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題名 台灣癌症病人主觀覺知醫病溝通於情緒壓力、因應、及生活品質之中介效果
The Mediation Effect of Perceived Doctor-Patient Communication among Emotional Distress, Coping, and Quality of Life in Taiwanese Cancer Patients作者 陳奕靜
Chen, I-Ching貢獻者 吳治勳
陳奕靜
Chen, I-Ching關鍵詞 醫病溝通
情緒壓力
生活品質
因應
乳癌
頭頸癌
doctor-patient communication
emotional distress
quality of life
coping
breast cancer
head & neck cancer日期 2020 上傳時間 3-Aug-2020 17:55:21 (UTC+8) 摘要 緒論：醫病溝通為病人就醫行為中相當重要的一部分，醫病溝通不良可能造成病人的情緒困擾與預後不佳。過去研究中多以「滿意度」的角度來詮釋「醫病溝通」，認為醫病溝通的責任主要在醫師身上。本研究試圖以病人的角度來思考，推論醫病溝通狀態可能是癌症病人的壓力，也可能是癌症病人的重要資源；以此探討醫病溝通是否能中介病人罹病後之情緒壓力與後續之疾病相關因應歷程與生活品質。研究方法：本研究參與者為來自北部某醫學中心的乳癌與頭頸癌患者，於術前接受情緒壓力評估，並於術後六個月填寫癌症病人醫病溝通量表、短版因應量表、及台灣簡明版世界衛生組織生活品質問卷。本研究將常用於測量醫病溝通狀態的「醫病溝通滿意度量表 (The Medical Interview Satisfaction Scale, MISS-21)」，翻譯後依據壓力概念將題項重新分為「正向醫病溝通」、「醫病溝通關係」、及「負向醫病溝通」等三個因素，再以驗證性因素分析（CFA）檢驗此因素建構是否適用於台灣癌症病人，並進行信度與效度檢驗。醫病溝通之中介效果部份，將以路徑分析探討乳癌與頭頸癌樣本於術前情緒壓力、術後六個月之醫病溝通（正向、關係、負向）、因應（個人、社會、逃避）與生活品質（生理、心理、社會、環境）間之關係。研究結果：共有乳癌患者123人(全女性，平均年齡53.342歲)與頭頸癌患者94人(男性76人女性18人，平均年齡52.723歲)，總計217人納入本研究。差異分析上發現乳癌與頭頸癌樣本除了「逃避因應」與「心理生活品質」外，所有研究變項上皆有顯著差異。在醫病溝通之中介效果部份，乳癌病人術前情緒壓力可顯著正向預測負向醫病溝通，負向醫病溝通可顯著正向預測逃避因應，逃避因應可顯著負向預測四個面向之生活品質；術前情緒壓力亦可負向預測四個面向之生活品質。頭頸癌病人之術前情緒壓力可顯著負向預測正向醫病溝通，正向醫病溝通顯著正向預測個人因應，個人因應顯著正向預測心理、社會、及環境生活品質。正向醫病溝通可正向預測四個面向之生活品質，負向醫病溝通則可負向預測心理與環境生活品質。簡而言之，對乳癌患者來說，「負向醫病溝通預測」可能為術前情緒壓力對術後六個月之逃避因應與生活品質之部份中介因子；對頭頸癌患者來說，「正向醫病溝通」可能為術前情緒壓力對術後六個月之個人因應與生活品質之完全中介因子。討論：本研究結果顯示台灣中文版「癌症病人醫病溝通量表」可從病人主觀覺知角度分為「正向醫病溝通」、「醫病溝通關係」、及「負向醫病溝通」三個因素且具有良好信效度。乳癌患者之術前情緒壓力對後續適應影響甚鉅，而「負向醫病溝通」為重要中介因子，因此提供心理介入以降低乳癌患者術前情緒壓力與其後續知覺醫病溝通為壓力情境的程度，應為提升乳癌患者後續因應與生活品質之重要方向。在頭頸癌患者中，「正向醫病溝通」有顯著效果，顯示醫病溝通為重要醫療資源，若跨專科醫療團隊能協助頭頸癌患者恰當表達其醫療需求，應可提升照護品質並增進生活品質。
Objective: Doctor-patient communication is an essential part of patients` medical behaviors. Poor doctor-patient communication might cause emotional distress and predict poor prognosis. In past studies, "satisfaction" was used as the central concept to define "doctor-patient communication," and it was assumed that the responsibility of doctor-patient communication quality mainly relied on the doctors. This study attempts to take the patient`s perspective. We proposed that communication with doctors could be a crucial resource for cancer patients, but it could also be detrimental if the communication were unsuccessful. Furthermore, this study aimed to explore whether doctor-patient communication could mediate patients` emotional distress after illness, subsequent coping, and quality of life(QoL).Method: Breast cancer and head and neck cancer patients were recruited from a medical center in northern Taiwan. Participants received an emotional distress assessment one-day before surgery(t1). At six-months post-surgery follow-up(t2), they were asked to fill out the "Medical Interview Satisfaction Scale (MISS-21)," "Brief COPE," and the Taiwan Concise World Health Organization Quality of Life Questionnaire. The items of the MISS-21 was first translated into Traditional Chinese (Taiwan) and then restructured into subscales based on the stress model to reflect the patient`s perspective of doctor-patient communication. Three factors, including "positive communication between doctors and patients," and "rapport," and "negative communication between doctors and patients," were identified. Confirmatory factor analysis (CFA) was used to conclude whether this factor structure was suitable for cancer patients in Taiwan, and the reliability and validity were also tested. Path analysis was used to explore the mediating effect of the "perceived doctor-patient communication (positive, rapport, negative)" between "emotional distress(t1)", "coping (individual, social, avoidance)(t2)," and "the QoL (physical, psychological, social, environmental)(t2)," in both breast cancer and head and neck cancer patients.Results: A total of 217 patients were included in this study. In which, 123 were breast cancer patients (all women, average age 53.342 years old), and 94 were head and neck cancer patients (76 males and 18 females, average age 52.723 years). Results showed significant differences in all research variables except for "escape response" and "psychological quality of life" between the two cancer groups. As to the mediating effect of the "perceived doctor-patient communication," the "emotional distress" at t1 can predict the "negative communication(t2)," then the "avoidance coping," and the "avoidance coping" can negatively predict all four aspects of the QoL in breast cancer patients. Furthermore, "emotional distress (t1)" can also negatively predict all four aspects of the QoL. In head and neck cancer patients, "emotional distress" at t1 can negatively predict the "positive communication(t2)," which then can positively predict "individual coping(t2)," and which can predict the psychological, social, and environmental QoL(t2). The "positive communication(t2)" can positively predict all four aspects of the QoL, and the "negative communication(t2)" can negatively predict the psychological and environmental QoL(t2). In short, for breast cancer patients, the "negative communication" could be a partial mediator between pre-operational emotional distress and subsequent quality of life. For patients with head and neck cancer, "positive communication" could be a full mediator between pre-operational emotional distress and subsequent quality of life.Discussion: The results of this study show that the modified Taiwan version of MISS-21 can be restructured into"positive communication between doctors and patients," and "rapport," and "negative communication between doctors and patients," and can serve as a"Cancer Patient Medical Communication Scale" with sound reliability and validity. In breast cancer patients, the preoperative emotional distress had significant impacts on subsequent adaptation, and "negative communication between doctors and patients" was an essential mediating factor. Therefore, psychological interventions aimed to diminish preoperative emotional distress and reduce negative communication could improve the succeeding quality of life. For patients with head and neck cancer, "positive communication" had a significant, full mediating effect, showing that positive communication was an indispensable medical resource. Therefore, the multi-disciplinary team needs to assist head and neck cancer patients to express their needs to medical staff to improve the subsequent quality of life.參考文獻 周碧玲（2011）。癌症病人使用止痛藥物遵從性之影響因子—中介及調節效應之測試（博士論文）。臺北醫學大學護理系博士學位論文，1-149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：台灣版世界衛生組織生活品質問卷發展小組衛生福利部國民健康署（2018）：中華民國105年癌症登記報告。取自https://www.hpa.gov.tw/Home/Index.aspxAmerican Society of Clinical Oncology. (1996). Outcomes of cancer treatment for technologyassessment and cancer treatment guidelines. Journal of Clinical Oncology, 14(2), 671-679.Arborelius, E., & Bremberg, S. (1992). What can doctors do to achieve a successful consultation? Videotaped interviews analyzed by the ‘consultation map’ method. Family Practice, 9(1), 61-67.Butow, P. N., Kazemi, J. N., Beeney, L. J., Griffin, A. M., Dunn, S. 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What is the optimal combination of Emotion Thermometers? Psycho-Oncology, 19, 134-140. doi:10.1002/pon.1557National Comprehensive Cancer Network. (2017). NCCN Practice Guidelines in Oncology—V. 2.2017, Distress Management. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/distress.pdfSiegel, R. L., Miller, K. D., & Jemal, A. (2019). Cancer statistics, 2019. CA: a cancer journal for clinicians, 69(1), 7-34.Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychological methods, 7(4), 422-445.Stewart, M., Brown, J. B., Boon, H., Galajda, J., Meredith, L., & Sangster, M. (1999). Evidence on patient-doctor communication. Cancer, 25(1999), 25-30Taylor, S. E. (2018). Health psychology. Tata McGraw-Hill Education.Roberts, C. S., Cox, C. E., Reintgen, D. S., Baile, W. F., & Gibertini, M. (1994). Influence of physician communication on newly diagnosed breast patients’ psychologic adjustment and decision‐making. Cancer, 74(S1), 336-341.Roth, A. J., Kornblith, A. B., Batel-Copel, L., Peabody, E., Scher, H. I., & Holland, J. C. (1998). Rapid screening for psychologic distress in men with prostate carcinoma. Cancer, 82, 1904-1908. doi: 10.1002/(SICI)1097-0142(19980515)82:10<1904::AID-CNCR13>3.0.CO;2-XWang, G. L., Hsu, S. H., Feng, A. C., Chiu, C. Y., Shen, J. F., Lin, Y. J., & Cheng, C. C. (2011). The HADS and the DT for screening psychosocial distress of cancer patients in Taiwan. Psycho-Oncology, 20, 639-646. doi: 10.1002/pon.1952Ware Jr, J. E., & Snyder, M. K. (1975). Dimensions of patient attitudes regarding doctors and medical care services. Medical care, 669-682.Wolf, M. H., Putnam, S. M., James, S. A., & Stiles, W. B. (1978). The Medical Interview Satisfaction Scale: development of a scale to measure patient perceptions of physician behavior. Journal of behavioral medicine, 1(4), 391-401.Wolf, M. H., & Stiles, W. B. (1981, August). Further development of the medical interview satisfaction scale. In American Psychological Association Meeting, Los Angeles(CA), 1981Zachariae, R., Pedersen, C. G., Jensen, A. B., Ehrnrooth, E., Rossen, P. B., & von der Maase, H. (2003). Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. British journal of cancer, 88(5), 658-665. 描述 碩士
國立政治大學
心理學系
105752018資料來源 http://thesis.lib.nccu.edu.tw/record/#G0105752018 資料類型 thesis dc.contributor.advisor 吳治勳 zh_TW dc.contributor.author (Authors) 陳奕靜 zh_TW dc.contributor.author (Authors) Chen, I-Ching en_US dc.creator (作者) 陳奕靜 zh_TW dc.creator (作者) Chen, I-Ching en_US dc.date (日期) 2020 en_US dc.date.accessioned 3-Aug-2020 17:55:21 (UTC+8) - dc.date.available 3-Aug-2020 17:55:21 (UTC+8) - dc.date.issued (上傳時間) 3-Aug-2020 17:55:21 (UTC+8) - dc.identifier (Other Identifiers) G0105752018 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/131096 - 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) 105752018 zh_TW dc.description.abstract (摘要) 緒論：醫病溝通為病人就醫行為中相當重要的一部分，醫病溝通不良可能造成病人的情緒困擾與預後不佳。過去研究中多以「滿意度」的角度來詮釋「醫病溝通」，認為醫病溝通的責任主要在醫師身上。本研究試圖以病人的角度來思考，推論醫病溝通狀態可能是癌症病人的壓力，也可能是癌症病人的重要資源；以此探討醫病溝通是否能中介病人罹病後之情緒壓力與後續之疾病相關因應歷程與生活品質。研究方法：本研究參與者為來自北部某醫學中心的乳癌與頭頸癌患者，於術前接受情緒壓力評估，並於術後六個月填寫癌症病人醫病溝通量表、短版因應量表、及台灣簡明版世界衛生組織生活品質問卷。本研究將常用於測量醫病溝通狀態的「醫病溝通滿意度量表 (The Medical Interview Satisfaction Scale, MISS-21)」，翻譯後依據壓力概念將題項重新分為「正向醫病溝通」、「醫病溝通關係」、及「負向醫病溝通」等三個因素，再以驗證性因素分析（CFA）檢驗此因素建構是否適用於台灣癌症病人，並進行信度與效度檢驗。醫病溝通之中介效果部份，將以路徑分析探討乳癌與頭頸癌樣本於術前情緒壓力、術後六個月之醫病溝通（正向、關係、負向）、因應（個人、社會、逃避）與生活品質（生理、心理、社會、環境）間之關係。研究結果：共有乳癌患者123人(全女性，平均年齡53.342歲)與頭頸癌患者94人(男性76人女性18人，平均年齡52.723歲)，總計217人納入本研究。差異分析上發現乳癌與頭頸癌樣本除了「逃避因應」與「心理生活品質」外，所有研究變項上皆有顯著差異。在醫病溝通之中介效果部份，乳癌病人術前情緒壓力可顯著正向預測負向醫病溝通，負向醫病溝通可顯著正向預測逃避因應，逃避因應可顯著負向預測四個面向之生活品質；術前情緒壓力亦可負向預測四個面向之生活品質。頭頸癌病人之術前情緒壓力可顯著負向預測正向醫病溝通，正向醫病溝通顯著正向預測個人因應，個人因應顯著正向預測心理、社會、及環境生活品質。正向醫病溝通可正向預測四個面向之生活品質，負向醫病溝通則可負向預測心理與環境生活品質。簡而言之，對乳癌患者來說，「負向醫病溝通預測」可能為術前情緒壓力對術後六個月之逃避因應與生活品質之部份中介因子；對頭頸癌患者來說，「正向醫病溝通」可能為術前情緒壓力對術後六個月之個人因應與生活品質之完全中介因子。討論：本研究結果顯示台灣中文版「癌症病人醫病溝通量表」可從病人主觀覺知角度分為「正向醫病溝通」、「醫病溝通關係」、及「負向醫病溝通」三個因素且具有良好信效度。乳癌患者之術前情緒壓力對後續適應影響甚鉅，而「負向醫病溝通」為重要中介因子，因此提供心理介入以降低乳癌患者術前情緒壓力與其後續知覺醫病溝通為壓力情境的程度，應為提升乳癌患者後續因應與生活品質之重要方向。在頭頸癌患者中，「正向醫病溝通」有顯著效果，顯示醫病溝通為重要醫療資源，若跨專科醫療團隊能協助頭頸癌患者恰當表達其醫療需求，應可提升照護品質並增進生活品質。 zh_TW dc.description.abstract (摘要) Objective: Doctor-patient communication is an essential part of patients` medical behaviors. Poor doctor-patient communication might cause emotional distress and predict poor prognosis. In past studies, "satisfaction" was used as the central concept to define "doctor-patient communication," and it was assumed that the responsibility of doctor-patient communication quality mainly relied on the doctors. This study attempts to take the patient`s perspective. We proposed that communication with doctors could be a crucial resource for cancer patients, but it could also be detrimental if the communication were unsuccessful. Furthermore, this study aimed to explore whether doctor-patient communication could mediate patients` emotional distress after illness, subsequent coping, and quality of life(QoL).Method: Breast cancer and head and neck cancer patients were recruited from a medical center in northern Taiwan. Participants received an emotional distress assessment one-day before surgery(t1). At six-months post-surgery follow-up(t2), they were asked to fill out the "Medical Interview Satisfaction Scale (MISS-21)," "Brief COPE," and the Taiwan Concise World Health Organization Quality of Life Questionnaire. The items of the MISS-21 was first translated into Traditional Chinese (Taiwan) and then restructured into subscales based on the stress model to reflect the patient`s perspective of doctor-patient communication. Three factors, including "positive communication between doctors and patients," and "rapport," and "negative communication between doctors and patients," were identified. Confirmatory factor analysis (CFA) was used to conclude whether this factor structure was suitable for cancer patients in Taiwan, and the reliability and validity were also tested. Path analysis was used to explore the mediating effect of the "perceived doctor-patient communication (positive, rapport, negative)" between "emotional distress(t1)", "coping (individual, social, avoidance)(t2)," and "the QoL (physical, psychological, social, environmental)(t2)," in both breast cancer and head and neck cancer patients.Results: A total of 217 patients were included in this study. In which, 123 were breast cancer patients (all women, average age 53.342 years old), and 94 were head and neck cancer patients (76 males and 18 females, average age 52.723 years). Results showed significant differences in all research variables except for "escape response" and "psychological quality of life" between the two cancer groups. As to the mediating effect of the "perceived doctor-patient communication," the "emotional distress" at t1 can predict the "negative communication(t2)," then the "avoidance coping," and the "avoidance coping" can negatively predict all four aspects of the QoL in breast cancer patients. Furthermore, "emotional distress (t1)" can also negatively predict all four aspects of the QoL. In head and neck cancer patients, "emotional distress" at t1 can negatively predict the "positive communication(t2)," which then can positively predict "individual coping(t2)," and which can predict the psychological, social, and environmental QoL(t2). The "positive communication(t2)" can positively predict all four aspects of the QoL, and the "negative communication(t2)" can negatively predict the psychological and environmental QoL(t2). In short, for breast cancer patients, the "negative communication" could be a partial mediator between pre-operational emotional distress and subsequent quality of life. For patients with head and neck cancer, "positive communication" could be a full mediator between pre-operational emotional distress and subsequent quality of life.Discussion: The results of this study show that the modified Taiwan version of MISS-21 can be restructured into"positive communication between doctors and patients," and "rapport," and "negative communication between doctors and patients," and can serve as a"Cancer Patient Medical Communication Scale" with sound reliability and validity. In breast cancer patients, the preoperative emotional distress had significant impacts on subsequent adaptation, and "negative communication between doctors and patients" was an essential mediating factor. Therefore, psychological interventions aimed to diminish preoperative emotional distress and reduce negative communication could improve the succeeding quality of life. For patients with head and neck cancer, "positive communication" had a significant, full mediating effect, showing that positive communication was an indispensable medical resource. Therefore, the multi-disciplinary team needs to assist head and neck cancer patients to express their needs to medical staff to improve the subsequent quality of life. en_US dc.description.tableofcontents 謝辭 i摘要 iiiAbstract v目次 viii表次 1圖次 3第一章 緒論 4第一節 研究動機與目的 4第二節 文獻探討 5一、壓力模式與醫病溝通 5二、癌症疾病議題與醫病溝通 7三、醫病溝通的測量 11四、小結 17第三節 研究假設 19第二章 研究方法 21第一節 研究參與者 21第二節 研究流程 21第三節 研究工具 22一、 情緒壓力評估 22二、癌症病人醫病溝通量表（MISS-21） 22三、短版因應量表 23四、台灣簡明版世界衛生組織生活品質問卷 24第四節 資料分析 25一、人口學變項描述統計 25二、癌症病人醫病溝通量表（MISS-21）項目分析與信、效度分析 25四、乳癌與頭頸癌病人之差異分析 26五、路徑分析 26第三章 研究結果 28第一節 樣本資料及各變項描述統計 28第二節 癌症病人醫病溝通量表 31第三節 術前情緒壓力、醫病溝通與因應之關係 35一、不分癌別之路徑分析結果 36二、分癌別之路徑分析結果 40一、含生活品質之不分癌別路徑分析結果 47二、含生活品質之乳癌樣本結果 63三、含生活品質之頭頸癌樣本結果 79第四章 討論 96第一節 醫病溝通量表於乳癌與頭頸癌患者之結果比較 96一、 以壓力歷程之社會資源概念使用台灣癌症病人醫病溝通量表 96二、乳癌患者於情緒壓力、醫病溝通、因應與生活品質之特性 96三、頭頸癌患者於情緒壓力、醫病溝通、因應與生活品質之特性 101第二節 研究貢獻與應用、限制與未來方向 103一、 研究貢獻與應用 103二、研究限制與未來方向 104參考文獻 106附錄 109一、情緒壓力評估 109二、癌症病人知覺醫病溝通量表 110三、短版因應量表 111四、世界衛生組織生活品質問卷（台灣簡明版） 113五、原作者授權同意使用 115六、CFA路徑圖與標準化係數 116七、因應量表各因素與題項 117 zh_TW dc.format.extent 7167463 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0105752018 en_US dc.subject (關鍵詞) 醫病溝通 zh_TW dc.subject (關鍵詞) 情緒壓力 zh_TW dc.subject (關鍵詞) 生活品質 zh_TW dc.subject (關鍵詞) 因應 zh_TW dc.subject (關鍵詞) 乳癌 zh_TW dc.subject (關鍵詞) 頭頸癌 zh_TW dc.subject (關鍵詞) doctor-patient communication en_US dc.subject (關鍵詞) emotional distress en_US dc.subject (關鍵詞) quality of life en_US dc.subject (關鍵詞) coping en_US dc.subject (關鍵詞) breast cancer en_US dc.subject (關鍵詞) head & neck cancer en_US dc.title (題名) 台灣癌症病人主觀覺知醫病溝通於情緒壓力、因應、及生活品質之中介效果 zh_TW dc.title (題名) The Mediation Effect of Perceived Doctor-Patient Communication among Emotional Distress, Coping, and Quality of Life in Taiwanese Cancer Patients en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 周碧玲（2011）。癌症病人使用止痛藥物遵從性之影響因子—中介及調節效應之測試（博士論文）。臺北醫學大學護理系博士學位論文，1-149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：台灣版世界衛生組織生活品質問卷發展小組衛生福利部國民健康署（2018）：中華民國105年癌症登記報告。取自https://www.hpa.gov.tw/Home/Index.aspxAmerican Society of Clinical Oncology. 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