政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/141172

政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/141172

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Title:	以壓力模式探討癌症末期病人於醫療決定之主觀經驗 Exploring the medical decision-making experience in advanced cancer patients - Using the stress model approach
Authors:	盛心毓 Sheng, Hsin-Yu
Contributors:	吳治勳盛心毓 Sheng, Hsin-Yu
Keywords:	癌症末期病人醫療決定壓力模式主題分析 Advanced cancer patients Medical decision-making Stress model Thematic analysis
Date:	2022
Issue Date:	2022-08-01 18:11:00 (UTC+8)
Abstract:	緒論：在心理腫瘤學相關研究中，可以發現癌症末期病人的醫療決定不僅是與疾病或醫療訊息的認識有關，亦與病人的主觀因素有所關聯，如：認知思考歷程、身心調適。唯過往針對癌症末期病人的醫療決定相關的研究，較多是探討醫療決定之結果而非心理歷程，較難以瞭解癌症末期病人是「如何」做選擇。因此本研究欲以癌症末期病人為研究對象，透過健康心理學之壓力模式為基礎，以瞭解病人在疾病末期與醫療相關之壓力源、壓力評估、及因應等心理歷程，並藉此探索癌末病人於醫療決定上之重要議題。研究方法：以半結構式訪談方法進行訪談，並以壓力模式作為訪談大綱設計指引，訪談大綱包含以下項目：疾病與治療背景、疾病之相關變化與轉折、治療效果之變化與醫療方式的選擇、關於安寧緩和醫療的認識與想法、家人／重要他人的想法及其他治療／改善身體狀況經驗。結果：共訪談16位癌症末期病人，以主題分析方法進行資料分析後，以病人資料為基礎，歸納出二大類共7個主題。第一類為癌症末期病人的疾病與治療經驗，包含(1)罹癌是充滿受苦的經驗，包含生理、心理與社會層面之苦痛、(2)面對生命有限性的述說方式等2個主題。第二類為癌症末期病人的治療選擇與考量，包含(3)避免身心痛苦、(4)因為治不好被迫做出決定、(5)想要活著、(6)社會性的因素影響、(7)資源上的考量等5個主題。本研究另初探受訪者對於安寧緩和醫療的認識，依照受訪者回應可分為「不清楚」、「偏向正向的認知」、「偏向負向的認知」等三個類型。討論：結果顯示，癌症末期病人的壓力源不僅是疾病本身，而是包含生理、心理及社會層面之痛苦，且彼此會交互影響。同一位受訪者的決定可能經常是矛盾或衝突的，例如有時候會希望能繼續治療，但有時則否。由心理歷程來看，發現病人經常會以「放棄治療」的說法形容安寧緩和醫療，這樣現象可能是與其面臨因應失敗的現狀有關。若癌症末期病人以治癒為因應目標時，醫療人員依循醫療系統常規轉介安寧緩和醫療服務，可能使病人認為醫療人員是放棄他們。病人在面臨因應失敗的情況下，常伴隨無奈、絕望、失落等負向情緒，再成為新的壓力源，此時對於病人來說更需要的是情緒上的調適，但結果顯示病人常常採取逃避情緒的因應方式，如：迴避死亡相關刺激，且他們經常沒有資源處理負向情緒。綜合前述，臨床人員可以生理－心理－社會層面的整體性角度來理解癌症末期病人的受苦經驗，除關心癌症末期病人醫療決定之結果外，可陪伴瞭解其在醫療決定的心理歷程，並留意病人的情緒反應，更有助於病人面對癌症末期的壓力調適。 Background: Through psycho-oncology related studies, it seems that the medical decisions made by advanced cancer patients are not only associated with the knowledge of the disease or medical information, but also the patients’ cognitive thinking process or psychological adjustment. However, past studies mainly focused on the outcome of medical decision-making rather than the process itself. Accordingly, this study aimed to explore the patients’ psychological processes from the medical decision-making experience with stress model in health psychology. Method: Semi-structured interview was adopted to explore the disease and medical decision-making experience. The outline was based on stress model and includes following items: disease and treatment background; related changes of disease and treatment effects, and influences on the choice of medical methods; personal thoughts of palliative care; treatment opinions of family members or significant others; other experience in treating/improving physical conditions. Result: On the basis of bottom-up thematic analysis, data from 16 participants showed 2 categories of 7 themes. The first category is disease and treatment experience: (1) the experiences included biological, psychological, and social suffer, (2) narratives about limitation of life. The second category is the considerations in medical decision-making: (3) reliving physical and psychological pain, (4) being forced to make decisions, (5) wanting to live, (6) social factors, and (7) limited-resources. In addition, this study explored patients’ understanding of palliative care, participants showed 3 types of response: feedback of not-sure, positive and negative comments. Discussion: The results show that the stressors of advanced cancer patients are not only disease itself, but include physical, psychological, social distress, and the interaction of them. The same person may encounter conflicting choices, such as he/she sometimes hopes to receive treatments but sometimes doesn’t. When understanding patients’ medical decision through their psychological process, it can be found that patients often describes palliative care as "give up", and the phenomenon may be related to the failure of coping outcome. The referrals to palliative care services under professional custom may let patients feel being abandoned by medical personnel if patients hold the coping goal to cure themselves. Faced with the failure of coping, there would be negative emotions like helplessness, despair, or loss accompanying by, which may then become a new stressor. As a result, emotional adjustment is more needed for patients. But patients often use emotion avoidance coping, such as: avoiding death-related stimuli. Also, they often lack resources to cope the negative emotion. In conclusion, medical personnel could understand the suffering experience of advanced cancer patients from a bio-psycho-social holistic perspective. In addition to the outcome of medical decisions, it is worth paying more attention to advanced cancer patients’ psychological process and emotion response, which may be more helpful for patients’ adjustment under the related stress of advanced cancer.
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Description:	碩士國立政治大學心理學系 107752004
Source URI:	http://thesis.lib.nccu.edu.tw/record/#G0107752004
Data Type:	thesis
DOI:	10.6814/NCCU202200773
Appears in Collections:	[Department of Psychology] Theses

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