文):The Discriminant Validity of Cancer Appraisal and Coping Types in Breast Cancer Patients
指導教授:王韋婷王韋婷引用關係陳俊宏陳俊宏引用關係
指導教授(外文):WANG, WEI-TINGCHEN, JYUN-HONG
口試委員:許文耀陳承德
口試委員(外文):HSU, WEN-YAUCHEN, CHENG-TE
口試日期:2022-07-01
學位類別:碩士
校院名稱:東吳大學
系所名稱:心理學系
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2022
畢業學年度:110
語文別:中文
論文頁數:61
中文關鍵詞:乳癌因應策略因應組型認知評估心理適應
外文關鍵詞:breast cancercopingcoping typescognitive appraisalpsychological adaptation
相關次數:
  • 被引用被引用:0
  • 點閱點閱:270
  • 評分評分:
  • 下載下載:75
  • 收藏至我的研究室書目清單書目收藏:0
本研究目的為探討臺灣乳癌患者的癌症認知評估與因應是否可區分為不同組型,以及心理適應指標對組型的區辨效果。過往癌症因應文獻中,因素分析結果有所分歧,且因應因素是否能幫助適應壓力的結果也有不一致的情況,因此本研究擬採用「組型」的概念來探討因應,「組型」是指個人所使用的所有因應策略的整體趨勢,通常會將不同策略使用的多寡畫成剖面圖而形成不同的「組型」。透過分析乳癌患者的因應策略組合,可能類聚為幾個組別,探索這些不同因應組型組別間的差異。除了考慮因應策略,同時也加入對癌症衝擊的評估,探討因應策略與癌症衝擊評估可能類聚為多少種組型(類別),並以心理適應指標進行組型(類別)間的區辨分析。
本研究採立意取樣,以中部某一教學醫院醫學乳房中心之初診斷乳癌的患者為研究對象,使用量表「短版COPE因應量表」、「癌症衝擊程度量表」測量癌症患者對癌症衝擊的評估及使用的因應策略,以「醫院版焦慮-憂鬱量表」、「情緒平衡量表」和「SF-36健康量表」三個量表作為心理適應指標的測量,並在術後3個月進行問卷測量。
資料分析以集群分析進行評估與因應的組型分析,並使用卡方分析、變異數分析進行後續不同組型間,社會人口學特徵、癌症醫療狀況的差異比較。最後以心理適應指標對不同組型進行邏輯斯回歸,檢驗分組效果。
最終集群分析以五組結果為最佳結果,各組別根據其認知評估與因應特性定義為低衝擊-適應因應組、高衝擊-高因應組、低評估-平均因應組、低衝擊-低因應組及高衝擊-逃避因應組。在社會人口學特徵及癌症醫療狀況上,低衝擊-低因應組的年齡較高、教育程度較低,其認知評估與因應型態可能反映了年齡較長或教育程度較低的乳癌患者的因應特性,而其餘組別則沒有明顯差異。
在心理適應指標區辨分析上,低評估-平均因應組的認知評估分數皆低,而因應皆為平均,適合作為邏輯斯迴歸分析的基礎組別,同時低評估-平均因應組也反映了生、心理生活品質較良好的人的因應特性。與低評估-平均因應組相比,當心理生活品質或憂鬱較低、正向情緒較高時,可能是低衝擊-適應因應組。與低評估-平均因應組相比,當生理生活品質較低、正向情緒或焦慮較高時,可能是高衝擊-高因應組;而只有生理生活品質較低時,則可能是高衝擊-逃避因應組。此外心理適應指標對低評估-平均因應組與低衝擊-低因應組的邏輯斯迴歸未顯著,無法區分這兩組,而從個別變項顯著性來看,當心理生活品質或焦慮較低時,可能是低衝擊-低因應組。從上述結果可以發現,正向情緒可以預測較多適應性因應,焦慮同時也高可以預測使用所有的因應都使用較多。
乳癌認知評估與因應組型提供探討乳癌因應的不同觀點,而情緒及生、心理生活品質等心理適應指標與認知評估與因應組型間的差異有關係,未來若能分析不同因應組型對心理適應的預測,以及隨時間因應組型的變化,對乳癌患者在因應癌後壓力與心理適應上應能提供臨床介入的應用價值。
The purpose of this study was to investigate whether cancer cognitive appraisal and coping in Taiwanese breast cancer patients could be differentiated into different groups, and the effect of psychological adaptation indicators on the differentiation of groups. The results of the factor analysis in the previous literature on cancer coping are divergent, and there are also inconsistent results on whether coping factors can help to adapt to stress. Therefore, this study intends to use the concept of "type" to investigate coping, which refers to the overall trend of all coping strategies used by individuals. By analyzing the combination of coping strategies of breast cancer patients, it is possible to cluster them into several groups and explore the differences between these different coping groups. In addition to the coping strategies, the appraisal of cancer impact was also included to explore how many types (groups) the coping strategies and cancer impact appraisal could be clustered into, and the differentiation between types (groups) was analyzed using psychological adjustment indicators.
Our patients were recruited by purposive Sampling. The data were draw from newly-diagnosed breast cancer patients in a breast center unit at a hospital in central of Taiwan. The Brief Coping Orientation to Problems Experienced scale (Brief COPE) and the Cancer Impact Scale were used to assess patients’ attitude and coping strategies in cancer. The Hospital Anxiety and Depression Scale (HADS), the Affects Balance Scale and the SF-36 Health Survey were used to assess patients’ psychological adjustment. All this scales were gathered in 3-month after surgery.
Cluster analysis was used to differentiate cancer cognitive appraisal and coping types. Chi-square analysis, one-way ANOVA and post Tukey HSD test were used to compare the differences in sociodemographic characteristics and cancer medical conditions between different coping types. Logistic regression was performed to examine the effect of differentiation by using psychological adaptation indicators.
The final cluster analysis yielded the best results for the five groups, which were defined as low impact-adaptive coping group, high impact-high coping group, low appraisal-average coping group, low impact-low coping group, and high impact-avoidance coping group according to their cognitive appraisal and response characteristics. In terms of sociodemographic characteristics and cancer medical conditions, the low impact-low coping group was older and less educated than other groups, and their cognitive appraisal and coping types may reflect the coping patterns of breast cancer patients who are older or less educated, while the other groups did not differ significantly.
In the discriminant analysis, the low appraisal-average coping group had low cognitive appraisal scores and average coping scores, which is suitable as a base group for logistic regression analysis, and the low appraisal-average coping group also reflected the coping patterns of people with better physical and mental quality of life. Compared to the low appraisal-average coping group, people who have lower mental quality of life or depression and higher positive affect are more likely to be the low impact-adaptive coping group. Compared to the low appraisal-average coping group, people who have lower physical quality of life and higher positive affect or anxiety are more likely to be the high impact-high coping group. Compared to the low appraisal-average coping group, people who have only lower physical quality of life are more likely to be the high impact-avoidance coping group. In addition, the logistic regression couldn’t differentiate the low appraisal-average coping group and the low impact-low coping group, the analysis was not significant. But in individual variable significance, people who have lower mental quality of life or anxiety are more likely to be the low impact-low coping group. From the above results, it can be found that positive affect predicted more adaptive coping and anxiety also predicted more use of all coping.
Breast cancer cognitive appraisal and coping types provide different perspectives for exploring breast cancer coping, and psychological adaptation indicators such as emotion, physical and mental quality of life are related to the differences between cognitive appraisal and coping type groups. In the future, if we can analyze the prediction of psychological adaptation by different coping types and the changes of coping types over time, it should provide clinical application value for breast cancer patients in coping with post-cancer stress and psychological adaptation.
摘要 I
英文摘要 III
目次 V
表次 VII
圖次 VIII
第一章 緒論 1
第一節 研究動機 1
第二章 文獻回顧 3
第一節 乳癌患者的因應文獻 3
壹、 乳癌患者的因應 3
貳、 影響乳癌患者因應方式的可能因素 3
第二節 COPE量表與相關研究 5
壹、 COPE的編制理論概念 5
貳、 COPE量尺介紹 5
參、 COPE效度證據 8
第三節 Brief COPE量表與相關研究 10
壹、 Brief COPE的編制理論概念 10
貳、 Brief COPE量尺介紹 10
參、 Brief COPE效度探討 11
第四節 研究COPE、Brief COPE因素與效度所遇到的困難 24
第五節 因應組型與壓力情境認知評估 25
壹、 因應組型概念 25
貳、 壓力情境認知評估 27
第六節 研究目的與假設 28
第三章 研究方法與設計 30
第一節 研究對象 30
第二節 研究工具 30
第三節 研究程序 32
第四節 資料統計分析 33
第四章 研究結果 35
第一節 集群分析及組別差異 35
壹、 集群分析 35
貳、 組別差異 37
第二節 社會人口學及臨床醫療變項分析 41
壹、 社會人口學變項 41
貳、 臨床醫療變項 44
第三節 心理適應指標對乳癌患者因應組型的區辨分析 45
第五章 討論與建議 47
第一節 研究結果討論 47
壹、 認知評估與因應的組型分布探討 47
貳、 因應組型是否反應乳癌患者的不同特性 48
參、 心理適應指標對因應組型的區辨效度 49
第二節 研究貢獻 50
第三節 研究限制與建議 51
參考文獻 52
附錄 56
附錄一:基本資料表 56
附錄二:因應策略量表 57
附錄三:癌症衝擊程度量表 59
附錄四:醫院版焦慮-憂鬱量表 60
附錄五:情緒平衡量表 61

一、中文部分
中華民國衛生福利部(2020)。109年國人死因統計結果。中華民國衛生福利部。2022年03月22日,取自https://www.mohw.gov.tw/cp-5017-61533-1.html
王韋婷(2013)。初診斷乳癌患者創傷後成長與心理適應的關係之長期追蹤研究-從創傷後成長異質性變化軌跡的觀點探討(未出版之博士論文)。國立政治大學,臺北市。

二、英文部分
Aguado Loi, C.X., Baldwin, J.A., McDermott, R.J., McMillan, S., Martinez Tyson, D., Yampolskaya, S. & VandeWeerd, C. (2013), Risk factors associated with increased depressive symptoms among Latinas diagnosed with breast cancer within 5 years of survivorship. Psycho-Oncology, 22(12), 2779-2788. https://doi.org/10.1002/pon.3357
Al-Azri, M., Al-Awisi, H., & Al-Moundhri, M. (2009). Coping With a Diagnosis of Breast Cancer-Literature Review and Implications for Developing Countries. Breast Journal, 15(6), 615-622. doi:10.1111/j.1524-4741.2009.00812.x
Aldenderfer, M. S., & Blashfield, R. K. (1984). A review of clustering methods. In Cluster analysis (pp. 34-62). doi:10.4135/9781412983648
Baumstarck, K., Alessandrini, M., Hamidou, Z., Auquier, P., Leroy, T., & Boyer, L. (2017). Assessment of coping: a new french four-factor structure of the brief COPE inventory. Health Qual Life Outcomes 15(1), 1-9. https://doi.org/10.1186/s12955-016-0581-9
Bellizzi, K. M., & Blank, T. O. (2006). Predicting posttraumatic growth in breast cancer survivors. Health Psychology, 25(1), 47-56. doi:10.1037/0278-6133.25.1.47
Boatemaa Benson, R., Cobbold, B., Opoku Boamah, E., Akuoko, C. P., & Boateng, D. (2020). Challenges, coping strategies, and social support among breast cancer patients in Ghana. Advances in Public Health, 2020. https://doi.org/10.1155/2020/4817932
Bradburn, N. M. (1969). The structure of psychological well-being. Oxford, England: Aldine.
Brain, K., Henderson, B. J., Tyndel, S., Bankhead, C., Watson, E., Clements, A., . . . Grp, P. S. M. (2008). Predictors of breast cancer-related distress following mammography screening in younger women on a family history breast screening programme. Psycho-Oncology, 17(12), 1180-1188. doi:10.1002/pon.1355
Bright, E. E., & Stanton, A. L. (2018). Prospective Investigation of Social Support, Coping, and Depressive Symptoms: A Model of Adherence to Endocrine Therapy Among Women With Breast Cancer. Journal of Consulting and Clinical Psychology, 86(3), 242-253. doi:10.1037/ccp0000272
Carver, C. S. (1997). You want to measure coping but your protocol's too long: Consider the brief COPE. International Journal of Behavioral Medicine, 4(1), 92-100. doi:10.1207/s15327558ijbm0401_6
Carver, C. S., Pozo, C., Harris, S. D., Noriega, V., Scheier, M. F., Robinson, D. S., . . . Clark, K. C. (1993). HOW COPING MEDIATES THE EFFECT OF OPTIMISM ON DISTRESS - A STUDY OF WOMEN WITH EARLY-STAGE BREAST-CANCER. Journal of Personality and Social Psychology, 65(2), 375-390. doi:10.1037/0022-3514.65.2.375
Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). ASSESSING COPING STRATEGIES - A THEORETICALLY BASED APPROACH. Journal of Personality and Social Psychology, 56(2), 267-283. doi:10.1037/0022-3514.56.2.267
Cheng, C. (2001). Assessing coping flexibility in real-life and laboratory settings: A multimethod approach. Journal of Personality and Social Psychology, 80(5), 814-833. doi:10.1037//3415.80.5.814
Cheng, C., Lau, H. P. B., & Chan, M. P. S. (2014). Coping Flexibility and Psychological Adjustment to Stressful Life Changes: A Meta-Analytic Review. Psychological Bulletin, 140(6), 1582-1607. doi:10.1037/a0037913
Elsheshtawy, E. A., Abo-Elez, W. F., Ashour, H. S., Farouk, O., & zaafarany, M. I. E. E. (2014). Coping Strategies in Egyptian Ladies with Breast Cancer. Breast Cancer: Basic and Clinical Research. https://doi.org/10.4137/BCBCR.S14755
Fillion, L., Kovacs, A. H., Gagnon, P., & Endler, N. S. (2002). Validation of the shortened COPE for use with breast cancer patients undergoing radiation therapy. Current Psychology, 21(1), 17-34. doi:10.1007/bf02903157
García, F. E., Barraza-Peña, C. G., Wlodarczyk, A., Alvear-Carrasco, M., & Reyes-Reyes, A. (2018). Psychometric properties of the Brief-COPE for the evaluation of coping strategies in the Chilean population. Psicologia: Reflexão e Crítica, 31. https://doi.org/10.1186/s41155-018-0102-3
Gilbar, O. (2005). Breast cancer: How do Israeli women cope? A cross-sectional sample. Families, Systems, & Health, 23(2), 161-171.
Gilts, C. D., Parker, P. A., Pettaway, C. A., & Cohen, L. (2013). Psychosocial Moderators of Presurgical Stress Management for Men Undergoing Radical Prostatectomy. Health Psychology, 32(12), 1218-1226. doi:10.1037/a0030189
Hagan, T. L., Fishbein, J. N., Nipp, R. D., Jacobs, J. M., Traeger, L., Irwin, K. E., . . . Temel, J. S. (2017). Coping in Patients With Incurable Lung and Gastrointestinal Cancers: A Validation Study of the Brief COPE. Journal of Pain and Symptom Management, 53(1), 131-138. doi:10.1016/j.jpainsymman.2016.06.005
Helms, R. L., O'Hea, E. L., & Corso, M. (2008). Body image issues in women with breast cancer. Psychology, Health & Medicine, 13(3), 313-325. doi:10.1080/13548500701405509
International Agency for Research on Cancer. (n.d.). LATEST GLOBAL CANCER DATA: CANCER BURDEN RISES TO 19.3 MILLION NEW CASES AND 10.0 MILLION CANCER DEATHS IN 2020. Retrieved March 22, 2022, from: https://www.iarc.who.int/faq/latest-global-cancer-data-2020-qa/
Kato, T. (2012). Development of the Coping Flexibility Scale: Evidence for the Coping Flexibility Hypothesis. Journal of Counseling Psychology, 59(2), 262-273. doi:10.1037/a0027770
Kershaw, T., Northouse, L., Kritpracha, C., Schafenacker, A., & Mood, D. (2004). Coping strategies and quality of life in women with advanced breast cancer and their family caregivers. Psychology & Health, 19(2), 139-155. doi:10.1080/08870440310001652687
Kvillemo, P., & Bränström, R. (2014). Coping with breast cancer: a meta-analysis. PLoS One, 9(11), e112733.
Langford, D. J., Cooper, B., Paul, S., Humphreys, J., Keagy, C., Conley, Y. P., . . . Dunn, L. B. (2017). Evaluation of Coping as a Mediator of the Relationship Between Stressful Life Events and Cancer-Related Distress. Health Psychology, 36(12), 1147-1160. doi:10.1037/hea0000524
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping: Springer publishing company.
Mackay, S., Burdayron, R., & Korner, A. (2021). Factor Structure of the Brief COPE in Patients With Melanoma. Canadian Journal of Behavioural Science-Revue Canadienne Des Sciences Du Comportement, 53(1), 78-83. doi:10.1037/cbs0000184
Moreno, P. I., Bauer, M. R., Yanez, B., Jorge, A., Maggard-Gibbons, M., & Stanton, A. L. (2016). Dispositional Emotional Expressivity, Cancer-Specific Coping, and Distress in Socioeconomically-Disadvantaged Latinas. Health Psychology, 35(6), 584-593. doi:10.1037/hea0000319
Park, C. L., Edmondson, D., Fenster, J. R., & Blank, T. O. (2008). Positive and Negative Health Behavior Changes in Cancer Survivors A Stress and Coping Perspective. Journal of Health Psychology, 13(8), 1198-1206. doi:10.1177/1359105308095978
Shand, L. K., Brooker, J. E., Burney, S., Fletcher, J., & Ricciardelli, L. A. (2015). Symptoms of posttraumatic stress in Australian women with ovarian cancer. Psycho-Oncology, 24(2), 190-196. doi:10.1002/pon.3627
Shand, L. K., Brooker, J. E., Burney, S., Fletcher, J., & Ricciardelli, L. A. (2018). Psychosocial factors associated with posttraumatic stress and growth in Australian women with ovarian cancer. Journal of Psychosocial Oncology, 36(4), 470-483. doi:10.1080/07347332.2018.1461728
Skinner, E. A., Edge, K., Altman, J., & Sherwood, H. (2003). Searching for the structure of coping: A review and critique of category systems for classifying ways of coping. Psychological Bulletin, 129(2), 216-269. doi:10.1037/0033-2909.129.2.216
Wang, A. W.-T., Cheng, C.-P., Chang, C.-S., Chen, D.-R., Chen, S.-T., Shieh, V., . . . Hsu, W.-Y. (2016). Does the Factor Structure of the Brief COPE Fit Different Types of Traumatic Events? European Journal of Psychological Assessment, 34(3), 162-173. doi:10.1027/1015-5759/a000321
Ward, J. H. (1963). Hierarchical Grouping to Optimize an Objective Function. Journal of the American Statistical Association, 58(301), 236-244. doi:10.1080/01621459.1963.10500845
Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). Health survey manual and interpretation guide. Boston, MA: The Health Institute, New England Medical Center.
Yang, H. C., Brothers, B. M., & Andersen, B. L. (2008). Stress and quality of life in breast cancer recurrence: Moderation or mediation of coping? Annals of Behavioral Medicine, 35(2), 188-197. doi:10.1007/s12160-008-9016-0
Yusoff, N., Low, W. Y., & Yip, C. H. (2009). Reliability and validity of the Malay version of Brief COPE Scale: a study on Malaysian women treated with adjuvant chemotherapy for breast cancer. Malaysian Journal of Psychiatry, 18(1).
Zigmond, A. S., & Snaith, R. P. (1983). THE HOSPITAL ANXIETY AND DEPRESSION SCALE. Acta Psychiatrica Scandinavica, 67(6), 361-370. doi:10.1111/j.1600-0447.1983.tb09716.x
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關期刊