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題名 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
作者 盛心毓
Sheng, Hsin-Yu
貢獻者 吳治勳
盛心毓
Sheng, Hsin-Yu
關鍵詞 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
日期 2022
上傳時間 1-Aug-2022 18:11:00 (UTC+8)
摘要 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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描述 碩士
國立政治大學
心理學系
107752004
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0107752004
資料類型 thesis
dc.contributor.advisor 吳治勳zh_TW
dc.contributor.author (Authors) 盛心毓zh_TW
dc.contributor.author (Authors) Sheng, Hsin-Yuen_US
dc.creator (作者) 盛心毓zh_TW
dc.creator (作者) Sheng, Hsin-Yuen_US
dc.date (日期) 2022en_US
dc.date.accessioned 1-Aug-2022 18:11:00 (UTC+8)-
dc.date.available 1-Aug-2022 18:11:00 (UTC+8)-
dc.date.issued (上傳時間) 1-Aug-2022 18:11:00 (UTC+8)-
dc.identifier (Other Identifiers) G0107752004en_US
dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/141172-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 心理學系zh_TW
dc.description (描述) 107752004zh_TW
dc.description.abstract (摘要) 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。		zh_TW
dc.description.abstract (摘要) 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.		en_US
dc.description.tableofcontents 摘要 iv
Abstract vi
目次 viii
表次 x
圖次 xi
第一章 緒論 1
第一節 研究動機 1
第二節 文獻回顧 4
一、癌症末期病人醫療決定議題 4
二、關於癌症末期病人的心理調適與醫療決定 16
三、醫療決定與壓力模式 18
第三節 研究目的 21
第二章 研究方法 22
第一節 研究參與者 22
第二節 研究程序 23
第三節 訪談大綱 24
第四節 資料分析方法 27
第三章 結果 29
第一節 癌症末期病人的疾病與治療經驗 33
一、罹癌是充滿受苦的經驗 33
二、面對生命有限性的述說方式 42
第二節 癌症末期病人的治療選擇與考量 53
一、避免身心（繼續）痛苦或追求身心的平穩 53
二、因為治不好被迫做出決定 60
三、想要活著 65
四、社會性的因素影響 69
五、資源上的考量 76
第三節 安寧緩和醫療相關主題 78
一、安寧緩和醫療對受訪者而言是什麼 78
第四章 討論 80
第一節 以壓力模式看見癌症末期病人的心理歷程 80
一、癌症末期病人的壓力來源與認知評估 83
二、透過壓力互動歷程了解對癌症末期病人而言進入安寧緩和醫療場域可能是種放棄或被放棄 85
三、癌症末期病人的因應方式 88
四、小結 89
第二節 由心理歷程探討臨床應用 91
一、應以整體性的角度來理解受苦經驗 91
二、實際受苦經驗的多樣性與專屬於自己的受苦經驗 91
三、應試著理解選擇的過程而非僅重視結果 93
四、研究臨床貢獻 94
第三節 研究限制與未來研究方向 96
一、研究限制 96
二、未來研究方向 97
參考文獻 98		zh_TW
dc.format.extent 3016726 bytes-
dc.format.mimetype application/pdf-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0107752004en_US
dc.subject (關鍵詞) 癌症末期病人zh_TW
dc.subject (關鍵詞) 醫療決定zh_TW
dc.subject (關鍵詞) 壓力模式zh_TW
dc.subject (關鍵詞) 主題分析zh_TW
dc.subject (關鍵詞) Advanced cancer patientsen_US
dc.subject (關鍵詞) Medical decision-makingen_US
dc.subject (關鍵詞) Stress modelen_US
dc.subject (關鍵詞) Thematic analysisen_US
dc.title (題名) 以壓力模式探討癌症末期病人於醫療決定之主觀經驗zh_TW
dc.title (題名) Exploring the medical decision-making experience in advanced cancer patients - Using the stress model approachen_US
dc.type (資料類型) thesisen_US
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dc.identifier.doi (DOI) 10.6814/NCCU202200773en_US