第五章 討論與建議
第三節 研究限制與建議
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檢驗患者之正向情緒、心理症狀對因應策略特殊的關聯性。由於過去缺乏因應策 略如何影響正向情緒之實證研究，因此，本研究多增加正向情緒的評估。本研究 的初步結果可做為後續相關研究設計與理論推演之參考。
二、研究結果
因應關係與心理症狀的關係結果上發現，與以往文獻所得到結果並不一致。
依據 Lazarus(2000)的觀點，他認為因應策略對心理福祉感的影響會受到情境和個 人的特質所決定。他認為根據症狀不同困擾程度，因應策略會有不同的效果。這 意味著因應策略和心理症狀的對應關係並無法用單一的角度來看待，如:因應策 略與心理症狀的關係會隨著不同的因應策略和情緒組合而有所變化。
三、研究方法
本研究採縱貫性研究，探索患者手術半年內正向情緒、心理症狀與因應策略 的變化關係，突破橫斷性研究無法提供連續性、穩定性和個體改變的相關資訊。
第三節 研究限制與建議
(一) 研究樣本
本研究只收集 113 位中部某一間醫院的乳癌患者，屬於小規模的研究樣本，
研究對象都以女性為主，有其樣本的獨特形。因此推論到國內乳癌患者須謹慎和 保守，需考慮地域性所帶來的差異。建議未來的研究可蒐集不同的區域、其它癌 症種類，如:大腸癌或是口腔癌，作為不同疾病、不同性別的比較，驗證因應策 略與心理症狀在其他癌症患者身上是否均有此現象發生，讓結果更具代表性。由 於受限於人力和時間，因此無法以結構方程模式進行分析，建議可增加受試者。
(二) 研究方法
本研究採縱貫性研究，在術後半年內共施測兩次，因此因應策略與心理症狀 關係的推論僅屬於短期的變化。若推論到更長期的變化應更謹慎，建議持續追 蹤，並採用採階層線性模式(Hierarchical Linear Modeling，簡稱 HLM)進行分 析，如:焦慮不一定是不具適應性。了解不同的因應策略與焦慮的關係，並掌握
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整體的變化性。此外，在 Brief COPE 因素分析可採用驗證性因素分析進行因素 結構的驗證。
(三) 研究工具
本研究係以國外翻譯之中文測量評估工具，雖在本次的研究中獲得良好的信 效度，但仍屬於初期發展階段。建議應廣泛施測在不同的癌症類別，以建立更穩 定的信效度供日後研究工具之信效度參考。本研究針對正向情緒的評估只有 5 題，日後的研究可多增加正向情緒的評估。
(四) 正向情緒、心理症狀與因應策略在臨床上的應用
本研究結果可提供學術界了解乳癌患者其正向情緒、心理症狀與因應策略間 之關係，因而在未來在處遇上可提供臨床及諮商心理針對此結果之實際運用與訓 練之參考。本研究發現愈使用趨近因應，正向情緒愈多，因此臨床工作者可以檢 視病患的因應策略，並透過個別和團體治療著重增進患者有效的因應策略，教導 病人趨近因應策略，如:接受、正向重釋、計畫等問題解決技巧，鼓勵患者採用 更積極有效的因應行為。此外，由於憂鬱分數的高低會影響著患者使用趨近因應 策略的頻率，因此臨床工作者可藉由篩檢憂鬱分數，透過相關的心理衛教文宣，
或是以認知行為治療，因認知行為治療相較於支持性治療更能改善患者的生活品 質和心情，尤其是憂鬱情緒(Compas, Haaga, Keefe, Leitenberg, & Williams, 1998)，即時提供乳癌患者必要的心理社會介入，提昇其適應癌症的能力。
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