胡蓮珍HWU, LIEN-JEN王韻茹WANG, YUN-JUYUN-JUWANG護理學系碩士班2026-10-282026-08-1220262026-07-07https://handle.ncl.edu.tw/11296/mwa7vxhttps://scholars.csmu.edu.tw/handle/123456789/34786背景：肺癌在台灣為癌症死亡率首位。臨床照護多偏於症狀護理，但其心理症狀亦影響著患者後續疾病治療及調適。疾病詮釋即為個體健康受威脅時所產生的疾病感受、情緒及採取因應行為。不確定感為癌症患者常見心理問題，會影響尋求疾病相關訊息的能力，當情緒無法適應時，會降低治療遵從性，影響疾病預後與調適。本研究欲藉由疾病詮釋了解患者個人信念及不確定感，探討影響患者因應行為的因子。目的：探討肺癌初診斷患者疾病詮釋、疾病不確定感及因應行為之相關性。方法：本研究採橫斷式研究，立意取樣及結構式問卷調查，於中部某醫學中心胸腔內科門診及病房進行收案。量表包括中文簡易版疾病知覺量表（Brief Illness perception Questionnaire, CBIPQ）、中文版Mishel疾病不確定感量表（Mishel Uncertainty in Illness Scale, MUIS）、中文版Jalowiec因應行為量表（Jalowiec Coping Scale, JCS）。使用G*Power 3.1版本，效應（effect size）為0.15，統計檢力（power）設定80%，考慮問卷流失率，增加10％個案數，預估收案數為130人。以SPSS 28版進行百分比、平均值與標準差及多元迴歸進行統計分析。結果：本研究共回收有效問卷130份。個案整體疾病詮釋總分為49.20±9.22分，顯示個案對疾病抱持較負向之認知與情緒，其中以「高度關切自身疾病」得分最高；個案疾病不確定感總分為64.11±13.08分（總分125分，中位數75分），顯示患者在確立診斷後疾病不確定感受屬偏低狀態，此結果推測大致與近年醫療資訊普及及網路科技發展有關；整體因應行為屬中等頻率，顯示個案面臨壓力時，採取「問題取向」之主動解決行為顯著多於「情緒取向」之宣洩行為。相關性分析顯示，教育程度較高者之疾病詮釋顯著較負向；中年期與教育程度較低者的疾病不確定感顯著較高。疾病詮釋之認知層面與疾病不確定感呈顯著正相關（r=.38）；而疾病不確定感之「不明確性」與「複雜性」皆與情緒取向因應行為呈顯著正相關。多元迴歸分析顯示，疾病複雜性感受（β=.312）與疾病詮釋認知層面（β=-.228）能有效預測問題取向因應行為；疾病複雜性感受（β=.425）亦為情緒取向因應行為之顯著預測因子，為整體因應行為最關鍵之決定因素。 建議：臨床醫護團隊應於肺癌患者確診初期，及早評估其疾病不確定感與心理感受。針對「疾病複雜性感受」較高之個案，應實施分階段、個別化的臨床衛教，加強常見症狀的預測性指導與自我照護計畫，以降低其認知不確定感並提升控制感。此外，建議未來研究可結合質性訪談，或採用縱貫性研究設計，追蹤患者在不同治療階段之疾病適應與心理調適歷程，以發展更完善的抗癌照護介入方案。Background: Lung cancer ranks first in cancer mortality in Taiwan. Clinical care is mostly biased towards symptomatic care, but its psychological symptoms also affect the follow-up disease treatment and adjustment of patients. Illness representation it refers to the feeling of illness, emotions and coping behaviors that arise when an individual's health is threatened. Uncertainty is a common psychological problem in cancer patients, it will affect the ability to seek disease-related information, and when emotions cannot adapt, it will reduce treatment compliance and affect disease prognosis and adjustment. This study intends to understand patients' personal beliefs and uncertainties through disease interpretation, and to explore the factors that affect patients' coping behavior.Purpose : Explore the correlation of illness representation, uncertainty and coping behavior of patients with newly diagnosed lung cancer.Methods: This study adopts a cross-sectional study, intentional sampling and structured questionnaire survey, and accepts cases in the chest medicine outpatient clinic and ward of a medical center in central Taiwan. Scale tool includes chinese version Brief Illness perception Questionnaire(CBIPQ), chinese version Mishel Uncertainty in Illness Scale(MUIS), chinese version Jalowiec Coping Scale(JCS). Use G*Power 3.1 version, The effect size is 0.15, and the statistical power is set to 80%, considering the loss rate of questionnaires, increase the number of cases by 10%, and the estimated number of cases accepted is 124. Statistical analysis of percentage, mean and standard deviation and multiple regression with SPSS version 28.Outcome: A total of 130 valid questionnaires were analyzed. The mean score for overall illness representation was 49.20±9.22, indicating a relatively negative cognitive and emotional perception of the disease, with "illness concern" scoring the highest. The mean score for overall illness uncertainty was 64.11±13.08, which was below the scale's median (total score of 125, median of 75), demonstrating that the patients experienced a low-to-moderate level of uncertainty after diagnosis. This result is presumed to be associated with the popularization of medical information and the rapid development of internet technology in recent years. In terms of coping behaviors, the overall utilization was at a moderate frequency. When facing stress, patients used "problem-focused" active problem-solving behaviors significantly more than "emotion-focused" behaviors. Correlation analysis indicated that a higher educational level was significantly associated with a more negative illness representation; middle-aged patients and those with lower educational levels experienced significantly higher illness uncertainty. The emotional dimension of illness representation was significantly and positively correlated with illness uncertainty (r = .38). Furthermore, both the "ambiguity" and "complexity" dimensions of illness uncertainty were significantly and positively correlated with emotion-focused coping behaviors.Multiple regression analysis revealed that perceived complexity (β = .312) and the cognitive dimension of illness representation (β = -.228) were significant predictors of problem-focused coping behaviors. Moreover, perceived complexity (β = .425) was also a significant predictor of emotion-focused coping behaviors, serving as the most critical determinant affecting overall coping behaviors.Recommendations: Clinical healthcare teams should conduct early assessments of illness uncertainty and psychological perceptions in newly diagnosed lung cancer patients. For patients with higher "perceived complexity," structured, multi-stage, and individualized clinical health education should be implemented, focusing on predictive symptom management and self-care plans to reduce cognitive uncertainty and enhance their sense of control. Furthermore, future studies are recommended to incorporate qualitative interviews or adopt longitudinal research designs to track patients' illness adaptation and psychological adjustment processes across various treatment stages, thereby developing more comprehensive oncology care intervention protocols.肺癌初診斷疾病詮釋疾病不確定感因應行為Newly diagnosed lung cancerIllness representationIllness uncertaintyCoping behaviorthesis