臺灣博碩士論文加值系統

目的：探討兒童癌症父母家庭凝聚力、因應行為及決策喜好的現況及其影響家庭凝聚力之相關因子。
方法：本研究採橫斷式相關性研究設計，於南部一家醫學中心的小兒血液腫瘤科病房與門診進行收案，對象為子女經醫師診斷為兒童癌症且年齡≧20歲之父親或母親，採結構式問卷調查，以家庭調適力和親密度量表(第四版) (FACES IV)、因應行為量表(JCS)、兒科決策喜好量表(CPS-P)測量。
結果：共收案101位，平均年齡43.3歲；感知家庭功能狀態，以和諧親密度最高，而混亂最少；最常使用的因應策略是面對策略，而情緒策略使用最少；在子女醫療決策中，希望扮演合作角色最多，積極角色最少；而實際扮演角色以被動角色最多，而積極角色最少
。教育程度與親密度呈現正相關，具研究所教育程度的親密度顯著高於高中（職）教育程度的家庭。親密度與情緒策略、緩和策略、逃避策略呈負相關；家庭彈性度與情緒策略、逃避策略呈負相關；家庭溝通與情緒策略、逃避策略、宿命策略呈負相關，與面對策略呈正相關；家庭滿意度與逃避策略呈負相關，與面對策略呈正相關。
兒童癌症父母感知家庭親密度的預測因子為情緒策略、面對策略與教育程度，共可解釋24%的總變異數；家庭彈性度的預測因子為情緒策略，可解釋12%的總變異數；家庭溝通的預測因子為情緒策略與自我依賴策略，共可解釋21%的總變異數；家庭滿意度的預測因子為面對策略與逃避策略，共可解釋14%的總變異數。
結論：較高教育程度有較佳的家庭親密度，而父母負向因應策略也與不和諧的家庭功能有關，因此臨床建議評估父母因應行為與家庭功能，即早發現問題提供家庭介入計畫，以增進兒童癌症家庭溝通互動，提升家庭支持與滿意度，進而助於發展更平衡的家庭類型。

Objective: This study aims to explore the current status of family cohesion, coping behaviors, and decision making preferences among parents of children with cancer, and to identify factors influencing family cohesion.
Method: A cross-sectional correlational study was conducted in the pediatric hematology-oncology ward and outpatient clinic of a medical center in southern Taiwan. Participants included fathers or mothers of children diagnosed with cancer aged 20 years or older. Structured questionnaires were used, including FACES IV, JCS, and CPS-P.
Results: A total of 101 participants were included, with an average age of 43.3 years. Perceived family functioning scored highest in "Balanced Cohesion" and lowest in "Chaotic." The most commonly used coping strategy was "Confrontive coping," while " Emotive coping " was least used. Regarding decision-making for their child's medical care, most parents preferred a "Collaborative role," while "Active role" was least preferred, yet actual roles adopted were predominantly "Passive role," rather than "Active role." There was a positive correlation between educational level and family cohesion, with families where parents had a graduate-level education showing significantly higher family cohesion than those with only high school. Family cohesion negatively correlated with Emotive coping strategies, Palliative coping strategies, and Evasive coping strategies. Family flexibility negatively correlated with Emotive coping strategies and Evasive coping strategies. Family communication negatively correlated with Emotive coping strategies, Evasive coping strategies, and Fatalistic coping, while positively correlating with Confrontive coping. Family satisfaction negatively correlated with Evasive coping strategies and positively with Confrontive coping.
The predictors of perceived family cohesion among parents of children with cancer included emotive coping strategies, confrontive coping strategies, and educational level, explaining 24% of the total variance. Emotive coping strategies predicted family flexibility, explaining 12% of the variance. Family communication was predicted by emotive coping strategies and self-reliant coping strategies, explaining 21% of the variance. Family satisfaction was predicted by confrontive and evasive coping strategies, explaining 14% of the variance.
Conclusion: Higher education levels were associated with better family cohesion. Negative coping strategies among parents were associated with unbalanced family functioning. Therefore, it is clinically recommended to assess parents' coping styles and family functioning early on to provide appropriate family intervention plans, thereby enhancing communication, support, and satisfaction within families dealing with childhood cancer, ultimately promoting a more balanced family dynamic.

目錄
中文摘要.…………………………………………………............................………I
英文摘要.………………………………………………………….........................…III
致謝.………………………………………………………………….............................V
目錄.……………………………………………………………….........................…..VII
表目錄.……………………………………………………….........................………...X
圖目錄.…………………………………………………….........................………….XII
附錄.……………………………………………………………..........................…….XIII
第一章 緒論……………………………………………………...........................……1
第一節 研究背景與重要性…….………….........................……….1
第二節 研究目的…………………………………….……..........................5
第三節 研究問題………………………………………........................……..6
第四節 研究假設……………………………………........................………..7
第二章 文獻探討…………………………………………….........................………8
第一節 兒童癌症……………………………………………........................……8
第二節 家庭凝聚力………………………………………........................…20
第三節 影響家庭凝聚力之相關因子…….......................……30
第四節 名詞界定……………………………………………….......................…43
第三章 研究方法………………………………………….…….......................……45
第一節 研究設計…………………………………………….......................……45
第二節 研究架構……………………………………………….......................…46
第三節 研究對象與樣本…………………………….......................………47
第四節 研究工具……………………………………………….......................…48
第五節 資料收集與過程……………………………….......................……55
第六節 倫理考量……………………………………….......................…………55
第七節 資料分析…………………………………………….......................……56
第四章 研究結果……………………………………………………........................58
第一節 研究對象之人口學現況………………………………................…..58
第二節 家庭凝聚力分佈情形………………………………..................………62
第三節 因應行為量表分佈情形………………….................…………………76
第四節 兒科決策喜好量表分佈情形………………...............………………82
第五節 影響家庭凝聚力之因素分析……………...............…………………86
第六節 家庭凝聚力之預測因子………………………….....................96
第五章 討論……………………………………………………….........................101
第一節 家庭凝聚力、因應行為及決策喜好分佈探討……….........…101
第二節 家庭凝聚力之影響因素………………………....................108
第三節 家庭凝聚力之預測因子………………………...........……...…...112
第六章 結論與建議……………………………………………...................……..114
第一節 綜合重要研究發現………………………………................………..114
第二節 護理實務與教育之應用………………………...............……….…117
第三節 研究限制………………………………………….....................………119
參考文獻……………………………………………………………........................…120



表目錄
表4-1 兒童癌症父母之人口學現況……………………………................….59
表4-2 罹癌子女疾病治療特性……………………….…….....................61
表4-3兒童癌症父母家庭調適力和親密度量表分佈情形………...........65
表4-4兒童癌症父母家庭調適力和親密度量表百分位數分佈情形.......69
表 4-5 兒童癌症父母家庭溝通與家庭滿意度分佈情形…………..........70
表4-6兒童癌症父母因應行為量表分佈情形…………...…………............78
表4-7兒童癌症父母面對孩子醫療決策過程中的喜好與感受….........84
表4-8兒童癌症父母面對孩子女醫療決策的喜好與感受………...........84
表4-9不同性別兒童癌症父母在希望角色之差異性…………….............85
表4-10不同性別兒童癌症父母在實際扮演角色之差異性………..........85
表 4-11兒童癌症父母面對子女醫療決策的希望與實際角色之差異性…….85
表4-12兒童癌症父母家庭凝聚力在人口學之差異性分析…..……........88
表4-13兒童癌症父母家庭凝聚力、因應行為、決策喜好與人口學特性之相關性分析……95
表4-14兒童癌症父母感知家庭親密度之迴歸分析……………….............99
表4-15兒童癌症父母感知家庭彈性度之迴歸分析………...…….........….99
表4-16兒童癌症父母感知家庭溝通之迴歸分析……………............…….100
表4-17兒童癌症父母感知家庭滿意度之迴歸分析…………….............100


圖目錄
圖2-1 Circumplex Model and FACES IV………………………............…23
圖 3-1 研究架構...……………………………………………..................…..……46
圖 4-1兒童癌症父母家庭類型分佈………………….............…...……….….71
圖4-2 不同性別兒童癌症父母的家庭類型分佈…............………………….72
圖4-3 不同年齡兒童癌症父母的家庭類型分佈………….............…………72
圖4-4 不同教育程度兒童癌症父母的家庭類型分佈…...........……………73
圖4-5 不同生育子女數兒童癌症父母的家庭類型分佈…………...........73
圖4-6 不同罹癌子女診斷的家庭類型分佈………………………...............74
圖4-7 不同罹癌子女治療狀態的家庭類型分佈………………….............74
圖4-8 不同罹癌子女生病時間的家庭類型分佈………………….............75

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