乳癌存活者的壓力因應歷程之探索性研究

Abstract

本研究目的在於建構乳癌患者特有的壓力因應模式。研究者整合乳癌相關現象、壓力概念、因應概念等文獻，提出歷程性的壓力因應模式，此模式假設乳癌相關的壓力源包括「醫療過程或疾病進展相關的急性壓力」、「醫療或疾病造成的慢性壓力」、「主觀預期的醫病相關壓力事件」、「主觀預期的醫病相關壓力事件」、「其他壓力事件」，以及「負向情緒狀態」等，乳癌相關的因應則包括「問題聚焦取向的因應策略」、「情緒聚焦取向的因應策略」、「逃避取向的因應策略」，以及「尋求支持取向的因應策略策略」等；壓力因應模式亦假設乳癌相關的壓力與因應之間，具有時間向度上的歷程性變化關係。本研究的受訪者為被診斷為第二期乳癌的女性患者。研究者採取焦點式的半結構深度訪談方式，請受訪者自由地報告乳癌相關的壓力因應經驗。研究結果顯示，壓力因應模式可清楚描述受受訪者的主觀經驗，包括界定壓力源類別、區辨因應策略取向並描述其內涵，並釐清壓力源與因應的歷程性變化。對於個別受訪者的主觀經驗採取壓力因應歷程的分析，可深入探討特定壓力源與特定因應之間的交互作用，或歸納出受訪者特有的壓力因應傾向。此外，受訪者的主觀報告還顯示對於癌症復發等預期性壓力源所採取的預先因應。本研究屬於描述性質的探索性研究，適合應用於乳癌患者的個案分析。

Reviewing research articles of bresat cancer, stress, and coping, this study purposed to construct a theoretical model specifying the stress-coping process of women with breast cancer. The model (SCMBC) proposed three assumptions: first, stressors encountered by women with breast cancer could be categorized into “acute stressors induced by medical procedures and those developed along with disease progression”, “chornic stressors induced by medical procedures and those developed along with disease progression”, “subjective anticipatory stressors that related to oncoming medical procedures and possible disease progression”, “other life stressors”, and “negative emotional status”. Second, women of breast cancer would cope these stressors with different strategies, including “problem-focused coping strategies”, ”emotional-focused strategies”, “avoidance strategies”, and “support seeking coping strategies”. Third, SCMBC could display relationships between stressors and coping actions arranged in a time sequence to reveal the characteristics of individual stress-coping style. Five women, diagnosed with stage-II breast cancer, were interviewed with semi-structured focusing interview method. They freely report their subjetive stress-coping experiences related to medical procedures and those developed along with disease progression. The results display clearly the interviewees’ subjective experiences, including stressor categories, coping strategies adopted, the persistent interactive process between stresss and coping, the individual’s specific stress-coping style, and the proactive coping in advance to prevent potentially stressful event before it occurs. It was found that SEMBC was suitable for case study of breast cancer women, especially for the understanding of how breast cancer women cope their stressors effectively.