27-5 The Effects of Discrepant Views on Care Giving between Gynecological Cancer Patients and their Primary Caregivers
The purpose of this study was to investigate the relationship among depressive ten- dency, quality of life, and the perceived discrepancy between the care given and received in gynecological cancer patients and their primary caregivers and to explore the moderat- ing effect on the caregiver-patient relationship. In order to evaluate depressive symptoms, quality of life, and awareness of caring behavior and care needs, Care-Awareness Scale (CAS), the American Center of Epidemiology Study-Depression Scale (CES-D)-Chinese edition, and The World Health Organization Quality of Life shorter version (WHOQOL- BREF) Taiwan version were administered. Ninety two patients suffering from the illness for at least three years and sixty five caregivers holding this role for at least six months (61 dyad units paired) were included as participants. There were three major findings. First, both the patients and their caregivers were characterized by elevated depressive symptoms and low quality of life. Second, the caregiver role and the patient role are more important factors than the relationships between the patients and the caregivers in moderating the patients and their caregivers’ emotional states. Third, path analysis indicated that depres- sive mood was the most important mediator variable accounting for the perceived discrep- ancy between care given and received. Perceived discrepancies from the dyadic caring be- havior given and received affected the patients’ depression, patients’ depression affected patients’ and caregivers’ quality of life, and finally, caregivers’ depression affected care- givers’ quality of life. The implications and limitations of the findings were discussed fur- ther.
Keywords depressive tendency、gynecological cancer patient、primary caregiver、quality of life、discrepancy.
Reference
行政院衛生署(2008)。衛生資訊—衛生統計—死因統計。台北:行政院衛生署。
余德慧、石世明、夏淑怡、王英偉(2006)。病床陪伴的心理機制:一個二元複合模式的提出。應用心理研究,29,71-100。
林耀盛(2006)。聆聽受苦之聲:從「咱們」關係析究慢性病照顧。應用心理研究,29,183-212。
胡至家(2005)。憂鬱傾性、親密關係與乳癌術後婦女身體意象關係之探討。高雄醫學大學行為科學研究所,碩士論文,未出版,高雄。
姚開屏(2002 a)。台灣版世界衛生組織生活品質問卷之發展與應用。臺灣醫學,6(3),193-200。
姚開屏(2002 b)。健康相關生活品質概念與測量原理之簡介。臺灣醫學,6(2),183-192。
姚開屏(2005)。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。
侯懿真(2006)。悲悼的歧異:癌症新近喪偶者傷逝療癒歷程的建構詮釋。高雄醫學大學行為科學研究所碩士論文,未出版,高雄。
陳怡靜(2001)。婦癌患者身體心像、社會支持和憂鬱的對照研究。高雄醫學大學護理研究所碩士論文,未出版,高雄。 陳麗如(2004)。居家照護病患主要照顧者人格韌性健康狀況與生活品質相關性探討。高雄醫學大學護理研究所碩士論文,未出版,高雄。
湯梅芬(2004)。居家運動訓練指導改善癌症病患睡眠障礙與生活品質成效之探討。台北醫學大學護理學研究所碩士論文,未出版,高雄。
蔡盈盈(2006)。乳癌患者家屬照顧者的因應,社會支持與生活品質之相關性初探。國立成功大學行為醫學研究所碩士論文,未出版,台南。
Banthia, R., Malcarne, V. L., Varni, J. W., Ko, C. M., Sadler, G. R., & Greenbergs, H. L.(2003). The effects of dyadic strength and coping styles on psychological distress in couples faced with prostate cancer. Journal of Behavioral Medicine, 26, 31-52.
Barrera, M., Sandler, I., & Ramsay, T. (1981). Preliminary development of a scale of social support: Studies on college students. American Journal of Community Psychology, 9, 435-447.
Baumgarten, M., Battista, R. N., Infante-Rivard, C., Finley, J. A., Becker, R., & Gauthier, S. (1992). The psychological and physical health of family members caring for an elderly person with dementia. Journal of Clinical Epidemiology, 45(1), 61-70.
Ben-Zur, G., Gilbar, O., & Lev, S. (2001). Coping with breast cancer: Patient, spouse, and dyad models. Psychosomatic Medicine, 63(1), 32-39.
Berg-Weger, M., Rubio, D. M., & Tebb, S. S. (2000). Depression as a mediator: Viewing caregiver well-being and strain in a different light. Families in Society: The Journal of Contemporary Human Services, 81(2), 162-173.
Bleiker, E. M., Pouwer, F., van der Ploeg, H. M., Leer, J. W., & Ader, H. J. (2000). Psychological distress two years after diagnosis of breast cancer: Frequency and prediction. Patient Education and Counseling, 40(3), 209-217.
Cheng, C. (1998). Getting the right kind of support: Functional differences in the types of social support on depression for Chinese adolescents. Journal of Clinical Psychology, 54(6), 845-849.
Cheung, J., & Hocking, P. (2004). Caring as worrying: The experience of spousal carers. Journal of Advanced Nursing, 47, 475-482.
Chien, C. P., & Cheng, T. A. (1985). Depression in Taiwan: Epidemiological survey utilizing CES-D. Seishin Shinkeigaku Zasshi (Psychiatria et Neurologia Japonica), 87(5), 335-338.
Cohen, D., Luchins, D., Eisdorfer, C., Paveza, G., Ashford, J. W., & Gorelick, P. (1990). Caring for relatives with Alzheimer’s disease: The mental health risks to spouses, adult children and other family caregivers. Behavior, Health and Aging, 1(3), 171-182.
Cull, A., Stewart, M., & Altman, D. C. (1995). Assessment of and intervention for psycho- social problems in routine oncology practice. British Journal of Cancer, 72, 229-235.
Dakof, G. A., & Taylor, S. E. (1990). Victims' perceptions of social support: What is help- ful from whom? Journal of Personality and Social Psychology, 58(1), 80-89.
Downe-Wamboldt, B., Butler, L., & Coulter, L.(2006). The relationship between meaning of illness, social support, coping strategies, and quality of life for lung cancer patients and their family members. Cancer Nursing, 29(2), 111-119.
Feldman, B. N., & Broussard, C. A. (2006). Men’s adjustment to their partners’ breast cancer: A dyadic coping perspective. Health Social Work, 31, 117-127.
Hagedoorn, M., Sanderman, R., Buunk, B. P., & Wobbes, T. (2002). Failing in spousal caregiving: The 'identity-relevant stress' hypothesis to explain sex differences in care- giver distress. British Journal of Health Psychology, 7(4), 481-494.
Hipkins, J., Whitworth, M., Tarrier, N., & Jayson, G. (2004). Social support, anxiety and depression after chemotherapy for ovarian cancer: A prospective study. British Jour- nal of Health Psychology, 9, 569-581.
Hodges, L. J., Humphris, G. M., & Macfarlane, G. (2005). A meta-analytic nvestigation of the relationship between the psychological distress of cancer patients and their carers.Social Science and Medicine, 60(1), 1-12.
Hurt, G. J., McQuellon, R. P., & Barrett, R. J. (1994). After treatment ends: Neutral time.Cancer Practice, 2, 417-421.
Kalnins, I. (2006). Caring for the terminally ill: Experiences of Latvian family caregiver.International Nursing Review, 53, 129-135.
Lim, J-W., & Zebrack, B. (2004). Caring for family members with chronic physical illness: A critical review of caregiver literature. Health and Quality of Life Outcome, 2(50). Retrieved June 25, 2006 from http://www.hqlo.com/content /2/1/50
Little, M., & Sayers, E. J. (2004). While there’s life...Hope and the experience of cancer. Social Science and Medicine, 59, 1329-1337.
Manne, S., Taylor, K., Dougherty, J., & Kemeny, N. (1997). Supportive and negative responses in the partner relationship: Their association with psychological adjustment among individuals with cancer. Journal of Behavioral Medicine, 20(2), 101-125.
Martire, L. M., Stephens, M. A., Druley, J. A., & Wojno, W. C. (2002). Negative reactions to received spousal care: Predictors and consequences of miscarried support. Health Psychology, 21(2), 167-176.
Meshefedjian, G., McCusker, J., Bellavance, F., & Baumgarten, M. (1998). Factors associated with symptoms of depression among informal caregivers of demented elders in the community. Gerontologist, 38(2), 247-253.
Middelboe, T., Ovesen, L., Mortensen, E. L., & Bech, P. (1994). Depressive symptoms in cancer patients undergoing chemotherapy: A psychometric analysis. Psychotherapy and Psychosomatics, 61(3-4), 171-177.
Milne, D. J., Mulder L. L., Beelen H. C. M., Schofield, P., Kempen, G. I. J. M., & Aranda, S. (2006). Patients’ self-report and family caregivers’ perception of quality of life in patients with advanced cancer: How do they compare? European Journal of Cancer Care, 15, 125-132.
Newby, N. M. (1996). Chronic illness and the family life-cycle. Journal of Advanced Nursing, 23(4), 786-791.
Newport, D. J., & Nemeroff, C. B. (1998). Assessment and treatment of depression in the cancer patient. Journal of Psychosomatic Research, 45, 215-237.
Newsom, J. T. (1999). Another side to caregiving: Negative reactions to being helped.Current Directions in Psychological Science, 8(6), 183-187.
Noonan, A. E., & Tennstedt, S. L. (1997). Meaning in caregiving and its contribution to caregiver well-being. Gerontologist, 37(6), 785-794
Norton, T. R., Manne, S. L., Rubin, S., Hernandez, E., & Carlson, J. (2005). Ovarian cancer patients’ psychological distress: The role of physical impairment, perceived unsupportive family and friend behaviors, perceived control, and self-esteem. Health Psychology, 24, 143-152.
O’Connor, D. W., Pollitt, P. A., Roth, M., Brook, C. P. B., & Reiss, B. B. (1990). Memory complaints and impairment in normal, depressed and demented elderly persons iden- tified in a community survey. Archives of General Psychiatry, 47, 224-227.
O’Reilly, D., Connolly, S., Rosato, M., & Patterson, C. (2008). Is caring associated with an increased risk of mortality? A longitudinal study. Social Science & Medicine, 67, 1282-1290.
Pearman, T. (2003). Quality of life and psychosocial adjustment in gynecologic cancer survivors. Health and Quality of Life Outcomes, 1(33). Retrieved Novenber 19, 2006 from http://www.hqlo.com/content/1/1/33
Pitts, M., & Phillips, K. (2000). The psychology of health: An introduction (2nd ed.). Lon- don, UK: Routledge.
Reynolds, J. S., & Perrin, N. A. (2004). Mismatches in social support and psychosocial adjustment to breast cancer. Health Psychology, 23(4), 425-430.
Sarafino, E. P. (2008). Health psychology: Biopsychosocial interactions (6th ed.). New York, NY: John Wiley & Sons.
Sellick, S. M., & Crooks, D. L. (1999). Depression and cancer: An appraisal of the literature for prevalence, detection and practice guideline development for psychological interventions. Psycho-Oncology, 8, 315-333.
Silverstein, M., Chen, X., & Heller, K. (1996). Tou much of a good thing? Intergenerational soaul support and pecchologial well-being of older parents. Journal of Marni- age and Family, 58, 970-982.
Smerglia, V. L., & Deimling, G. T. (1997). Care-related decision-making satisfaction and caregiver well-being in families caring for older members. The Gerontologist, 37(5), 658-665.
Soothill, K., Morris, S. M., Harman, J. C., Thomas, C., Francis, B., & MCIllmurray, M. B. (2002). Cancer and faith. Having faith- does it make a difference among patients and their informal carers? Scandinavian Journal of Caring Sciences, 16(3), 256-263.
Van Manen, M.(1998). Modalities of body experience in illness and health. Qualitative Health Research, 8(1), 7-24.
Wenzel, L., DeAlba, I., Habbal, R., Kluhsman, B. C., Fairclough, D., & Krebs, L. U. (2005). Quality of life in long-term cervical cancer survivors. The Women’s Oncology Review, 5, 157-158.
Winkeler, M., Filipp, S.-H., & Aymanns, P. (2006). Direct and indirect strategies of mobilization as determinants of social support provided for cancer patients. Journal of Applied Psychology, 36, 248-267.
Yao, G., Chung, C. W., Yu, C. F., & Wang, J. D. (2002). Development and verification of validity and reliability of the WHOQOL-BRIEF Taiwan version. Journal of Formosan Medical Assosiation, 101(5), 342-351.