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| Title: | 初探頭頸癌病人疾病表徵與復發恐懼之間的關係：自我效能的中介效果
Exploring the Relationship between Illness Representation and Fear of Recurrence in Patients with Head and Neck Cancer: The Mediating Effect of Self-Efficacy |
| Authors: | 廖姝安
Liao, Shu-An |
| Contributors: | 吳治勳
Wu, Chih-Hsun
廖姝安
Liao, Shu-An |
| Keywords: | 自我效能
疾病表徵
疾病表徵常識模型
情緒壓力
復發恐懼
頭頸癌
Self-efficacy
Illness representation
Common-Sense Model
Distress
Fear of recurrence
Head and neck cancer |
| Date: | 2023 |
| Issue Date: | 2023-08-02 13:48:21 (UTC+8) |
| Abstract: | 緒論：頭頸癌病人由於患部的特殊性，治療後往往須面對大幅的生活改變，而對於癌症復發的恐懼也是頭頸癌病人術後的重大困擾之一。疾病表徵常識模型是復發恐懼理論中最常提及與應用的理論，病人對於疾病的理解與認識（即疾病表徵）會形塑其復發恐懼。本研究認為自我效能是疾病表徵與復發恐懼的關係中的中介心理機制。本研究以頭頸癌病人為對象，探討疾病表徵、自我效能與復發恐懼間的關係，以及情緒壓力的可能影響。
研究方法：本研究使用北部某醫學中心執行大型臨床追蹤研究的頭頸癌病人資料，選取該研究術後六個月追蹤時，完整填答短版疾病覺知量表、中文版短版癌症行為量表、台灣癌症態度量表復發恐懼分量表以及情緒壓力篩檢與情緒評估量表的樣本資料。分析變項包含疾病表徵（包含疾病影響、時間性、個人控制、治療控制、疾病本質、疾病在意、疾病理解以及情緒反應）、自我效能、復發恐懼以及情緒壓力。以路徑分析檢驗各疾病表徵、自我效能與復發恐懼的關係。除了全樣本的路徑分析外，也以情緒壓力分數4分為切截分數，進行高、低情緒壓力分組的多群組路徑分析。
研究結果：本研究共136名頭頸癌病人納入分析。全樣本的路徑分析結果顯示：（1）「時間性」可以預測「復發恐懼」。（2）「疾病影響」、「時間性」、「個人控制」、「治療控制」以及「情緒反應」可以預測「自我效能」。（3）「自我效能」無法預測「復發恐懼」。（4）「自我效能」是「疾病影響」、「個人控制」與「復發恐懼」關係的完全中介因子；依情緒壓力分組的路徑分析結果顯示：（1）低情緒壓力分組的「時間性」可以預測「復發恐懼」，高情緒壓力分組各疾病表徵皆無法預測「復發恐懼」。（2）低情緒壓力分組的「疾病影響」、「時間性」、「治療控制」與「疾病理解」可以預測「自我效能」，高情緒壓力分組的「個人控制」可以預測「自我效能」。（3）高低情緒壓力分組的「自我效能」皆無法預測「復發恐懼」。（4）低情緒壓力分組的各疾病表徵對「復發恐懼」的間接效果皆未達顯著，高情緒壓力分組中，「自我效能」是「個人控制」與「復發恐懼」關係的完全中介因子。
討論：（1）頭頸癌病人癌症因應的自我效能，是疾病表徵與復發恐懼關係中重要的心理機制；（2）對於高情緒壓力的頭頸癌病人而言，癌症帶來更大的威脅與挑戰，因應癌症的「自我效能」在「個人控制」與「復發恐懼」關係中顯得更為重要；（3）刪除甲狀腺診斷，復發恐懼的歷程與全樣本有所不同；（4）復發恐懼的臨床應用與延伸思考。依據本研究的結果，臨床介入上可透過改善頭頸癌病人的自我效能與釐清病人對於癌症的理解，降低對於復發過度的害怕。建議未來研究可納入更多人口背景與臨床資訊變項，針對頭頸癌特定癌別進行分析以及增加各時間點病人資料或是收案場域。
Objective: Head and neck cancer patients often face significant life changes due to the unique nature of the singular tumor location. Fear of recurrence is also a major concern among head and neck cancer patients after treatment. The Common-Sense Model is a frequently mentioned and applied theory of fear of recurrence. Patients’ understanding and perception of illness (i.e., illness representations) shape their fear of recurrence. This study proposed self-efficacy as a mediating psychological mechanism in the relationship of illness representations and fear of recurrence. This study aimed to explore the relationship between illness representations, self-efficacy, and fear of recurrence in patients with head and neck cancer, as well as the potential influence of distress.
Methods: This study used data from head and neck cancer patients in a large-scale clinical follow-up study conducted at a medical center in northern Taiwan. The sample consisted of patients who completed the Brief Illness Perception Questionnaire, the Chinese version of the Cancer Behavior Inventory, the fear of recurrence subscale of Taiwan Attitude toward Cancer Scale, and Distress Thermometer and emotion assessment scale. The analyzed variables included illness representations (consequence, timeline, personal control, treatment control, identity, concern, coherence, and emotional response), self-efficacy, fear of recurrence and distress of patients with head and neck cancer at 6-months post-surgery. Path analysis was conducted to explore the relationships between illness representations, self-efficacy, and fear of recurrence. In addition to whole sample path analysis, multi-group path analysis of high and low distress groups was conducted which was based on a curt-off score of 4 on the distress scores.
Results: A total of 136 head and neck patients were included in this study. The results of path analysis for whole sample showed that: (1) “time line” could predict “fear of recurrence”. (2) “Consequence”, “timeline”, “personal control”, “treatment control” and “emotional response” could predict “self-efficacy”. (4) “Self-efficacy” acted as a complete mediator of the relationship between “consequence”, “personal control” and “fear of recurrence”; The results of multi-group path analysis of high and low distress groups showed that: (1) In low distress group, “timeline” could predict “fear of recurrence”, while none of the illness representations predict “fear of recurrence” in high distress group. (2) In low distress group, “consequence”, “timeline”, “treatment control”, and “coherence” could predict “self-efficacy”. In high distress group, “personal control” could predict “self-efficacy”. (3) “Self-efficacy” did not predict “fear of recurrence” in either low distress group or high distress group. (4) The indirect effects of the illness representations and “fear of recurrence” was not significant in low distress group, while in high distress group, “self-efficacy” acted as a complete mediator of the relationship between “consequence”, “personal control” and “fear of recurrence”.
Discussion: (1) Self-efficacy of head and neck cancer patients is an important psychological mechanism of the relationship between illness representations and fear of recurrence. (2) For high distress head and neck cancer patients, cancer poses greater threats and challenges, making self-efficacy of coping more important in the relationship between “personal control” and “fear of recurrence”. (3) Excluding the diagnosis of thyroid, the process of fear of recurrence is different from whole sample. (4) The clinical application and further exploration fear of recurrence. According to the results of this study, improving self-efficacy of head and neck cancer patients, and clarifying patients’ understanding of cancer can reduce the excessive fear of recurrence. Future research should incorporate more demographic and clinical variable, analyze specific head and neck cancer subtypes separately, and gather data from patients at various time points or clinical settings. |
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| Description: | 碩士
國立政治大學
心理學系
108752006 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0108752006 |
| Data Type: | thesis |
| Appears in Collections: | [心理學系] 學位論文
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