學術產出-Theses
Article View/Open
Publication Export
-
題名 初探癌末病人疾病調適歷程之正向經驗
Exploring Positive Experiences in The Process of Adjustment to Illness in Advanced Cancer Patients作者 王郁
Wang, Yu貢獻者 吳治勳
Wu, Chih-Hsun
王郁
Wang, Yu關鍵詞 癌末
正向經驗
正向轉變
疾病調適
主題分析
Advanced cancer
Positive experience
Transformation
Illness adjustment
Thematic Analysis日期 2023 上傳時間 6-Jul-2023 16:57:36 (UTC+8) 摘要 研究背景：癌症病人自罹癌便面臨一連串生理、心理、社會、與靈性困擾。過往癌末研究多聚焦於疾病對於癌末病人的負面影響，也因此癌末病人研究幾乎等同於受苦的研究。然而，亦有過往研究指出，個體即便在高度疾病壓力狀況下，正向與負向的心理狀態仍可能同時發生。有鑑於目前國內對於癌末病人疾病正向經驗的討論仍相對缺乏，本研究旨在進一步探索癌末病人正向經驗內涵，及其與身心調適間的關聯與意義，期能增進對癌末病人臨終經驗與適應歷程的豐富理解。研究方法：本研究於北部某醫學中心安寧緩和醫療單位進行收案，一共訪問22位門診或住院之癌末病人。研究採半結構式晤談方法進行錄音訪談，過程中鼓勵病人自由談論與癌症經驗有關的想法與感受，錄音檔後續轉錄為逐字稿進行主題分析 (thematic analysis) ，並以資料為導向，歸納出癌末正向經驗重要主題內涵。結果：本研究透過主題分析歸納出癌末病人正向經驗四大主題與十個次主題。四大主題包含 (1) 「順應生命自然秩序」：此主題下再分三項次主題「生老病死是必經之路」、「盡人事聽天命」、「生命是禍福相依，有失有得」。 (2) 「生活秩序的建立」：此主題下的次主題分別為「與疾病共處」、「重新分辨輕重緩急」。 (3) 「正向的人我關係」：此主題下有「深化家人連結」、「良好醫病關係」兩項次主題。 (4) 「當下與來世的盼望」：此主題下有「活在他人心中」、「來世的寄望」，以及「細緻的身心感受」三項次主題。討論：本研究所歸納出之癌末正向經驗主題具有經驗相對性、時間有限性，以及主動因應下的被動性等特徵，同時指出正向經驗亦為轉化經驗，個體從困厄中獲得心理成長的契機。個別主題之內涵亦反映癌末病人透過不同因應策略來面對臨終處境。最後，本研究亦就訪談中所觀察到癌末病人笑容的行為表現，與其臨床意義進行初步討論。
Background: Cancer patients face multiple bio-psycho-social-spiritual issues ever since their diagnosis and throughout the entire disease process, hence a large body of research literature has focused on negative impacts on patients with advanced cancer. However, past studies also indicated that positive and negative experiences or emotions co-exist even when people are in a stressful situation. Given that the positive side of the illness experience is rarely discussed in this population, this study aims to explore the positive experience as well as its possible adaptive functions, in an effort to enrich the understanding of end-of-life experiences and the process of adjustment to illness in advanced cancer patients.Method: A total of 22 end-stage cancer patients were interviewed and recorded in a hospice care setting, including outpatients and hospitalized patients. This study adopted a semi-structure interview in which the interviewees were encouraged to talk about their thoughts and feelings related to cancer experiences. The recorded interviews were later transcribed for a bottom-up inductive approach thematic analysis.Results: 4 main themes and 10 sub-themes of positive experiences in advanced cancer patients were developed from the collected data. The 4 main themes included (1) “Adapt to The Natural Order of Life” subsumed with “ Life Path that Everyone Must Go Through”, “ Do the Best and Leave It To the Fate”, and “Misfortune and Blessings Are Interconnected In Life”. (2) “The Establishment of Life Order” subsumed with “ Living With the Illness” and “Reassessing Priorities”. (3) “Positive Interpersonal Relationships” subsumed with “Deepening Family Bonds” and “ A Good Doctor-Patient Relationship”. (4) “Hope For The Present and Afterlife” subsumed with “ Delicate Sensory and Living Experience of The Body”, “ Believing In The Afterlife” and “ Living In The Hearts of Others”.Conclusion: The inductive themes illustrated the relativeness, time-limitedness, and the passivity under active coping of cancer patients’ end-of-life positive experiences. This study then further indicated that advanced cancer patients’ positive experience is also a transformation process, that gives rise to the possible psychological growth of an individual in adversity. Each theme reflects how patients use different coping strategies to better adjust to the near-death situation. Finally, a preliminary observation of patients’ laughter/smile behavior is also discussed in this study.參考文獻 方俊凱(2011)：〈概述失志症候群〉。《安寧療護雜誌》，16(3)，371-379。https://doi.org/10.6537/tjhpc.2011.16(3).8方俊凱、林子涵、畢世萱、李閏華、李佩怡 (2017)：〈癌症末期病人的善終觀點〉。《安寧療護雜誌》，22(3)，288-309。https://doi.org/10.6537/TJHPC.201711_22(3).003王建雅 (2010)：〈八向度幽默風格量表之發展暨其與自尊、人格特質、依附風格關係之探討〉 （未出版博士論文）。國立臺灣師範大學。https://hdl.handle.net/11296/c369gf安寧緩和醫療條例（條文修正日期：民國110年1月20日）。取自： https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020066西蒙德波娃 (2021)：《一場極為安詳的死亡》（周桂音譯）。商周。（原著出版年：1964）[Simone de Beauvoir(2021). Une mort très douche. (G.Y. Zhou. Trans.).Business Weekly. (Original work published in 1964)]余德慧、石世明 (2006) ：《臨終心理與陪伴研究》。心靈工坊。余德慧 (2018) ：《生命轉化的技藝學》。心靈工坊。洪家暐 (2020) ：《乳癌病人疾病控制感與生活品質的關係-初探壓力因應的中介效果》(未出版碩士論文)。國立政治大學。吳啟誠、張瓊云 (2020)：〈主題分析在教育研究上的應用〉。《特殊教育發展期刊》，(69)， 29-42。https://doi.org/10.7034/dse.202006_(69).0003李政洋、陳虹汶、李玉嬋、唐婉如、方俊凱(2011)：〈癌症照顧的自殺防治〉。《內科學誌》，22(5)，335-343。 https://doi.org/10.6314/jimt.2011.22(5).05林耀盛 (2006)：〈慢性病心理社會模式之探討：以癌症為例〉。《臨床心理學刊》， 3(2)， 056-067。洪福建、鄭逸如、邱泰源、胡文郁、陳慶餘、吳英璋(1999)：〈癌末患者的心理社會問題、因應策與負向情緒〉。《應用心理研究》(3)，79-104。Doi: 10.29798/LCXLTX.200702.0002胡文郁(2004)：〈台灣文化脈絡下癌末患者之生活品質〉。《台灣醫學》，8(5)。 https://doi.org/10.6320/FJM.2004.8(5).12高綺吟、胡文郁、邱泰源(2012)：〈癌症病人末期病情告知與心理情緒之相關性研究〉。《安寧療護雜誌》，17(3)，288 – 299，2012。Doi：10.6537/TJHPC.2012.17(3).4陳亭儒、胡文郁、程劭儀、邱泰源 (2013)：〈善終評量之反思〉 。《安寧療護雜誌》，18(1)， 76-88。https://doi.org/10.6537/tjhpc.2013.18(1).7陳啟明 (1996)：〈羅傑斯與斯金納「人」觀之比較研究〉。《教育研究集刊》，101-130。Doi: 10.6910/BER.199603_(37).0004黃文翰、鄭逸如、楊于婷、張琦郁、黃士哲 (2017)：〈如何面對臨終的死亡焦慮－誰該為自身的死亡負責〉。《安寧療護雜誌》，22(2)。 https://doi.org/10.6537/TJHPC.2017.22(2).6鄭逸如、呂碧鴻(1997)：〈癌症末期患者心理層面的照顧〉。《台灣醫學》，1(2)。 https://doi.org/10.6320/FJM.1997.1(2).10衛生福利部國民健康署（2022）：中華民國109年癌症登記報告。取自： https://www.hpa.gov.tw/File/Attach/16434/File_20339.pdf衛生福利部統計處（2021）：世界抗癌日衛生福利部統計通報。取自： https://dep.mohw.gov.tw/DOS/cp-5112-63000-113.html維克多・法蘭可 (2002)：《意義的呼喚：維克多・法蘭克的生命傳記》（鄭納無譯）。 心靈工坊。（原著出版年：1995）[Viktor E. Frankl (2002). Recollections: An Autobiography (N.W. Cheng, Trans.). PsyGarden Publishing. (Original work published in 1995)]維克多・法蘭可 (1967)：《活出意義來: 從集中營說到存在主義》（趙可式、沈錦惠譯）。光啟文化。（原著出版年：1946）[Viktor E. Frankl(1967). Man`s Search for Meaning (K.S. Zhao & J.H. Shen. Trans.). Kuangchi. (Original work published in 1946) ] 卡爾・羅哲斯 (2014)：《成為一個人：一個治療者對心理治療的觀點》（宋文里譯）。左岸文化。（原著出版年：1961）[Carl R. Rogers (2014). On Becoming A Person: A Therapist View of Psychotherapy(W.L.Sung. Trans). Rive Gauche.(Original work published in 1961)]Adler, P. A., & Adler, P. (1987). Membership roles in field research [Article]. Beverly Hills, CA: Sage.An, E., Lo, C., Hales, S., Zimmermann, C., & Rodin, G. (2018). Demoralization and death anxiety in advanced cancer. Psycho‐oncology, 27(11), 2566-2572.Bandura, A. (2006). Toward a Psychology of Human Agency. Perspectives on Psychological Science, 1(2), 164-180. https://doi.org/10.1111/j.1745-6916.2006.00011.xBoyatzis, R. E. (1998). Transforming qualitative information: Thematic analysis and code development. sage.Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.Clarke, D. M., & Kissane, D. W. (2002). Demoralization: its phenomenology and importance. Australian & New Zealand Journal of Psychiatry, 36(6), 733-742.Dans, M., Kutner, J. S., Agarwal, R., Baker, J. N., Bauman, J. R., Beck, A. C., Campbell, T. C., Carey, E. C., Case, A. A., Dalal, S., Doberman, D. J., Epstein, A. S., Fecher, L., Jones, J., Kapo, J., Lee, R. T., Loggers, E. T., McCammon, S., Mitchell, W., . . . Campbell, M. (2021). NCCN Guidelines® Insights: Palliative Care, Version 2.2021: Featured Updates to the NCCN Guidelines. Journal of the National Comprehensive Cancer Network, 19(7), 780-788. https://doi.org/10.6004/jnccn.2021.0033Darwin, C. (2012). The Expression of the Emotions in Man and Animals. CreateSpace Independent Publishing Platform. https://books.google.com.tw/books?id=KtsrngEACAAJ Davis, C. G., Nolen-Hoeksema, S., & Larson, J. (1998). Making sense of loss and benefiting from the experience: two construals of meaning. Journal of personality and social psychology, 75(2), 561.Davis, S., Serfaty, M., Low, J., Armstrong, M., Kupeli, N., & Lanceley, A. (2022). Experiential Avoidance in Advanced Cancer: a Mixed-Methods Systematic Review. Int J Behav Med. https://doi.org/10.1007/s12529-022-10131-4De Faye, B. J., Wilson, K. G., Chater, S., Viola, R. A., & Hall, P. (2006). Stress and coping with advanced cancer. Palliative & supportive care, 4(3), 239-249.de Figueiredo, J. M. (1993). Depression and demoralization: Phenomenologic differences and research perspectives. Comprehensive Psychiatry, 34(5), 308-311. https://doi.org/https://doi.org/10.1016/0010-440X(93)90016-WDerogatis, L. R., Abeloff, M. D., & McBeth, C. D. (1976). Cancer Patients and their Physicians in the Perception of Psychological Symptoms. Psychosomatics, 17(4), 197-201. https://doi.org/https://doi.org/10.1016/S0033-3182(76)71116-2Ekman, P. (2004). Emotions revealed. Bmj, 328(Suppl S5).Engel, G. L. (1980). The clinical application of the biopsychosocial model. Am J Psychiatry, 137(5), 535-544. https://doi.org/10.1176/ajp.137.5.535Epstein, S., & Meier, P. (1989). Constructive thinking: a broad coping variable with specific components. Journal of personality and social psychology, 57(2), 332.Erikson, E. H. (1993). Childhood and society. WW Norton & Company.Fang, C.-K., Chang, M.-C., Chen, P.-J., Lin, C.-C., Chen, G.-S., Lin, J., Hsieh, R.-K., Chang, Y.-F., Chen, H.-W., Wu, C.-L., Lin, K.-C., Chiu, Y.-J., & Li, Y.-C. (2014). A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer. Supportive Care in Cancer, 22(12), 3165-3174. https://doi.org/10.1007/s00520-014-2290-4 Ferris, F., Balfour, H., Bowen, K., Farley, J., Hardwick, M., Lamontagne, C., Lundy, M., Syme, A., & West, P. (2002). A model to guide patient and family care: Based on nationally accepted principles and norms of practice. Journal of pain and symptom management, 24, 106-123. https://doi.org/10.1016/S0885-3924(02)00468-2Folkman, S. (1997). Positive psychological states and coping with severe stress. Social science & medicine, 45(8), 1207-1221.Folkman, S., & Moskowitz, J. T. (2000). Stress, positive emotion, and coping. Current directions in psychological science, 9(4), 115-118.Fredrickson, B. L. (1998). What good are positive emotions? Review of general psychology, 2(3), 300-319.Hem, E., Loge, J. H., Haldorsen, T., & Ekeberg, Ø. (2004). Suicide risk in cancer patients from 1960 to 1999. Journal of clinical Oncology, 22(20), 4209-4216.Hofmann, J., Platt, T., & Ruch, W. (2017). Laughter and smiling in 16 positive emotions. IEEE Transactions on Affective Computing, 8(4), 495-507.Janoff-Bulman, R. (1998). From Terror to Appreciation: Confronting Chance after Extreme Misfortune. Psychological Inquiry, 9(2), 99-101. http://www.jstor.org/stable/1449099Joseph, S., & Linley, P. A. (2005). Positive adjustment to threatening events: An organismic valuing theory of growth through adversity. Review of general psychology, 9(3), 262-280.Keltner, D., & Bonanno, G. A. (1997). A study of laughter and dissociation: distinct correlates of laughter and smiling during bereavement. Journal of personality and social psychology, 73(4), 687.Keyes, C. L., Shmotkin, D., & Ryff, C. D. (2002). Optimizing well-being: the empirical encounter of two traditions. Journal of personality and social psychology, 82(6), 1007. Kissane, D. W., Clarke, D. M., & Street, A. F. (2001). Demoralization Syndrome — a Relevant Psychiatric Diagnosis for Palliative Care. Journal of Palliative Care, 17(1), 12-21. https://doi.org/10.1177/082585970101700103Kuiper, N. A., Grimshaw, M., Leite, C., & Kirsh, G. (2004). Humor is not always the best medicine: Specific components of sense of humor and psychological well-being.Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer publishing company.Maercker, A., & Zoellner, T. (2004). The Janus face of self-perceived growth: Toward a two-component model of posttraumatic growth. Psychological Inquiry, 15(1), 41-48.Martin, R. A., Kuiper, N. A., Olinger, L. J., & Dance, K. A. (1993). Humor, coping with stress, self-concept, and psychological well-being.Martin, R. A., & Lefcourt, H. M. (1983). Sense of humor as a moderator of the relation between stressors and moods. Journal of personality and social psychology, 45(6), 1313-1324. https://doi.org/10.1037/0022-3514.45.6.1313Martin, R. A., Puhlik-Doris, P., Larsen, G., Gray, J., & Weir, K. (2003). Individual differences in uses of humor and their relation to psychological well-being: Development of the Humor Styles Questionnaire. Journal of research in personality, 37(1), 48-75.Maurer, M. M., & Daukantaitė, D. (2020). Revisiting the organismic valuing process theory of personal growth: A theoretical review of Rogers and its connection to positive psychology. Frontiers in psychology, 11, 1706.Miovic, M., & Block, S. (2007). Psychiatric disorders in advanced cancer. Cancer, 110(8), 1665-1676. https://doi.org/https://doi.org/10.1002/cncr.22980Mishler, E. G. (1991). Research interviewing: Context and narrative. Harvard university press.Mohan, G., T P, A. H., A J, J., K M, S. D., Narayanasamy, A., & Vellingiri, B. (2019). Recent advances in radiotherapy and its associated side effects in cancer—a review. The Journal of Basic and Applied Zoology, 80(1), 14. Doi: 10.1186/s41936-019-0083-5NCI. [June 2, 2023] Retrieved from:https://www.cancer.gov/about-cancer/diagnosis-staging/stagingOgden, J. (1995). Changing the subject of health psychology. Psychology & Health, 10(4), 257-265. https://doi.org/10.1080/08870449508400238，引自林耀盛 (2006)：〈慢性病心理社會模式之探討：以癌症為例〉。《臨床心理學刊》， 3(2)，056-067。Ownby, K. K. (2019). Use of the Distress Thermometer in Clinical Practice. J Adv Pract Oncol, 10(2), 175-179.Park, C. L., & Fenster, J. R. (2004). Stress-related growth: Predictors of occurrence and correlates with psychological adjustment. Journal of Social and Clinical Psychology, 23, 195-215. https://doi.org/10.1521/jscp.23.2.195.31019Paterson, B. L. (2001). The shifting perspectives model of chronic illness. Journal of nursing scholarship, 33(1), 21-26.Riba, M. B., Donovan, K. A., Andersen, B., Braun, I., Breitbart, W. S., Brewer, B. W., Buchmann, L. O., Clark, M. M., Collins, M., Corbett, C., Fleishman, S., Garcia, S., Greenberg, D. B., Handzo, R. G. F., Hoofring, L., Huang, C.-H., Lally, R., Martin, S., McGuffey, L., . . . Darlow, S. D. (2019). Distress Management, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw, 17(10), 1229-1249. https://doi.org/10.6004/jnccn.2019.0048Richman, J. (2007). The Role of Psychotherapy and Humor for Death Anxiety, Death Wishes, and Aging. Omega: Journal of Death and Dying, 54(1), 41-51. https://doi.org/10.2190/D0NX-7V03-W1H0-4614Rodríguez-Prat, A., Pergolizzi, D., Crespo, I., Balaguer, A., Porta-Sales, J., & Monforte-Royo, C. (2022). Control in patients with advanced cancer: an interpretative phenomenological study. BMC Palliative Care, 21(1), 97. https://doi.org/10.1186/s12904-022-00984-7Rogers, C. R. (2008). The actualizing tendency in relation to`motives` and to consciousness. Nebraska Symposium on Motivation, 1963, NE, US; Reprinted from the aforementioned conference.,Rogers, C. R. (2013). A theory of therapy and personality change: As developed in the client-centered framework”. Perspectives in Abnormal Behavior: Pergamon General Psychology Series, 341.Rothbaum, F., Weisz, J. R., & Snyder, S. S. (1982). Changing the world and changing the self: A two-process model of perceived control. Journal of personality and social psychology, 42, 5-37. https://doi.org/10.1037/0022-3514.42.1.5Ruch, W., & Ekman, P. (2001). The expressive pattern of laughter. In Emotions, qualia, and consciousness (pp. 426-443). World Scientific.Saldaña, J. (2009). The Coding Manual for Qualitative Researchers. Sage. https://books.google.com.tw/books?id=OE7LngEACAAJSaunders, C. (2001). The evolution of palliative care. Journal of the royal society of medicine, 94(9), 430-432.Savard, J., Ivers, H., Savard, M. H., & Morin, C. M. (2015). Cancer treatments and their side effects are associated with aggravation of insomnia: results of a longitudinal study. Cancer, 121(10), 1703-1711.Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health psychology, 4(3), 219.Schmidt, K. L., Cohn, J. F., & Tian, Y. (2003). Signal characteristics of spontaneous facial expressions: Automatic movement in solitary and social smiles. Biological psychology, 65(1), 49-66.Schwarzer, R. (1994). Optimism, vulnerability, and self-beliefs as health-related cognitions: A systematic overview. Psychology and health, 9(3), 161-180. Scott, S. K., Lavan, N., Chen, S., & McGettigan, C. (2014). The social life of laughter. Trends in cognitive sciences, 18(12), 618-620.Seligman, M. E. (1999). The president’s address. American psychologist, 54(8), 559-562.Seligman, M. E., & Csikszentmihalyi, M. (2014). Positive psychology: An introduction. In Flow and the foundations of positive psychology (pp. 279-298). Springer.Sellick, S. M., & Edwardson, A. D. (2007). Screening new cancer patients for psychological distress using the hospital anxiety and depression scale. Psychooncology, 16(6), 534-542. https://doi.org/10.1002/pon.1085Smith, J., Harr, Rom, & Langenhove, L. (1995). Rethinking Methods in Psychology https://doi.org/10.4135/9781446221792Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation. Sage.Tedeschi, R. G., & Calhoun, L. G. (2004). " Posttraumatic growth: conceptual foundations and empirical evidence". Psychological Inquiry, 15(1), 1-18.Tsai, J.-S., Wu, C.-H., Chiu, T.-Y., Hu, W.-Y., & Chen, C.-Y. (2005). Fear of death and good death among the young and elderly with terminal cancers in Taiwan. Journal of pain and symptom management, 29(4), 344-351.White, R. W. (1959). Motivation reconsidered: The concept of competence. Psychological Review, 66, 297-333. https://doi.org/10.1037/h0040934，引自洪家暐（2020）：《乳癌病人疾病控制感與生活品質的關係-初探壓力因應的中介效果》（未出版碩士論文）。國立政治大學。WHO. [June 2, 2023] Cancer. Retrived from: https://www.who.int/health-topics/cancer#tab=tab_1Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 10(1), 19-28. 描述 碩士
國立政治大學
心理學系
108752003資料來源 http://thesis.lib.nccu.edu.tw/record/#G0108752003 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) 王郁 zh_TW dc.contributor.author (Authors) Wang, Yu en_US dc.creator (作者) 王郁 zh_TW dc.creator (作者) Wang, Yu en_US dc.date (日期) 2023 en_US dc.date.accessioned 6-Jul-2023 16:57:36 (UTC+8) - dc.date.available 6-Jul-2023 16:57:36 (UTC+8) - dc.date.issued (上傳時間) 6-Jul-2023 16:57:36 (UTC+8) - dc.identifier (Other Identifiers) G0108752003 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/145909 - 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) 108752003 zh_TW dc.description.abstract (摘要) 研究背景：癌症病人自罹癌便面臨一連串生理、心理、社會、與靈性困擾。過往癌末研究多聚焦於疾病對於癌末病人的負面影響，也因此癌末病人研究幾乎等同於受苦的研究。然而，亦有過往研究指出，個體即便在高度疾病壓力狀況下，正向與負向的心理狀態仍可能同時發生。有鑑於目前國內對於癌末病人疾病正向經驗的討論仍相對缺乏，本研究旨在進一步探索癌末病人正向經驗內涵，及其與身心調適間的關聯與意義，期能增進對癌末病人臨終經驗與適應歷程的豐富理解。研究方法：本研究於北部某醫學中心安寧緩和醫療單位進行收案，一共訪問22位門診或住院之癌末病人。研究採半結構式晤談方法進行錄音訪談，過程中鼓勵病人自由談論與癌症經驗有關的想法與感受，錄音檔後續轉錄為逐字稿進行主題分析 (thematic analysis) ，並以資料為導向，歸納出癌末正向經驗重要主題內涵。結果：本研究透過主題分析歸納出癌末病人正向經驗四大主題與十個次主題。四大主題包含 (1) 「順應生命自然秩序」：此主題下再分三項次主題「生老病死是必經之路」、「盡人事聽天命」、「生命是禍福相依，有失有得」。 (2) 「生活秩序的建立」：此主題下的次主題分別為「與疾病共處」、「重新分辨輕重緩急」。 (3) 「正向的人我關係」：此主題下有「深化家人連結」、「良好醫病關係」兩項次主題。 (4) 「當下與來世的盼望」：此主題下有「活在他人心中」、「來世的寄望」，以及「細緻的身心感受」三項次主題。討論：本研究所歸納出之癌末正向經驗主題具有經驗相對性、時間有限性，以及主動因應下的被動性等特徵，同時指出正向經驗亦為轉化經驗，個體從困厄中獲得心理成長的契機。個別主題之內涵亦反映癌末病人透過不同因應策略來面對臨終處境。最後，本研究亦就訪談中所觀察到癌末病人笑容的行為表現，與其臨床意義進行初步討論。 zh_TW dc.description.abstract (摘要) Background: Cancer patients face multiple bio-psycho-social-spiritual issues ever since their diagnosis and throughout the entire disease process, hence a large body of research literature has focused on negative impacts on patients with advanced cancer. However, past studies also indicated that positive and negative experiences or emotions co-exist even when people are in a stressful situation. Given that the positive side of the illness experience is rarely discussed in this population, this study aims to explore the positive experience as well as its possible adaptive functions, in an effort to enrich the understanding of end-of-life experiences and the process of adjustment to illness in advanced cancer patients.Method: A total of 22 end-stage cancer patients were interviewed and recorded in a hospice care setting, including outpatients and hospitalized patients. This study adopted a semi-structure interview in which the interviewees were encouraged to talk about their thoughts and feelings related to cancer experiences. The recorded interviews were later transcribed for a bottom-up inductive approach thematic analysis.Results: 4 main themes and 10 sub-themes of positive experiences in advanced cancer patients were developed from the collected data. The 4 main themes included (1) “Adapt to The Natural Order of Life” subsumed with “ Life Path that Everyone Must Go Through”, “ Do the Best and Leave It To the Fate”, and “Misfortune and Blessings Are Interconnected In Life”. (2) “The Establishment of Life Order” subsumed with “ Living With the Illness” and “Reassessing Priorities”. (3) “Positive Interpersonal Relationships” subsumed with “Deepening Family Bonds” and “ A Good Doctor-Patient Relationship”. (4) “Hope For The Present and Afterlife” subsumed with “ Delicate Sensory and Living Experience of The Body”, “ Believing In The Afterlife” and “ Living In The Hearts of Others”.Conclusion: The inductive themes illustrated the relativeness, time-limitedness, and the passivity under active coping of cancer patients’ end-of-life positive experiences. This study then further indicated that advanced cancer patients’ positive experience is also a transformation process, that gives rise to the possible psychological growth of an individual in adversity. Each theme reflects how patients use different coping strategies to better adjust to the near-death situation. Finally, a preliminary observation of patients’ laughter/smile behavior is also discussed in this study. en_US dc.description.tableofcontents 目次摘要 Iabstract II目次 IV表次 VII圖次 VIII第一章 緒論 1第一節 研究背景 1第二節 文獻回顧 3一、 癌末病人處境 4二、 疾病歷程中的正向論述 8三、 個人的主動性與福祉 11第三節 研究問題 13第二章 研究方法 14第一節 研究參與者 14第二節 研究場域與程序 14第三節 研究工具 16一、 半結構式晤談 16二、 訪談大綱 16第四節 資料分析方法 18第三章 研究結果 23第一節 資料描述 23第二節 癌末病人正向經驗 26一、 順應生命自然秩序 361. 生老病死是必經之路 362. 盡人事聽天命 393. 生命是禍福相依，有失有得 42二、 生活秩序的建立 451. 與疾病共處 452. 重新分辨輕重緩急 50三、 正向的人我關係 521. 深化家人連結 522. 良好醫病關係 57四、 當下與未來的盼望 591. 活在他人心中 602. 來世的寄望 623. 細緻的身心感受 63第四章 討論 66第一節 正負交織的經驗述說 66第二節 正向經驗主題的臨床意義 68第三節 笑的反應及其臨床意義 73一、 臨床現象 731. 愉悅經驗的述說方式 732. 幽默 743. 苦笑 75二、 小結 76第四節 研究貢獻與臨床建議 79一、 研究貢獻 79二、 臨床建議 79第五節 研究限制與未來方向 81一、 研究限制 81二、 未來研究方向 81參考文獻 83附錄一：安寧療護雜誌近十年發表整理 92 zh_TW dc.format.extent 2345111 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0108752003 en_US dc.subject (關鍵詞) 癌末 zh_TW dc.subject (關鍵詞) 正向經驗 zh_TW dc.subject (關鍵詞) 正向轉變 zh_TW dc.subject (關鍵詞) 疾病調適 zh_TW dc.subject (關鍵詞) 主題分析 zh_TW dc.subject (關鍵詞) Advanced cancer en_US dc.subject (關鍵詞) Positive experience en_US dc.subject (關鍵詞) Transformation en_US dc.subject (關鍵詞) Illness adjustment en_US dc.subject (關鍵詞) Thematic Analysis en_US dc.title (題名) 初探癌末病人疾病調適歷程之正向經驗 zh_TW dc.title (題名) Exploring Positive Experiences in The Process of Adjustment to Illness in Advanced Cancer Patients en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 方俊凱(2011)：〈概述失志症候群〉。《安寧療護雜誌》，16(3)，371-379。https://doi.org/10.6537/tjhpc.2011.16(3).8方俊凱、林子涵、畢世萱、李閏華、李佩怡 (2017)：〈癌症末期病人的善終觀點〉。《安寧療護雜誌》，22(3)，288-309。https://doi.org/10.6537/TJHPC.201711_22(3).003王建雅 (2010)：〈八向度幽默風格量表之發展暨其與自尊、人格特質、依附風格關係之探討〉 （未出版博士論文）。國立臺灣師範大學。https://hdl.handle.net/11296/c369gf安寧緩和醫療條例（條文修正日期：民國110年1月20日）。取自： https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020066西蒙德波娃 (2021)：《一場極為安詳的死亡》（周桂音譯）。商周。（原著出版年：1964）[Simone de Beauvoir(2021). Une mort très douche. (G.Y. Zhou. Trans.).Business Weekly. (Original work published in 1964)]余德慧、石世明 (2006) ：《臨終心理與陪伴研究》。心靈工坊。余德慧 (2018) ：《生命轉化的技藝學》。心靈工坊。洪家暐 (2020) ：《乳癌病人疾病控制感與生活品質的關係-初探壓力因應的中介效果》(未出版碩士論文)。國立政治大學。吳啟誠、張瓊云 (2020)：〈主題分析在教育研究上的應用〉。《特殊教育發展期刊》，(69)， 29-42。https://doi.org/10.7034/dse.202006_(69).0003李政洋、陳虹汶、李玉嬋、唐婉如、方俊凱(2011)：〈癌症照顧的自殺防治〉。《內科學誌》，22(5)，335-343。 https://doi.org/10.6314/jimt.2011.22(5).05林耀盛 (2006)：〈慢性病心理社會模式之探討：以癌症為例〉。《臨床心理學刊》， 3(2)， 056-067。洪福建、鄭逸如、邱泰源、胡文郁、陳慶餘、吳英璋(1999)：〈癌末患者的心理社會問題、因應策與負向情緒〉。《應用心理研究》(3)，79-104。Doi: 10.29798/LCXLTX.200702.0002胡文郁(2004)：〈台灣文化脈絡下癌末患者之生活品質〉。《台灣醫學》，8(5)。 https://doi.org/10.6320/FJM.2004.8(5).12高綺吟、胡文郁、邱泰源(2012)：〈癌症病人末期病情告知與心理情緒之相關性研究〉。《安寧療護雜誌》，17(3)，288 – 299，2012。Doi：10.6537/TJHPC.2012.17(3).4陳亭儒、胡文郁、程劭儀、邱泰源 (2013)：〈善終評量之反思〉 。《安寧療護雜誌》，18(1)， 76-88。https://doi.org/10.6537/tjhpc.2013.18(1).7陳啟明 (1996)：〈羅傑斯與斯金納「人」觀之比較研究〉。《教育研究集刊》，101-130。Doi: 10.6910/BER.199603_(37).0004黃文翰、鄭逸如、楊于婷、張琦郁、黃士哲 (2017)：〈如何面對臨終的死亡焦慮－誰該為自身的死亡負責〉。《安寧療護雜誌》，22(2)。 https://doi.org/10.6537/TJHPC.2017.22(2).6鄭逸如、呂碧鴻(1997)：〈癌症末期患者心理層面的照顧〉。《台灣醫學》，1(2)。 https://doi.org/10.6320/FJM.1997.1(2).10衛生福利部國民健康署（2022）：中華民國109年癌症登記報告。取自： https://www.hpa.gov.tw/File/Attach/16434/File_20339.pdf衛生福利部統計處（2021）：世界抗癌日衛生福利部統計通報。取自： https://dep.mohw.gov.tw/DOS/cp-5112-63000-113.html維克多・法蘭可 (2002)：《意義的呼喚：維克多・法蘭克的生命傳記》（鄭納無譯）。 心靈工坊。（原著出版年：1995）[Viktor E. Frankl (2002). Recollections: An Autobiography (N.W. Cheng, Trans.). PsyGarden Publishing. (Original work published in 1995)]維克多・法蘭可 (1967)：《活出意義來: 從集中營說到存在主義》（趙可式、沈錦惠譯）。光啟文化。（原著出版年：1946）[Viktor E. Frankl(1967). Man`s Search for Meaning (K.S. Zhao & J.H. Shen. Trans.). Kuangchi. (Original work published in 1946) ] 卡爾・羅哲斯 (2014)：《成為一個人：一個治療者對心理治療的觀點》（宋文里譯）。左岸文化。（原著出版年：1961）[Carl R. Rogers (2014). On Becoming A Person: A Therapist View of Psychotherapy(W.L.Sung. Trans). Rive Gauche.(Original work published in 1961)]Adler, P. A., & Adler, P. (1987). Membership roles in field research [Article]. Beverly Hills, CA: Sage.An, E., Lo, C., Hales, S., Zimmermann, C., & Rodin, G. (2018). Demoralization and death anxiety in advanced cancer. Psycho‐oncology, 27(11), 2566-2572.Bandura, A. (2006). Toward a Psychology of Human Agency. Perspectives on Psychological Science, 1(2), 164-180. https://doi.org/10.1111/j.1745-6916.2006.00011.xBoyatzis, R. E. (1998). Transforming qualitative information: Thematic analysis and code development. sage.Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.Clarke, D. M., & Kissane, D. W. (2002). Demoralization: its phenomenology and importance. Australian & New Zealand Journal of Psychiatry, 36(6), 733-742.Dans, M., Kutner, J. S., Agarwal, R., Baker, J. N., Bauman, J. R., Beck, A. C., Campbell, T. C., Carey, E. C., Case, A. A., Dalal, S., Doberman, D. J., Epstein, A. S., Fecher, L., Jones, J., Kapo, J., Lee, R. T., Loggers, E. T., McCammon, S., Mitchell, W., . . . Campbell, M. (2021). NCCN Guidelines® Insights: Palliative Care, Version 2.2021: Featured Updates to the NCCN Guidelines. Journal of the National Comprehensive Cancer Network, 19(7), 780-788. https://doi.org/10.6004/jnccn.2021.0033Darwin, C. (2012). The Expression of the Emotions in Man and Animals. CreateSpace Independent Publishing Platform. https://books.google.com.tw/books?id=KtsrngEACAAJ Davis, C. G., Nolen-Hoeksema, S., & Larson, J. (1998). Making sense of loss and benefiting from the experience: two construals of meaning. Journal of personality and social psychology, 75(2), 561.Davis, S., Serfaty, M., Low, J., Armstrong, M., Kupeli, N., & Lanceley, A. (2022). Experiential Avoidance in Advanced Cancer: a Mixed-Methods Systematic Review. Int J Behav Med. https://doi.org/10.1007/s12529-022-10131-4De Faye, B. J., Wilson, K. G., Chater, S., Viola, R. A., & Hall, P. (2006). Stress and coping with advanced cancer. Palliative & supportive care, 4(3), 239-249.de Figueiredo, J. M. (1993). Depression and demoralization: Phenomenologic differences and research perspectives. Comprehensive Psychiatry, 34(5), 308-311. https://doi.org/https://doi.org/10.1016/0010-440X(93)90016-WDerogatis, L. R., Abeloff, M. D., & McBeth, C. D. (1976). Cancer Patients and their Physicians in the Perception of Psychological Symptoms. Psychosomatics, 17(4), 197-201. https://doi.org/https://doi.org/10.1016/S0033-3182(76)71116-2Ekman, P. (2004). Emotions revealed. Bmj, 328(Suppl S5).Engel, G. L. (1980). The clinical application of the biopsychosocial model. Am J Psychiatry, 137(5), 535-544. https://doi.org/10.1176/ajp.137.5.535Epstein, S., & Meier, P. (1989). Constructive thinking: a broad coping variable with specific components. Journal of personality and social psychology, 57(2), 332.Erikson, E. H. (1993). Childhood and society. WW Norton & Company.Fang, C.-K., Chang, M.-C., Chen, P.-J., Lin, C.-C., Chen, G.-S., Lin, J., Hsieh, R.-K., Chang, Y.-F., Chen, H.-W., Wu, C.-L., Lin, K.-C., Chiu, Y.-J., & Li, Y.-C. (2014). A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer. Supportive Care in Cancer, 22(12), 3165-3174. https://doi.org/10.1007/s00520-014-2290-4 Ferris, F., Balfour, H., Bowen, K., Farley, J., Hardwick, M., Lamontagne, C., Lundy, M., Syme, A., & West, P. (2002). A model to guide patient and family care: Based on nationally accepted principles and norms of practice. Journal of pain and symptom management, 24, 106-123. https://doi.org/10.1016/S0885-3924(02)00468-2Folkman, S. (1997). Positive psychological states and coping with severe stress. Social science & medicine, 45(8), 1207-1221.Folkman, S., & Moskowitz, J. T. (2000). Stress, positive emotion, and coping. Current directions in psychological science, 9(4), 115-118.Fredrickson, B. L. (1998). What good are positive emotions? Review of general psychology, 2(3), 300-319.Hem, E., Loge, J. H., Haldorsen, T., & Ekeberg, Ø. (2004). Suicide risk in cancer patients from 1960 to 1999. Journal of clinical Oncology, 22(20), 4209-4216.Hofmann, J., Platt, T., & Ruch, W. (2017). Laughter and smiling in 16 positive emotions. IEEE Transactions on Affective Computing, 8(4), 495-507.Janoff-Bulman, R. (1998). From Terror to Appreciation: Confronting Chance after Extreme Misfortune. Psychological Inquiry, 9(2), 99-101. http://www.jstor.org/stable/1449099Joseph, S., & Linley, P. A. (2005). Positive adjustment to threatening events: An organismic valuing theory of growth through adversity. Review of general psychology, 9(3), 262-280.Keltner, D., & Bonanno, G. A. (1997). A study of laughter and dissociation: distinct correlates of laughter and smiling during bereavement. Journal of personality and social psychology, 73(4), 687.Keyes, C. L., Shmotkin, D., & Ryff, C. D. (2002). Optimizing well-being: the empirical encounter of two traditions. Journal of personality and social psychology, 82(6), 1007. Kissane, D. W., Clarke, D. M., & Street, A. F. (2001). Demoralization Syndrome — a Relevant Psychiatric Diagnosis for Palliative Care. Journal of Palliative Care, 17(1), 12-21. https://doi.org/10.1177/082585970101700103Kuiper, N. A., Grimshaw, M., Leite, C., & Kirsh, G. (2004). Humor is not always the best medicine: Specific components of sense of humor and psychological well-being.Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer publishing company.Maercker, A., & Zoellner, T. (2004). The Janus face of self-perceived growth: Toward a two-component model of posttraumatic growth. Psychological Inquiry, 15(1), 41-48.Martin, R. A., Kuiper, N. A., Olinger, L. J., & Dance, K. A. (1993). Humor, coping with stress, self-concept, and psychological well-being.Martin, R. A., & Lefcourt, H. M. (1983). Sense of humor as a moderator of the relation between stressors and moods. Journal of personality and social psychology, 45(6), 1313-1324. https://doi.org/10.1037/0022-3514.45.6.1313Martin, R. A., Puhlik-Doris, P., Larsen, G., Gray, J., & Weir, K. (2003). Individual differences in uses of humor and their relation to psychological well-being: Development of the Humor Styles Questionnaire. Journal of research in personality, 37(1), 48-75.Maurer, M. M., & Daukantaitė, D. (2020). Revisiting the organismic valuing process theory of personal growth: A theoretical review of Rogers and its connection to positive psychology. Frontiers in psychology, 11, 1706.Miovic, M., & Block, S. (2007). Psychiatric disorders in advanced cancer. Cancer, 110(8), 1665-1676. https://doi.org/https://doi.org/10.1002/cncr.22980Mishler, E. G. (1991). Research interviewing: Context and narrative. Harvard university press.Mohan, G., T P, A. H., A J, J., K M, S. D., Narayanasamy, A., & Vellingiri, B. (2019). Recent advances in radiotherapy and its associated side effects in cancer—a review. The Journal of Basic and Applied Zoology, 80(1), 14. Doi: 10.1186/s41936-019-0083-5NCI. [June 2, 2023] Retrieved from:https://www.cancer.gov/about-cancer/diagnosis-staging/stagingOgden, J. (1995). Changing the subject of health psychology. Psychology & Health, 10(4), 257-265. https://doi.org/10.1080/08870449508400238，引自林耀盛 (2006)：〈慢性病心理社會模式之探討：以癌症為例〉。《臨床心理學刊》， 3(2)，056-067。Ownby, K. K. (2019). Use of the Distress Thermometer in Clinical Practice. J Adv Pract Oncol, 10(2), 175-179.Park, C. L., & Fenster, J. R. (2004). Stress-related growth: Predictors of occurrence and correlates with psychological adjustment. Journal of Social and Clinical Psychology, 23, 195-215. https://doi.org/10.1521/jscp.23.2.195.31019Paterson, B. L. (2001). The shifting perspectives model of chronic illness. Journal of nursing scholarship, 33(1), 21-26.Riba, M. B., Donovan, K. A., Andersen, B., Braun, I., Breitbart, W. S., Brewer, B. W., Buchmann, L. O., Clark, M. M., Collins, M., Corbett, C., Fleishman, S., Garcia, S., Greenberg, D. B., Handzo, R. G. F., Hoofring, L., Huang, C.-H., Lally, R., Martin, S., McGuffey, L., . . . Darlow, S. D. (2019). Distress Management, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw, 17(10), 1229-1249. https://doi.org/10.6004/jnccn.2019.0048Richman, J. (2007). The Role of Psychotherapy and Humor for Death Anxiety, Death Wishes, and Aging. Omega: Journal of Death and Dying, 54(1), 41-51. https://doi.org/10.2190/D0NX-7V03-W1H0-4614Rodríguez-Prat, A., Pergolizzi, D., Crespo, I., Balaguer, A., Porta-Sales, J., & Monforte-Royo, C. (2022). Control in patients with advanced cancer: an interpretative phenomenological study. BMC Palliative Care, 21(1), 97. https://doi.org/10.1186/s12904-022-00984-7Rogers, C. R. (2008). The actualizing tendency in relation to`motives` and to consciousness. Nebraska Symposium on Motivation, 1963, NE, US; Reprinted from the aforementioned conference.,Rogers, C. R. (2013). A theory of therapy and personality change: As developed in the client-centered framework”. Perspectives in Abnormal Behavior: Pergamon General Psychology Series, 341.Rothbaum, F., Weisz, J. R., & Snyder, S. S. (1982). Changing the world and changing the self: A two-process model of perceived control. Journal of personality and social psychology, 42, 5-37. https://doi.org/10.1037/0022-3514.42.1.5Ruch, W., & Ekman, P. (2001). The expressive pattern of laughter. In Emotions, qualia, and consciousness (pp. 426-443). World Scientific.Saldaña, J. (2009). The Coding Manual for Qualitative Researchers. Sage. https://books.google.com.tw/books?id=OE7LngEACAAJSaunders, C. (2001). The evolution of palliative care. Journal of the royal society of medicine, 94(9), 430-432.Savard, J., Ivers, H., Savard, M. H., & Morin, C. M. (2015). Cancer treatments and their side effects are associated with aggravation of insomnia: results of a longitudinal study. Cancer, 121(10), 1703-1711.Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health psychology, 4(3), 219.Schmidt, K. L., Cohn, J. F., & Tian, Y. (2003). Signal characteristics of spontaneous facial expressions: Automatic movement in solitary and social smiles. Biological psychology, 65(1), 49-66.Schwarzer, R. (1994). Optimism, vulnerability, and self-beliefs as health-related cognitions: A systematic overview. Psychology and health, 9(3), 161-180. Scott, S. K., Lavan, N., Chen, S., & McGettigan, C. (2014). The social life of laughter. Trends in cognitive sciences, 18(12), 618-620.Seligman, M. E. (1999). The president’s address. American psychologist, 54(8), 559-562.Seligman, M. E., & Csikszentmihalyi, M. (2014). Positive psychology: An introduction. In Flow and the foundations of positive psychology (pp. 279-298). Springer.Sellick, S. M., & Edwardson, A. D. (2007). Screening new cancer patients for psychological distress using the hospital anxiety and depression scale. Psychooncology, 16(6), 534-542. https://doi.org/10.1002/pon.1085Smith, J., Harr, Rom, & Langenhove, L. (1995). Rethinking Methods in Psychology https://doi.org/10.4135/9781446221792Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation. Sage.Tedeschi, R. G., & Calhoun, L. G. (2004). " Posttraumatic growth: conceptual foundations and empirical evidence". Psychological Inquiry, 15(1), 1-18.Tsai, J.-S., Wu, C.-H., Chiu, T.-Y., Hu, W.-Y., & Chen, C.-Y. (2005). Fear of death and good death among the young and elderly with terminal cancers in Taiwan. Journal of pain and symptom management, 29(4), 344-351.White, R. W. (1959). Motivation reconsidered: The concept of competence. Psychological Review, 66, 297-333. https://doi.org/10.1037/h0040934，引自洪家暐（2020）：《乳癌病人疾病控制感與生活品質的關係-初探壓力因應的中介效果》（未出版碩士論文）。國立政治大學。WHO. [June 2, 2023] Cancer. Retrived from: https://www.who.int/health-topics/cancer#tab=tab_1Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 10(1), 19-28. zh_TW
