乳癌患者的自傳式理解與PTG的發展軌跡異質性之關係

Abstract

研究目的：本研究假設PTG如果涉及到意義建構，則乳癌患者的生命故事所透露的自傳式理解應與PTG具有正相關，本研究假設在不同的生命故事敘述中，PTG與自傳理解指標的關係是具差異性的，且認為乳癌患者述說其生命故事時，若願意分享罹癌的經歷，本研究預期這類患者的自傳式理解指標與PTG的關聯性更顯著，最後，本研究比較不同PTG的發展軌跡的乳癌個案之自傳式理解的差異。方法：本研究於2014至2016期間，共收錄126名乳癌患者進行研究，這些患者均是初次罹患乳癌，這群患者從出診斷至接受訪問的平均時距為3.69年，（SD=1.09）。這些患者共進行PTGI、HADS、及希望感量表的施測，並進行生命故事訪談。對於患者生命故事的收集程序，本研究採用Northwestern University 的Foley Center發展的生命故事訪談法(The Life Story Interview)。結果：本研究發現乳癌患者提到的自我連結事件數、自我改變連結類型、處理程度、處理結果、救贖化內容愈多時，創傷後成長量表分數越高，這些結果支持本研究的假設。另一方面，本研究結果顯示在不同的生命故事裡，改變連結及解釋連結與PTG間的相關型態是不同的。本研究發現只有在低潮的生命故事中，改變連結與PTG具有顯著的正相關，而解釋連結與PTG具有顯著的負相關；但在高峰與轉折的生命故事中，改變連結及解釋連結與PTG間的相關是不顯著的。提及癌症者似乎有較創傷後成長的的趨勢。再者，有提及癌症事件的參與者在所有事件的處理程度也較未提及者來的深入，而有提及癌症事件的參與者中，大多數（59人、66.29%）只提及一次與癌症相關事件，這似乎顯示對於癌症事件的處理，似乎有助於更深入地處理其他生命事件。最後，韌性組的患者之自傳式理解表現顯著地比其他組別佳。討論：本研究的結果支持乳癌患者的PTG是一意義建構的過程，且為實質的結果。

Aims: On the basis of PTG literature, we assumed that if the processes underlying posttraumatic growth (PTG) involve meaning construction, autobolophical reasoning emerged in life narrative of breast cancer patients would be positively correlated with PTG. We also assumed that autobolophical reasoning correlated with PTG differentially in different themes of life narrative. In addition, the more the woman is willing to talk about her life story related to the cancer experience, the more significant the correlation between autobolophical reasoning and PTG. Last, we explored how PTG trajectories might be related to autobolophical reasoning. Method: Between 2014 - 2016, a total of 126 Taiwanese women who were newly-diagnosed with breast cancer were interviewed. Averaged time since diagnosis was 3.69 years (SD = 1.09). Measures of PTG, hope, and psychological distress (the HADS) were assessed. The interview protocol was developed from The life story interview of Foley Center, Northwestern University. Results: Number of Self-relevant events (Meaning Tied to Self), Self-relevant change, Level of processing, Outcome of processing, and The theme of redemption were associated with high level of PTG, supporting the first hypothesis. Second, self-relevant change was correlated with greater level of PTG only in low-point event, so as the negative correlation between 解釋連結 and PTG. On the other hand, self-relevant change and解釋連結was not correlated with PTG in high-point or turning-point events. Therefore, autobolophical reasoning correlated with PTG differentially in different themes of life narrative, support the second hypothesis. There was a trend that women who were willing to share their cancer-related life story reported a higher level of PTG. Compared with those who never referred to their cancer experience, women who referred to cancer experience had deeper level of processing. Most of them (n= 59, 66.29%) referred to cancer-related event only once. It is likely that processes of cancer-related event helped deeper process other life events. Last, women in Stable high PTG trajectory showed better autobolophical reasoning than the other trajectory groups. Discussion: The results support that PTG is a process of meaning construction, and an actual outcome.