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題名 癌症病人術前憂慮量表之編製與心理計量特性
Development and Psychometric Properties of the Preoperative Cancer Patient’s Worry Scale (PCPWS)作者 李昀芷
Li, Yun-Jhih貢獻者 吳治勳
Wu, Chih-Hsun
李昀芷
Li, Yun-Jhih關鍵詞 憂慮
癌症病人
手術前
生活品質
Worry
Cancer Patients
Preoperative period
Quality of life日期 2019 上傳時間 7-Aug-2019 16:33:22 (UTC+8) 摘要 研究背景：憂慮（worry）為「人們面對不確定且包含一個或多個負向結果之問 題時可能啟動之內在心理問題解決的嘗試」。由於癌症病人幾乎均會經歷不確定的治療過程，憂慮應為病人診斷至治療過程常見之經驗。而診斷至治療前常被認為較具壓力，應為臨床介入之良好時間點,然目前卻少有適用於此重要時期之癌症病人憂慮相關評估工具。研究方法：本研究重新整理癌症病人憂慮相關量表及臨床實務經驗，編製「癌症病人術前憂慮量表（Preoperative Cancer Patient’s Worry Scale, PCPWS）」。 研究參與者來自北部某醫學中心，共有 348 位入院接受腫瘤切除手術之癌症病 人，其中乳癌病人 173 位（皆為女性），頭頸癌病人 175 位（男性 140 人、女 性 35 人）。病人於手術前一天入院時填寫 PCPWS 量表、情緒壓力、害怕情緒 評估,以及術後 1、3、6 個月追蹤填寫生活品質評估量表。研究結果：本研究編製之 PCPWS 共有 12 個題項，探索性因素分析結果顯示具有「社會角色（5 題）」與「疾病負擔（6 題）」兩因素，而「6. 經濟問題」 未屬任一因素，各因素皆具良好內部一致信度（Cronbach’s α = .88 與.87）驗證性因素分析亦顯示本量表之二因素結構（χ2 = 86.82、RMSEA = .07、SRMR = .03、GFI =.96、CFI = .98）具有良好之建構效度。PCPWS 亦具有良好之同時性效標關聯效度，「社會角色」、「疾病負擔」分別與「情緒壓力（r = .52, p < .01；r = .67, p < .01）」、「害怕情緒（r = .54, p < .01;r = .70, p < .01）」具顯著正相關；以及良好之預測性效標關連效度，不論是否控制情緒壓力或害怕情緒，乳癌病人（55 人）術前之「社會角色」均能預測術後 3 個月之生理與心理範疇的生活品質；而頭頸癌病人（36 人）術前之「社會角色」則能顯著預測術後 1 個月社會與環境範疇的生活品質。討論與結論：整體而言，本研究編製之 PCPWS 具有良好之信效度，可作為臨床上術前評估癌症病人憂慮之工具。本研究參與者在「疾病負擔」的擔心程度顯著高於「社會角色」（t = 15.59, p < .001），但「社會角色」對術後生活品質則有較穩定的預測。此結果可能反應出癌症病人雖然在「疾病負擔」上有較高的憂慮，但是對「社會角色」的憂慮，反而對後續之生活品質有較佳的預測力，顯示在臨床上應多關注病人在術前「社會角色」部份的擔心。然而由於完成完整追蹤的人數較少，故本研究較難以對 PCPWS如何預測生活品質的歷程/原因有較完整的推論，此部份需有待後續相關研究之補足。
Background: Worry represents “an attempt to engage in mental problem-solving on an issue whose outcome is uncertain but contains the possibility of one or more negative outcomes.” Due to the uncertainty of the disease and following treatments, cancer patients usually experienced “worry”. However, there were few measurements to evaluate worry in the preoperative period, which had been found one of the most stressful time for patients and maybe an effective phase for intervention. Therefore, the aim of the present study was to develop a “Preoperative Cancer Patient’s Worry Scale (PCPWS)”.Methods: Three hundred and forty-eight cancer patients, 173 breast cancer patients (all female) and 175 head and neck cancer patients (140 males, and 35 females), who admitted to the medical center for operation were included in the study. Participants were asked to fill the PCPWS and distress thermometer one day before surgery, and followed up by WHOQOL at 1, 3, and 6 months after the surgery.Results: Results of the exploratory factor analysis showed that the PCPWS is composed of two factors “social role (5-items)” and “disease burden (6-items)”, both factors had good internal consistency (Cronbach’s α= .88 and.87). The results of the confirmatory factor analysis also showed the PCPWS had good construct validity. As to criterion-related validity, “social role” and “disease burden” both had significant positively relations with emotional distress and fear measures supported the PCPWS had good concurrent validity. The significant predictions of the “social role” to the physical and the mental QOL at three months after operation in breast cancer patients, and to the social and the environmental QOL at one month after operation in head and neck cancer patients supported a good predictive validity.Discussion and Conclusion: In conclusion, the PCPWS has good psychometrics properties and is a suitable instrument to evaluate worry in cancer patients during the preoperative period in clinical settings. Although participants were worrier in “disease burden” than in “social role” (t = 15.59, p < .001), but “social role” was a better predictor to QOL after surgery. These results reflected that although cancer patients did worry more about their “disease burden”, but worries in their “social role” was a stronger predictor to their QOL afterwards. Thus, it is important for us to attend to patients’ “social role” worries during the pre-operative period. However, due to the relatively small sample size, the process from “social role” worries to QOL remain unclear. Future study is needed to further clarify the process.參考文獻 邱皓政（2006）。量化研究與統計分析（基礎版）：SPSS中文視窗版資料分析範例解析。台北：五南。姚開屏（2001）。台灣簡明版世界衛生組織生活品質問卷之發展及使用手冊。台北：世界衛生組織生活品質問卷台灣版問卷發展小組。鄧閔鴻（2010）。廣泛性焦慮疾患的心理病理：病態憂慮、注意偏誤、與憂慮的後設認知（博士論文）。取自：http://dx.doi.org/10.6342/NTU.2010.00289鄧閔鴻、吳翠殷、張素凰、侯育銘（2015）。臺灣版賓州憂慮量表的因素結構與心理計量特性。中華心理衛生學刊，28，521-568。Boehnke, K., Schwartz, S., Stromberg, C., & Sagiv, L. (1998). The Structure and Dynamics of Worry: Theory, Measurement, and Cross-National Replications. Journal of Personality, 66(5), 745-782. doi:10.1111/1467-6494.00031Bowling, A. (2001). A Review of Disease-Specific Quality of Life Measurement Scales. Philadelphia: Open University Press.Calman, K. C. (1984). Quality of life in cancer patients — an hypothesis. Journal of Medical Ethics, 10(3), 124-127. doi:10.1136/jme.10.3.124Carli, F., Gillis, C., & Scheede-Bergdahl, C. (2017). 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Worry about cancer progression and low perceived social support: Implications for quality of life among early-stage breast cancer patients. Annals of Behavioral Medicine, 45(1), 57-68. doi:10.1007/s12160-012-9406-1Wells, A. (2006). The metacognitive of worry and General Anxiety Disorder. In G. C. L., Davey. & A. Well (Eds.), Worry and its psychological disorders: Theory, assessment and treatment (pp. 179-199). Chichester, England: John Wiley & Sons.Yao, G., Chung, C. W., Yu, C. F., & Wang, J. D. (2002). Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version. Journal of the Formosan Medical Association, 101(5), 342-351. 描述 碩士
國立政治大學
心理學系
104752021資料來源 http://thesis.lib.nccu.edu.tw/record/#G0104752021 資料類型 thesis dc.contributor.advisor 吳治勳 zh_TW dc.contributor.advisor Wu, Chih-Hsun en_US dc.contributor.author (Authors) 李昀芷 zh_TW dc.contributor.author (Authors) Li, Yun-Jhih en_US dc.creator (作者) 李昀芷 zh_TW dc.creator (作者) Li, Yun-Jhih en_US dc.date (日期) 2019 en_US dc.date.accessioned 7-Aug-2019 16:33:22 (UTC+8) - dc.date.available 7-Aug-2019 16:33:22 (UTC+8) - dc.date.issued (上傳時間) 7-Aug-2019 16:33:22 (UTC+8) - dc.identifier (Other Identifiers) G0104752021 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/124859 - 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) 104752021 zh_TW dc.description.abstract (摘要) 研究背景：憂慮（worry）為「人們面對不確定且包含一個或多個負向結果之問 題時可能啟動之內在心理問題解決的嘗試」。由於癌症病人幾乎均會經歷不確定的治療過程，憂慮應為病人診斷至治療過程常見之經驗。而診斷至治療前常被認為較具壓力，應為臨床介入之良好時間點,然目前卻少有適用於此重要時期之癌症病人憂慮相關評估工具。研究方法：本研究重新整理癌症病人憂慮相關量表及臨床實務經驗，編製「癌症病人術前憂慮量表（Preoperative Cancer Patient’s Worry Scale, PCPWS）」。 研究參與者來自北部某醫學中心，共有 348 位入院接受腫瘤切除手術之癌症病 人，其中乳癌病人 173 位（皆為女性），頭頸癌病人 175 位（男性 140 人、女 性 35 人）。病人於手術前一天入院時填寫 PCPWS 量表、情緒壓力、害怕情緒 評估,以及術後 1、3、6 個月追蹤填寫生活品質評估量表。研究結果：本研究編製之 PCPWS 共有 12 個題項，探索性因素分析結果顯示具有「社會角色（5 題）」與「疾病負擔（6 題）」兩因素，而「6. 經濟問題」 未屬任一因素，各因素皆具良好內部一致信度（Cronbach’s α = .88 與.87）驗證性因素分析亦顯示本量表之二因素結構（χ2 = 86.82、RMSEA = .07、SRMR = .03、GFI =.96、CFI = .98）具有良好之建構效度。PCPWS 亦具有良好之同時性效標關聯效度，「社會角色」、「疾病負擔」分別與「情緒壓力（r = .52, p < .01；r = .67, p < .01）」、「害怕情緒（r = .54, p < .01;r = .70, p < .01）」具顯著正相關；以及良好之預測性效標關連效度，不論是否控制情緒壓力或害怕情緒，乳癌病人（55 人）術前之「社會角色」均能預測術後 3 個月之生理與心理範疇的生活品質；而頭頸癌病人（36 人）術前之「社會角色」則能顯著預測術後 1 個月社會與環境範疇的生活品質。討論與結論：整體而言，本研究編製之 PCPWS 具有良好之信效度，可作為臨床上術前評估癌症病人憂慮之工具。本研究參與者在「疾病負擔」的擔心程度顯著高於「社會角色」（t = 15.59, p < .001），但「社會角色」對術後生活品質則有較穩定的預測。此結果可能反應出癌症病人雖然在「疾病負擔」上有較高的憂慮，但是對「社會角色」的憂慮，反而對後續之生活品質有較佳的預測力，顯示在臨床上應多關注病人在術前「社會角色」部份的擔心。然而由於完成完整追蹤的人數較少，故本研究較難以對 PCPWS如何預測生活品質的歷程/原因有較完整的推論，此部份需有待後續相關研究之補足。 zh_TW dc.description.abstract (摘要) Background: Worry represents “an attempt to engage in mental problem-solving on an issue whose outcome is uncertain but contains the possibility of one or more negative outcomes.” Due to the uncertainty of the disease and following treatments, cancer patients usually experienced “worry”. However, there were few measurements to evaluate worry in the preoperative period, which had been found one of the most stressful time for patients and maybe an effective phase for intervention. Therefore, the aim of the present study was to develop a “Preoperative Cancer Patient’s Worry Scale (PCPWS)”.Methods: Three hundred and forty-eight cancer patients, 173 breast cancer patients (all female) and 175 head and neck cancer patients (140 males, and 35 females), who admitted to the medical center for operation were included in the study. Participants were asked to fill the PCPWS and distress thermometer one day before surgery, and followed up by WHOQOL at 1, 3, and 6 months after the surgery.Results: Results of the exploratory factor analysis showed that the PCPWS is composed of two factors “social role (5-items)” and “disease burden (6-items)”, both factors had good internal consistency (Cronbach’s α= .88 and.87). The results of the confirmatory factor analysis also showed the PCPWS had good construct validity. As to criterion-related validity, “social role” and “disease burden” both had significant positively relations with emotional distress and fear measures supported the PCPWS had good concurrent validity. The significant predictions of the “social role” to the physical and the mental QOL at three months after operation in breast cancer patients, and to the social and the environmental QOL at one month after operation in head and neck cancer patients supported a good predictive validity.Discussion and Conclusion: In conclusion, the PCPWS has good psychometrics properties and is a suitable instrument to evaluate worry in cancer patients during the preoperative period in clinical settings. Although participants were worrier in “disease burden” than in “social role” (t = 15.59, p < .001), but “social role” was a better predictor to QOL after surgery. These results reflected that although cancer patients did worry more about their “disease burden”, but worries in their “social role” was a stronger predictor to their QOL afterwards. Thus, it is important for us to attend to patients’ “social role” worries during the pre-operative period. However, due to the relatively small sample size, the process from “social role” worries to QOL remain unclear. Future study is needed to further clarify the process. en_US dc.description.tableofcontents 第一章 緒論 1第一節 研究動機與目的 1第二節 文獻探討 2一、 憂慮（worry） 2二、 癌症病人的憂慮 4三、 憂慮對生活的影響 5四、 生活品質的測量 8五、 憂慮的測量 9六、 癌症病人憂慮相關測量 12第三節 研究假設 21第二章 研究方法 22第一節 癌症病人術前憂慮量表（PCPWS）編製 22第二節 研究參與者 24第三節 研究流程 26第四節 研究工具 27一、 台灣簡明版世界衛生組織生活品質問卷 27二、 情緒壓力篩檢與情緒評估 27第五節 資料分析 29一、 人口學變項描述統計與量表分數比較分析 29二、 PCPWS項目分析 29三、 PCPWS探索性因素分析與信度 29四、 PCPWS驗證性因素分析 30五、 PCPWS效度分析 30第三章 結果 32第一節 人口學變項描述統計 32第二節 PCPWS因素結構 33一、 項目分析 33二、 探索性因素分析與內部一致性 34三、 驗證性因素分析 35四、 效度分析 39第四章 討論 49第一節 PCPWS之心理計量特性 50一、 PCPWS題項描述與癌別比較 50二、 乳癌與頭頸癌病人之PCPWS預測效度 53第二節 研究貢獻與應用、限制與未來方向 59一、 研究貢獻與應用 59二、 研究限制與未來研究方向 59參考文獻 61附錄一 癌症病人術前憂慮量表（PCPWS） 68附錄二 台灣簡明版世界衛生組織生活品質問卷（WHOQOL-BREF Taiwan Version）69附錄三 情緒狀態評估問卷 71 zh_TW dc.format.extent 1792046 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0104752021 en_US dc.subject (關鍵詞) 憂慮 zh_TW dc.subject (關鍵詞) 癌症病人 zh_TW dc.subject (關鍵詞) 手術前 zh_TW dc.subject (關鍵詞) 生活品質 zh_TW dc.subject (關鍵詞) Worry en_US dc.subject (關鍵詞) Cancer Patients en_US dc.subject (關鍵詞) Preoperative period en_US dc.subject (關鍵詞) Quality of life en_US dc.title (題名) 癌症病人術前憂慮量表之編製與心理計量特性 zh_TW dc.title (題名) Development and Psychometric Properties of the Preoperative Cancer Patient’s Worry Scale (PCPWS) en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 邱皓政（2006）。量化研究與統計分析（基礎版）：SPSS中文視窗版資料分析範例解析。台北：五南。姚開屏（2001）。台灣簡明版世界衛生組織生活品質問卷之發展及使用手冊。台北：世界衛生組織生活品質問卷台灣版問卷發展小組。鄧閔鴻（2010）。廣泛性焦慮疾患的心理病理：病態憂慮、注意偏誤、與憂慮的後設認知（博士論文）。取自：http://dx.doi.org/10.6342/NTU.2010.00289鄧閔鴻、吳翠殷、張素凰、侯育銘（2015）。臺灣版賓州憂慮量表的因素結構與心理計量特性。中華心理衛生學刊，28，521-568。Boehnke, K., Schwartz, S., Stromberg, C., & Sagiv, L. 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