第五章 研究討論
第三節 研究貢獻與限制
一、 研究貢獻
1. 對創傷後成長的現象有更多元的了解。本研究從兩個面向來看創傷後成 長與因應策略的關係，不再只是將創傷後成長視為因應後的產物，而是 進一步看到創傷後成長確有其自我增強的效果。從研究結果可以看到創 傷後成長在整個乳癌因應歷程中扮演的角色，它可以促發個體在不同階 段採用不同的因應策略，而這樣的發現支持自我增強的觀點，正如同 Calhoun 與 Tedeschi（2006）以及 Janoff-Bulman（2006）提到，創傷後 成長也許並非充分反映個體當下適應狀況的指標（如幸福感、正負向情 緒等），但是它可以使個體更有能量面對未來的挑戰，讓個體在面臨其 他可能的威脅時做好準備，也就是帶有一種保護作用。因此在看待創傷 後成長的現象時，可以將其視為乳癌因應歷程中的一個良性因子，不必 然會減少負向的反應（如：逃避因應）但是可以促進正向反應（如：「自 我導向因應」與「社會導向因應」）。因此在實務上，過去協助乳癌患者 度過漫長的治療歷程時，經常將注意力放在減少負向的反應上，而此研 究的發現則提供了不同的思考方向，即可藉由讓患者從他知覺到的成長 中獲得力量，進而促使其採取較正向的反應。
2. 研究方法上的貢獻。過去研究創傷後成長與因應策略時，多採用迴歸預 測，而本研究採用交叉延宕分析，可以進一步控制變項的自我迴歸效果 及殘差間的共變，並同時檢驗兩個方向的預測效果，將更有助於釐清創 傷後成長與因應策略的關係。
3. 考量治療歷程，為實務上提供介入方向。研究發現不同治療階段著重不 同的因應策略，因此在密集治療時期，可以教導患者較多自我導向的因 應策略，或藉由讓患者看到自己的成長進而採取較有效的因應方式；而 在追蹤時期則可以協助患者覺察到較正向的互動經驗，以促使其主動運
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用社會資源來因應壓力。
4. 對台灣乳癌患者社會導向因應的歷程有更多瞭解。由於華人在尋求支持 時會考量人際關係的和諧，因此未來在提供社會支持時，可以從建立和 諧穩定的關係著手，如果能讓患者在密集治療的階段，便從支持網絡的 互動中感知到正向經驗，將有助於轉化成個體的力量，進而使患者在之 後追蹤與休養的階段，願意更主動運用社會資源來因應壓力。
二、 研究限制與建議
1. 本研究的追蹤時間為一年，若將創傷後成長視為是假設世界的重新建立
（Calhoun & Tedeschi, 2004），可能會需要更長時間的觀察，因此建議 未來可增加追蹤的時間點，以進一步釐清創傷後成長中此一面向的變 化。
2. 本研究樣本取自中部某醫院之乳癌患者，因此在結果的類推上需要較保 守，建議未來可收集不同區域的資料，以更廣泛地探討台灣乳癌婦女的 因應歷程與成長經驗。
3. 本研究未發現創傷後成長與逃避因應之間的預測效果，建議未來可加入 負向指標（如：憂鬱症狀）進一步探討，以釐清逃避因應在乳癌患者的 因應歷程中所扮演的角色。
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附錄
附錄一 問卷
第一部分 基本資料
基本資料 病歷號碼： 研究編碼：
姓名 填寫日期 年 月 日 出生日期 民國 年 月
日 性別:□女 □男 年齡: 歲
連絡電話 (白天) (晚上) 手機:
聯絡地址
職業 □農 □工 □商 □服務業 □家管 □無業 □退休 □其他 家庭收入 □1～3 萬 □3～6 萬 □6～10 萬 □10 萬以上
子女數 □無 □1 □2 □3 □4 □4 個以上
教育程度: □未入學 □小學 □國中 □高中、職 □專科 □大學(以上) 婚姻狀況：□未婚 □已婚 □再婚 □同居 □分居 □離婚 □喪偶
宗教信仰：□無 □民間信仰 □佛教 □道教 □基督教 □天主教 □一貫道
□回教 □其他
目前您癌症的期數為： □零期 □第一期 □第二期 □第三期 其他_________
是否復發：□是 □否 復發狀況 診斷癌症的日期：民國 年 月
是否轉移？□是 □否 總共轉移____處
轉移部位：□肺 □骨頭 □肝 □腦 □腸道 □腹腔 □淋巴 □脊椎 □其他 您是否曾經罹患其他癌症? (若是，請列出)
乳癌的手術經驗
您接受手術的時間：民國 年 月 您接受手術的形式：□全部切除 □部分切除
您接受手術的時間：民國 年 月 您接受手術的形式：□全部切除 □部分切除