[[alternative]]The Meaning of Cancer Pain as a Mediator of the Relationship between Pain and Demoralization

[[abstract]] 本研究將旨在探討癌症病人疼痛與失志狀態的關聯性，再者瞭解病人的疼痛意義對失志的影響，以疼痛意義的觀點介入，期許關注疼痛意義對病人心理健康之影響，提升病人生活品質。本研究為橫斷面研究，採單次問卷調查法，以「臺灣版簡易疼痛量表」、「中文版失志量表」、「自覺癌症疼痛意義量表」為研究工具，研究對象為南部某地區醫院具有疼痛情況之血腫科病人，採立意取樣共60 人，有效問卷60 份，回收率100%。研究資料以spss for 18.0 套裝軟體進行描述性統計、皮爾森積差相關分析、徑路分析，來了解疼痛狀態、自覺癌痛意義與失志彼此之的影響力，發現其直接效果與間接效果徑路，並解釋這些關係之假設，驗證研究者所提出之模式是否存在，研究結論如下：1. 不論癌症病人的疼痛嚴重程度，皆不直接影響失志狀態，僅能作為「間接」影響失志狀態的角色。2. 「疼痛程度」可有效預測疼痛干擾生活程度。3. 「疼痛干擾生活程度」可預測癌症病人失志狀態。4. 疼痛干擾生活程度越多，會以「失落」的疼痛意義詮釋，但「失落」不一定會影響失志。5. 不同的疼痛意義（挑戰與威脅）是中介變項，且在不同失志狀態有明顯轉換徑路。6. 若病人已經出現高失志的情況，不同的疼痛程度皆不造成疼痛意義上的改變，僅有在低失志組上不同的疼痛程度(最痛程度、最輕程度)的疼痛意義才有變化。 根據上述研究結果發現以徑路分析雖可讓故事更完整，但在估算上有限制，未來建議可以單一模型結構方程式取向的徑路分析來驗證本研究模式，對模式的修正更加完整。[[abstract]] This study established the relationship between cancer patients’ pain and demoralization and investigated the effects of the patients’ perceived meanings of the pain on their demoralization, to determine the changes in the patients’ psychological health associated with the meanings of pain and to improve their quality of life. A cross-sectional design was adopted. A single questionnaire (comprising three scales: the Brief Pain Inventory-Taiwan, Demoralization Scale-Mandarin Version, and Perceived Meanings of Cancer Pain Inventory)was administered to 60 oncological patients selected through purposive sampling, with 60 valid responses returned for a return rate of 100%. These data were examined through descriptive statistics, the Pearson product–moment correlation, and path analysis by using SPSS Version 18.0 to determine the correlations among pain characteristics, perceived meanings of cancer pain, and demoralization. Both direct and indirect effect paths were identified in these correlations, and the hypotheses for their interactions were interpreted to validate the model proposed in the study. The findings yielded the following conclusions:1. The intensity of cancer patients’ pain has an indirect, rather than direct, effect on thedemoralization level.2. Pain intensity effectively predicts pain interference.3. Pain interference predicts the demoralization level.4. Regarding patients’ perceived meanings of pain, greater pain interference is interpreted asloss, although this loss does not necessarily affect demoralization.5. The meanings of pain (e.g., “challenge” or “threat”) mediate the demoralization level.6. Changes in the meanings of pain because of pain intensity (whether highest or lowest) canbe found in patients with low levels of demoralization but not in those with high levels. The findings also indicate that, although path analysis established the above correlations,its estimations are limited. Further research should use structural equation modeling to validate and modify the model proposed in this study