研究生: |
方格正 Fang Ko-Cheng |
---|---|
論文名稱: |
年輕成人罹癌康復後生命經驗之詮釋 The Young Adults Experiences as Cancer Survivors: a Hermeneutic Phenomenology Research |
指導教授: |
李佩怡
Li, Pei-Yi |
學位類別: |
博士 Doctor |
系所名稱: |
教育心理與輔導學系 Department of Educational Psychology and Counseling |
論文出版年: | 2014 |
畢業學年度: | 102 |
語文別: | 中文 |
論文頁數: | 217 |
中文關鍵詞: | 癌症 、年輕成人 、詮釋現象學 、成人初顯期 |
英文關鍵詞: | cancer, young adulthood, hermeneutic phenomenology, emerging adulthood |
論文種類: | 學術論文 |
相關次數: | 點閱:565 下載:65 |
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前言:年輕癌症病人族群長久以來未受到研究或實務工作者足夠之關注,年輕人相對而言預後較佳,許多人在罹癌康復後仍需回歸原本的生活。儘管癌症已經緩解,但年輕人的生命往往再也不同了。為了提供年輕癌症病人適當的協助,臨床工作者必須對其生命經驗有深入足夠的了解。
研究目的:以詮釋現象心理學為立基,理解曾經罹患癌症的年輕成人在康復後如何詮釋生病經驗以及後續對人生造成的影響。
方法:研究參與者包含五位介於24至35歲之年輕成人,其中3位診斷為淋巴癌、另外兩位則分別為血癌與乳癌。他們在19到26歲之間確診為癌症並接受治療,受訪時距離治療結束的時間約為5至10年間,每位參與者均接受兩次深度訪談,述說有關癌症之生命經驗,包含確診、治療、以及治療結束後之心路歷程。本研究以視框之破裂與新視框的形成作為理解之基礎,分別針對各文本進行文本分析與理解,文本分析方法包含(1)受訪者的生病故事(2)對子分析與普遍視框之辨識(3)詮釋主題 (4)整體性詮釋(5)透過對先前文本的理解來拓展理解。(6)綜合詮釋等六步驟。
結果:本研究除了深入詮釋每一位受訪者所理解之癌症生命經驗與意義之外,亦統整所有的文本以進行綜合詮釋,結果包含「癌症作為邊界經驗」、「人生的中斷與銜接」、「罹患癌症對親密關係與婚姻的阻礙」、「罹患癌症與自我認同的建立」、「網路社群的幫助」、「內在語言的力量」,以及「創造屬於自己的生病意義」等七大主題,並在結論處總結年輕癌症病人的特殊性,提出研究與實務工作層面之建議。
結論:本研究有助於人們深入地理解年輕人生病經驗中的苦、欣賞其堅強與韌性,並認識到其身為人之主體性,將所遭逢之事予以組織、形成意義,並化整為人生的一部分。
Young adulthood is a transitional time in life circle when crucial decisions are made that could influence a person’s future, and having cancer makes the tasks even more challenging. Although increasing literatures have identified the unique psychological issues and the late effects of young cancer survivors, the attention to young people’s survivorship in Taiwan is still limited. The objective of this qualitative research is using hermeneutic phenomenology to understand young adults experience as cancer survivors in Taiwan.
Five participants were recruited from a cancer bulletin board. They were diagnosed and treated during age 19 to 26, and were interviewed 5 to 10 years after their treatments. Three of them were diagnosed with lymphoma, the rest were diagnosed with leukemia and breast cancer. We conduct a qualitative analysis to explore the understanding of the meaning in the text and to identify the main themes.
Seven main themes were identified that reflected survivors’ understanding of the impact of cancer in young adulthood: (1) having cancer as a boundary situation, (2) the interruption and resumption of life, (3) the impact on intimate relationship and marriage, (4) survivorship and self-identity, (5) the help from the cancer bulletin billboard, (6) the strength of inner speech, and (7) young adults create their own meaning of life with cancer.
This research helps us to recognize the challenge of the young cancer survivors, to appreciate their strength and resilience, and to understand their subjectivity as their own meaning makers.
中文部份
中華民國內政部(2013)。性別統計指標。線上檢索日期:2014年5月6日。網址:http://sowf.moi. gov.tw/ stat/gender/ ps03-04.xls
王鈺錤(2009)。歷劫歸來—自兒童癌症魔掌下逃出之青少年的故事。私立高雄學大學護理學研究所碩士論文。
余德慧(2001)。詮釋現象心理學。台北市:心靈工坊。
余德慧、徐臨嘉(1993)。詮釋中國人的悲怨。本土心理學研究,1,301-328。
李維倫、頼憶嫺(2009)。現象學方法論:存在行動的投入。中華輔導與諮商學報,25 ,275-321。
宋淑偵(2009)。新診斷癌症青少年之疾病症狀與復原力。國立國防醫學院護理研究所碩士論文。
金樹人(2010)。心理位移之結構特性及其辯證現象之分析:自我多重面向的敘寫與敘說。中華輔導與諮商學報,28,187–229。
洪麗珍、葉昭幸(2000)。癌症青少年的生活經驗之探討。長庚護理,11,14-24。
徐碧華(2010)。完成治療之癌症青少年與母親的生活經驗。國立國防醫學院護理研究所碩士論文。
高淑清(2008)。質性研究的18堂課—揚帆再訪之旅。台北市:麗文文化。
高淑清(2001)。在美華人留學生太太的生活世界—詮釋與反思。本土心理學研究,16,225-285。
國民健康局(2012)。民國98年癌症登記報告。線上檢索日期:2014年5月6日。網址:http:// www.bhp.doh.gov.tw/BHPNet/Web/Stat/ StatisticsShow.aspx? No=20 1206210001
張榮富(2006)。年齡對擇偶年齡與身高偏好門檻的影響。中華心理學刊,48,275-289。
張榮富(2006)。適婚人口性比例對擇偶年齡偏好的影響:以臺灣與日本大學學歷者為樣本。人文暨社會科學期刊,6,1-11。
畢恆達(1995)。生活經驗研究的反省:詮釋學的觀點。本土心理學研究,4,224-259。
程景琳、廖小雯、林書萱(2009)。臺灣成年初顯期現象初探。未出版之手稿。(引自廖小雯與程景琳,2011。成年初顯期的自我認同狀態, 自我定義記憶之解釋歷程與心理幸福感之關係探討。應用心理研究,51,79-110。)
黃莉婷(2007)。恩儒,我聽見了-我在青春期癌症生存者疾病意義研究之經驗敍說。國立彰化師範大學輔導與諮商學系碩士論文。
楊明磊(2001)。諮商工作者的專業發展—詮釋學的觀點。國立彰化師範大學輔導研究所博士論文。
劉梓潔(2010)。父後七日。台北市:寶瓶文化。
鄧美玲(1996)。青少年癌症患者的住院經驗。私立高雄醫學大學護理學研究所碩士論文。
易之新(譯)(2003)。存在心理治療(原作者:Yalom, I.)。臺北市:張老師文化。(原著出版年:1980)
廖宛如(譯)(2009)。凝視太陽—面對死亡恐懼(原作者:Yalom, I.)。台北市:心靈工坊
西文部份
Adamsa, M. J., Hardenberghe, P. H., Constinea, L. S., & Lipshultz, S. E. (2003). Radiation-associated cardiovascular disease. Critical Reviews in Oncology/Hematology, 45, 55-75.
Arnett, J. J. (1997). Young people's conceptions of the transition to adulthood. Youth and Society, 29, 3-23.
Arnett, J. J. (1998). Learning to stand alone: The contemporary American transition to adulthood in cultural and historical context. Human Development, 41, 295-315.
Arnett, J. J. (2000). Emerging adulthood: a theory of development from the late teens through the twenties. American Psychologist, 55, 469-480.
Arnett, J. J. (2001). Conceptions of the transition to adulthood: perspectives from Adolescence through midlife. Journal of Adult Development, 8, 133-143.
Arnett, J. J. (2004). Emerging adulthood: what is it, and what is it good for? Child Development Perspectives, 1, 68-73.
Badger, S., Nelson, L. J., Barry, C. M. (2008). Perception of transition to adulthood among Chinese and American emerging adults. International Journal of Behavioral Development, 30, 84-93.
Barskova, & Oesterreich, R.(2009). Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: A systematic review. Disability and Rehabilitation, 31, 1079-1033.
Bleyer, A. (2007). Young adult oncology: the patients and their survival challenges. A Cancer Journal for Clinicians, 57, 242-255.
Bleyer W.A., O. L. M., Barr R., & Ries LAG. (2006). Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age, Including SEER Incidence and Survival: 1975-2000. Bethesda: National Cancer Institute.
Boman, B. S. (2011). Narrative Therapy. In M. Watson, & Kissane, D. W. (Ed.), Handbook of Psychotherapy in Cancer Care (pp. 69-77). New York: John Wiley & Sons.
Bonanno, G. A., & Kaltman, S. (1999). Toward an integrative perspective on bereavement. Psychological Bulletin, 125, 760-776.
Breitbart, W., & Applebaum, A. (2011). Meaning-Centered Group Psychotherapy. In M. Watson, & Kissane, D. W. (Ed.), Handbook of Psychotherapy in Cancer Care (pp. 137-148). New York: John Wiley & Sons.
Butler, L. D., Koopman, C., Neri, E. et al. (2009). Effects of supportive-expressive group therapy on pain in women with metastatic breast cancer. Health Psychology, 28, 579–587.
Carpentier, M. Y., Fortenberry, J. D., Ott, M. A., Brames, M. J., & Einhorn, L. H. (2011). Perceptions of masculinity and self-image in adolescent and young adult testicular cancer survivors: implications for romantic and sexual relationships. Psycho-Oncology, 20, 738-745.
Casillas, J., Kahn, K. L., Doose, M., Landier, W., Bhatia, S., Hernandez, J., & Zeltzer L. K. (2010). Transitioning childhood cancer survivors to adultcentered healthcare: insights from parents, adolescent, and young adult survivors. Psycho-Oncology, 19, 982-990.
Chen, C., & Haase. (2008). Games of lives in surviving childhood brain tumors. Western Journal of Nursing Research, 30, 435-457.
Chiarelli, M., & Darlington. (1999). Early menopause and infertility in females after treatment for childhood cancer diagnosed in 1964–1988 in Ontario, Canada. American Journal of Epidemiology, 150, 245-254.
Chochinov, H. M., & McKeen, N. A. (2011). Dignity Therapy. In M. Watson, & Kissane, D. W. (Ed.), Handbook of Psychotherapy in Cancer Care (pp. 79-88). New York: John Wiley & Sons.
Clark, W. (2007). Delayed transitions of young adults. Canadian Social Trends, 11, 13-21.
Classen, C. C., & Spiegel, D. (2011). Supportive-Expressive Group Psychotherapy. In M. Watson, & Kissane, D. W. (Ed.), Handbook of Psychotherapy in Cancer Care (pp. 107-117). New York: John Wiley & Sons.
Clemons M, L., L., & Goss P. (2000). Breast cancer risk following irradiation for Hodgkin's disease. Cancer Treatment, 26, 291-302.
Crogan, N., Evans, B., & Bendel, R. (2008). Storytelling intervention for patients with cancer, part 2: pilot testing. Oncology Nursing Forum, 35, 265-272.
Ericson, E. H. (1968). Identity: Youth and crisis. New York: Norton
Fujimori, M., & Uchitomi, Y. (2009). Preferences of cancer patients regarding communication of bad news: A systematic literature review. Japanese Journal of Clinical Oncology 39, 201-206.
Garpentier, M., Fortenberry, J. D., Ott, M. A., Brames, M. J., & Einhorn L. H. Perceptions of masculinity and self-image in adolescent and young adult testicular cancer survivors: implications for romantic and sexual relationships. Psycho-Oncology, 20, 738-745.
Gilbert, E. S., Stovall, M.,Gospodarowicz, M., van Leeuwen, F. E., Andersson, M. ...Travis, L. B. (2003). Lung cancer after treatment for Hodgkin's disease: Focus on radiation effects. Radiation Research, 159, 161-173.
Green, D. M., Hyland, A., Chung, C. S., Zevon, M. A., & Hall, B. C. (1999). Cancer and cardiac mortality among 15-Year survivors of cancer diagnosed during childhood or adolescence. American Society of Clinical Oncology, 17, 3207-3215.
Grinyer, A. (2009). Life after cancer in adolescence and young adulthood. Oxon: Routledge.
Haase, J. E., & Phillips, C. R. (2004). The adolescent/young adult experience. Journal of Pediatric Oncology Nursing, 21, 145-149.
Hayat, M. J., Howlader, N., Reichman, M. E., & Edwards, B. K. (2007). Cancer Statistics, Trends, and Multiple Primary Cancer Analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. The Oncologist, 12, 20-37.
Hogan, D., & Astone, N. M. (1986). The transition to adultdood. Annual Review of Sociology, 12, 109-130.
Hollen, P. J., Hobbie, W. L., & Finley, S. M. (1997). Cognitive late effect factors related to decision making and risk behaviors of cancer-surviving adolescents. Cancer Nursing, 20, 305-314. .
Inskip, P. D. (2001). Thyroid cancer after radiotherapy for childhood cancer. Medical and Pediatric Oncology, 36, 568-573.
Joseph, S., & Linley, P. A. (2005). Positive adjustment to threatening events: An organismic valuing theory of growth through adversity. Review of General Psychology, 9, 262-280.
Kim, B., & Gillham, D. M. (2013). The experience of young adult cancer patients described through online narratives. Cancer Nursing, 36, 377-384.
Kingma, A., Rammeloo, L. A., van der Does-van den Berg, A., Rekers-Mombarg, L., & Postma, A. (2000). Academic career after treatment for acute lymphoblastic leukaemia. Archives of Disease in Childhood, 82, 353-357.
Kissane, D. W., Bloch, S., Smith, G. C., Miach, P., Clarke, D. M., Ikin, J., Love, A., Ranieri, N., and McKenzie, D. (2003). Cognitive-existential group psychotherapy for women with primary breast cancer: A randomised controlled trial. Psycho-Oncology, 12, 532-546.
Kumar, A. R., & Schapira, L. (2013). The impact of intrapersonal, interpersonal, and community factors on the identity formation of young adults with cancer: a qualitative study. Psycho-Oncology, 22, 1753-1758.
Kuroweck, D., & Fergus, K. D. (2014). Wearing my heart on my chest: dating, new relationships, and the reconfiguration of self-esteem after breast cancer. Psycho-Oncology, 23, 52-64.
Kyngas, H., Kroll, M. E., & Duff, T. (2000). Conceptual analysis of compliance. Journal of Clinical Nursing, 9, 5-12.
Levinson, D. J. (1978). The seasons of a man's life. New York: Ballantine.
Levitt, G. E. (2008). Long-term effects of cancer treatment. In D. G. Kelly, F. (Ed.), Cancer Care for Adolescents and Young Adults(pp. 167-191). Oxford: Blackwell.
Lieberman, M. A., & Goldstein, B. A. (2006). Not all negative emotions are equal: the role of emotional expression in online support groups for women with breast cancer. Psycho-Oncology, 15, 160-168.
Lincoln, Y. S. & Guba, E. G. (1999). Establishing trustworthiness. In A. Bryman & R. Burgess (Eds.), Qualitative Research Volume III (pp. 397-444). London: Sage.
McConnell, A. R. (2011). The multiple self-aspects framework: self-concept r epresentation and its implications. Personality and Social Psychology Review, 15, 3-27.
Meadow, A. T., McKee, L., & Kazak, A. E. (1989). Psychosocial status of young adult survivors of childhood cancer: A survey. Medical and Pediatric Oncology, 17, 466-470.
Meirow, D., & Nugent, D. (2001). The effect of radiotherapy and chemotherapy on female reproduction. Human Reproduction Update, 7, 533-543.
Miedema, B., Hamilton, R., & Easley, J. (2007). From "invicibility" to "normalcy": Coping strategies of young adults during the cancer journey. Palliative and Supportive Care, 5, 41-49.
Neimeyer, R. A. (2001). The language of loss: Grief therapy as a process of meaning reconstruction. In R. A. Neimeyer (Ed.), Meaning reconstruction and the experience of loss (pp. 261-292). Washington, DC: American Psychological Association.
Neimeyer, R. A. (2011). Reconstructing Meaning in Bereavement. In M. Watson, & Kissane, D. W. (Ed.), Handbook of Psychotherapy in Cancer Care (pp. 247-257). New York: John Wiley & Sons.
Nelson, L. J., Badger, S., & Wu, B. (2004). The influence of culthrre in emerging adulthood: Perspectives of Chinese college students. International Journal of Behavioral Development, 28, 26-36.
Neville, K. (2007). Psychosocial long term effects of surviving teenage cancer [Online article]. Retrieved June 20, 2013 from the world wild web http:// www.state.nj.us/ health/ccr/ documents/ 2005_1.pdf
Neville, K. L. (1999). The impact of cancer on adolescent development. European Journal of Oncology Nursing, 3, 253-255.
Noble, A., & Jones, C. (2005). Benefits of narrative therapy: holistic interventions at the end of life. British Journal of Nursing, 14, 330-333.
Park, C., Chmielewski, J., & Blank, T. O. (2010). Post-traumatic growth: finding positive meaning in cancer survivorship moderates the impact of intrusive thoughts on adjustment in younger adults. Psycho-Oncology, 19, 1139-1147.
Park, C. L. (2010). Making Sense of the Meaning Literature: An Integrative Review of Meaning Making and Its Effects on Adjustment to Stressful Life Events. Psychological Bulletin, 136, 257-301.
Rourke, M. T., Hobbie, W. L., & Schwartz, L. (2007). Posttrauamatic stress disorder (PTSD) in young adult survivors of childhood cancer. Pediatric Blood & Cancer, 49, 177-182.
Sadock, B. J., & Sadock, V. A. (2007). Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (10 ed.). Philadelphia: Lippincott Williams & Wilkins.
Shamberger, R. C., Sherins, R. J., & Rosenberg S. A. (1981). The effects of postoperative adjuvant chemotherapy and radiotherapy on testicular function in men undergoing treatment for soft tissue sarcoma. Cancer, 47, 2368-2374.
Smith, S., Davis, S., Wright, D., Chapman, C.,& Whiteson, M. (2007). The experience of teenagers and young adults with cancer--Results of 2004 conference survey. European Journal of Oncology Nursing, 11, 362-368.
Soliman, H., & Agresta, S. V. (2008). Current Issues in Adolescent and Young Adult Cancer Survivorship. Cancer control, 15, 55-62.
Stockton, H., Hunt, N., & Joseph, S. (2011). Cognitive processing, rumination, and posttraumatic growth. Journal of Traumatic Stress, 24, 85-92.
Syse, A., & Aas, G. B. (2009). Marriage after cancer in older adulthood. Journal of Cancer Survivorship, 3, 66-71.
Taylor, S. E. (1983). Adjustment to threatening events: A theory of cognitive adaptation. American Psychologist, 38, 1161-1173.
Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: conceptual f oundations and empirical evidence. Psychological Inquiry, 15, 1-18.
Thompason, K., Palmer, S., & Dyson, G. (2009). Adolescents & young adults: Issues in transition from active therapy into follow-up care. European Journal of Oncology Nursing, 13, 207-212.
Tindle, D., Denver, K., & Lilley, F. (2009). Identity, image, and sexuality in young adults with cancer. Seminars in Oncology, 36, 281-288.
U.S. Bureau of the Census. (1997). Statistical abstracts of the United States: 1997. Washington, DC: Author.
van Dalena, E. C., van der Pal, H. J., c, Kok, W. E., Carona, H. N., & Kremera, L. M. (2006). Clinical heart failure in a cohort of children treated with anthracyclines: A long-term follow-up study. European Journal of Cancer, 42, 3191-3198.
Whyte, F., & Smith L. (1997). A literature of adolescence and cancer. European Journal of Cancer Care, 6, 137-146.
Wiljer, D., Urowitz, S., Barbera, L., et al. (2011). A qualitative study of an Internetbased support group for women with sexual distress due to gynecologic cancer. Journal of cancer education, 26, 451-458.
Winzelberg, A. J., Classen, C., Alpers, G. W., Roberts, H., Koopman, C., Adams, R., Ernst, H., Dev, P., and Taylor, C. B. (2003). Evaluation of an internet support group for women with primary breast cancer. Cancer, 97, 1164-1173.
Wright, J. (2009). Self-soothing —a recursive intrapsychic and relational process: The contribution of the Bowen theory to the process of self-soothing. Australian and New Zealand Journal of Family Therapy 30, 29-41.
Zablotska, L. B., Matasar, M. J., & Neugut, A. I. (2007). Second malignancies after radioation treatment and chemotherapy for primary cancer. In Ganz, P. A. (Ed.), Cancer Survivorship(pp. 225-237). New York: Springer.
Zebrack, B., & Walsh-Burke, K. (2004). Advocacy Needs of Adolescent and Young Adult Cancer Survivors: Perspectives of Pediatric Oncology Social Workers. Journal of Psychosocial Oncology, 22, 75-87.
Zebrack, B. J. (2011). Psychological, social, and behavioral issues for young adults with cancer. Cancer, 117, 2289-2294.
Zeltzer, L. K. (1993). Cancer in adolescents and young adults psychosocial aspects: Long-term survivors. Cancer, 71, 3463-3468.