父母在癌症病童疾病治療階段的不確定感及其相關因素探討

Abstract

本研究目的旨在探討父母在癌症病童疾病治療階段的不確定感及其相關因素。研究方法採橫斷式研究設計，以立意取樣方式於台灣北部地區兩家醫學中心之兒童癌症病房進行收案，共收集103位癌症病童父母為研究對象，包含40位父親及63位母親。研究工具包括:兒童基本資料表、父母基本資料表、Mishel雙親知覺不確定感量表、本土化雙親不確定感量表、情境焦慮量表及健康生活品質量表。資料分析以SPSS Statistics 17.0 軟體進行統計分析，以描述性分析、t檢定、變異數分析、皮爾森相關係數分析。 研究結果，母親平均年齡40.5±5.7歲，父親平均年齡44.5±4.6歲，研究發現：1.癌童父母親整體在不確定感受，以Mishel雙親不確定感量表測量結果依序為「模稜兩可」最高，其次為「不可預測性」，再者為「不明確性」，最低為「缺乏訊息」；以本土化雙親不確定感量表測量結果依序為「不可預測性」最高，其次為「模稜兩可」，再者為「不明確性」，最低為「缺乏訊息」。2.本研究癌童基本屬性與父母親不確定感受皆無顯著相關。3.癌童父母親基本屬性以「教育程度」、「婚姻狀況」及「家庭月收入」與父母親不確定感受有顯著相關。即教育程度愈低、喪偶及月收入小於6萬元的癌童家庭，父母的不確定感愈高。4.癌童父母親之情境焦慮與不確定感為正相關，生活品質與不確定感為負相關。5.癌症病童父親與母親的不確定感並無因性別角色而有所差異(t=.029，p=.977)。6.分析父母親整體之「本土化雙親不確定感量表」與「Mishel雙親知覺不確定感量表」相關(r=.842，p=.000)、與「情境焦慮量表」相關(r=.549，p=.000)及與「健康生活品質量表」相關(r=-.510，p=.000)，皆達顯著相關(p<0.05)，表示本土化雙親不確定感量表有良好的效度。 依據研究目的針對癌童父母的不確定感，研究者自擬「本土化雙親不確定感量表」，與「Mishel雙親知覺不確定感量表」比較，雖然次量表得分順位上有差異，但已有初步不錯的信效度，且僅12題可使參與研究者減少作答時間及增加填答意願，若能進一步進行更多研究修訂改善，相信可以成為一簡易、受歡迎、有效的並符合本土文化的台灣版雙親不確定感量表。 本研究證實不確定感與焦慮及生活品質有相關性，因此了解癌童父母的不確定感是相當重要。醫護人員不僅照護癌童的健康，也需注意父母親的心理層次的需求。對於社經地位較低及喪偶者多予以關心及協助，依其個別家庭提供相關健康教育及資訊，以緩解父母親不確定感，盡可能協助家庭維持適應狀態。

The study aims to explore the uncertainty and its related factors of parents with a cancer child during their treatment. The study used a cross-sectional study design with purposive sampling from two medical centers of northern Taiwan children's cancer ward. The valid samples are 103 parents of children with cancer for the analysis of the study, including 40 fathers and 63 mothers. The structure questionnaires were including: the children's demographic variables, the parents demographic variables, Mishel Parent Perception of Uncertainty Scale (PPUS), the researcher-developed Taiwan Parent’s Uncertainty Scale (TPUS), State Anxiety Inventory (SAI), and 36-item Short-Form Health Survey (SF-36). The data were analyzed by SPSS 17.0 window and descriptive statistics, descriptive analysis, t test, ANOVA, Pearson correlation coefficient analysis. The study found the mean age of mothers was 40.5 ± 5.7 years, the mean age of fathers was 44.5 ± 4.6 years. The major findings of this study were as below：1. Cancer children of parents score of uncertainty four levels were as the followings by PPUS. Scores of subscales in order 'ambiguity' is the highest, followed by the 'unpredictability', 'lack of clarity', and 'lack of information'; By TPUS, scores of subscales in order 'unpredictability' is the highest, followed by the 'ambiguity', 'lack of clarity', and 'lack of information”. 2. In this study, parent’s uncertainty was not related to the cancer children demographic variables. 3. Three demographic characteristics of parents were related to PPU, including the level of education, marital status and family income. That is, when parents with lower level of education, widows and monthly family income lower than 60 thousand Taiwan dollars would have higher level of uncertainty. 4. Parent’s uncertainty was significantly positively correlated with anxiety and significantly negatively correlated with the quality of life. 5. There is no difference between the uncertainty of the father and the mother of children with cancer (t=.029, p=.977). And 6. The TPUS was significantly correlated with PPU (r=.842, p=.000)、SAI (r=.549, p=.000) and SF-36 (r=- .510, p=.000) with a p value less than .05, Based on the current finding, the TPUS has preliminary convergent validity with above three measures. Although there is difference between the sequence of subscales of both PPU and TPUS in current study, the TPUS might provide as a short and easy tool to quick measure the status of uncertainty of parents with a cancer child in Taiwan clinical setting. However there is a need for further research to validate the new developed too. The findings of current study support that the parents with a cancer child would have higher uncertainty which would lead a lower level of quality of life. It is important to pay attention to parent’s mental status when take care of their cancer child. In particular, the parents with lower level of education, widows, and lower monthly family income need more attention.