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    題名: 初診斷乳癌患者的因應策略與心理症狀之關係研究
    The relationships of coping strategies and psychological symptoms on newly-diagnosed breast cancer patient
    作者: 鄭麗芬
    Te, Lay Fuen
    貢獻者: 許文耀
    鄭麗芬
    Te, Lay Fuen
    關鍵詞: 乳癌
    因應策略
    正向情緒
    心理症狀
    雙向關係
    breast cancer
    coping
    positive affect
    psychological symptoms
    bidirectional relationship
    日期: 2011
    上傳時間: 2012-10-30 11:27:19 (UTC+8)
    摘要: 本研究旨在比較不同背景和臨床因素的乳癌患者其因應策略、正向情緒和心理症狀的差異情形。本研究除了關注個體所採取的因應策略與情緒的關聯性；另一方面，研究者認為患者的情緒亦可能影響其因應策略之選擇，因此因應策略與情緒間的變化關係，亦為本研究目的之一。
    本研究採立意取樣，並以中部某一教學醫學乳房中心初診斷之乳癌患者共計113位為研究對象，蒐集患者之｢基本資料表｣、｢短版因應策略量表｣、｢醫院版焦慮-憂鬱量表｣和｢情緒平衡量尺｣，並以術後3個月和6個月進行追蹤研究。
    資料處理以相關分析、t考驗、單因子變異數分析及階層迴歸分析等統計方法為主。由於本研究擬以Brief COPE作為臺灣乳癌病患因應壓力之測量工具，因此將採用探索性因素分析(Exploratory Factor Analysis；EFA)，探討此量表在初診斷乳癌患者身上的因素結構。
    依據本研究問題與假設，主要發現摘述如下:
    一、本研究以主成分分析法抽取Brief COPE量表因素，並以斜交轉軸進行因素轉軸，依據陡坡圖和平行分析結果抽取三個因素。此三因素的解釋總變異量為62.1%。研究者將因素I命名為｢趨近因應｣；因素II命名為｢情緒性因應｣和因素III命名為｢逃避因應｣。
    二、教育程度、收入和有無職業與正向情緒呈正相關；現有小孩人數和年齡與正向情緒呈負相關；年齡和副作用與憂鬱具有正向關係，教育程度則與憂鬱呈負相關;副作用與焦慮呈正相關。有無結婚、有無職業、教育程度、收入、乳房重建與趨近因應呈正相關，期數和年齡則和趨近因應有顯著負相關；有無職業和情緒性因應呈正相關。
    三、乳癌患者於術後3、6個月最常採用的因應策略為趨近因應，其次為情緒性因應，最少採用逃避因應。
    四、焦慮對逃避和趨近因應有獨特的預測力，即焦慮程度愈高會愈使用逃避和趨近因應策略；憂鬱則對趨近因應有獨特的預測力，憂鬱程度愈高者，其趨近因應的使用愈少；在因應策略的部分，只有趨近因應可顯著預測正向情緒；正向情緒在趨近因應和焦慮的關係中並無法形成部份或完全中介之角色。
    最後，根據研究結果與限制提出若干具體建議，以供臨床工作者及未來研究之相關人員參考。
    The purpose of this study is to explore the differences of coping strategies, positive affect and psychological symptoms among newly-diagnosed breast cancer patients in different sociodemographic backgrounds. Research has found that coping strategies predict psychological outcomes; however, a few studies have also reported that psychological symptoms could predict the use of coping strategies. Therefore, the relationship between coping strategies and psychological symptoms was the first aim of the current study.
    One-hundred and thirteen participants 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. Demographic and clinical data were gathered at the first time point, and the Brief Coping Orientations to Problems Experienced scale (Brief COPE), the Hospital Anxiety and Depression Scale (HADS), Positive Affect subscale of Affect Balance, and side effect checklists were gathered 2 times during the first 3- and 6-month after discharge respectively.
    Pearson product-moment correlation, t-test, one-way ANOVA, post Scheffe test and hierarchical regression analysis were applied. In an attempt to confirm the factor structure of the Brief COPE, the Exploratory Factor Analyses (EFA) were performed before those analyses.
    The major findings of the current study were as follows：
    1.Using principal components factor analysis with oblique rotation, scree plot and parallel analyses revealed three factors for the Brief COPE were the best factor structure of the current sample: (1) approach coping, (2) emotional coping, and (3) avoidance coping. These 3 factors accounted for 62.1% of the total variance of the data.
    2.Education, income and employment status were significantly correlated with
    positive affect. Number of kids and age were found to be inversely correlated with positive affect. Age and side effects were positively correlated with depression. Side effects were found to be correlated with anxiety. Marital status, employment status, cancer stage, education, income, age, breast reconstruction surgery were found to be correlated with approach coping. Meanwhile stage and age were found to be negatively correlated with emotional coping.
    3.Approach coping was the most commonly used coping strategies, while avoidance coping was the least commonly used coping strategies.
    4.Anxiety could reliably predict the use of avoidance and approach coping. High anxiety level predicted more use of avoidance and approach coping, whereas depression predicted the use of approach coping, high depressive mood predicted less use of approach coping. Approach coping predicted higher positive affect, but positive affect was fail to be the mediator between approach coping and anxiety.
    Implications for these results were discussed. The results can also serve as a helpful reference for healthcare professionals.
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