探討初診斷慢性病患者之個人建構組型——「威脅指標——台灣版」之臨床應用

Grouping Patients with Newly Diagnosed Chronic Illness by Their Personal Constructs: A Clinical Application of the ''Threat Index-Taiwan Version''

研究目的：本研究運用以個人建構理論為基礎所編製的工具「威脅指標—台灣版（TI-T）」，探討初診斷慢性病患者是否有不同的建構特性，並進行初步分類，以及探討建構特性、心理威脅與因應之間的關係。研究方法：研究對象為初檢查出異常或確定診斷之慢性病患者，研究工具為TI-T與慢性病因應評量表。收案期間為2009年2至5月，總計收到69位有效患者。研究結果：（1）初診斷患者依TI-T對偶核心建構做分組，可分出「探索組」、「正向反應組」、「負向反應組」三組。「探索組」的「自我」與「慢性病」都是處在探索狀態的建構較多；「正向反應組」的「自我」與「慢性病」建構都較正向；「負向反應組」對「自我」的建構較正向，但「慢性病」建構較負向。（2）在心理威脅上，「負向反應組」患者的「慢性病對自我的威脅」較另二組高，「正向反應組」患者的「慢性病對理想自我的威脅」較另二組低。（3）在因應上，「探索組」的「病情認知」顯著低於「正向反應組」與「負向反應組」。（4）三組中，「探索組」可能是臨床上特別需要關注的一個組別，他們對「慢性病」與「自我」都較為困惑，因應上也較不易有計畫性的因應行為或使用情緒導向的因應行為。研究結論：本研究結果顯示利用TI-T能對慢性病患者進行有效的分組，並說明各組之建構特性及可能的臨床意涵，當搭配探討患者的心理威脅與因應，則更顯現TI-T在疾病調適之評估與介入上的臨床價值，TI-T將可能是極具實用性的臨床工具。

Purpose: This study explores the personal construct of patients newly diagnosed with chronic disease (CD) and groups them using the “Threat Index-Taiwan Version” (TI-T). The relationship among personal construct, psychological threat, and coping is also investigated. Methods: Participants were 69 patients newly diagnosed with CD. The measures used were the TI-T and the Rating Scale of Coping with Chronic Disease. This research was undertaken from February to May 2009. Results: (1) Patients newly diagnosed with CD were grouped according to the TI-T paired core constructs: exploration, positive, and negative groups. The exploration group showed more negative constructs of self and CD, the positive group was more positive on both, and the negative group had more positive constructs of self and more negative constructs of CD. (2) The relation of psychological threat of CD to the self was higher for the negative group than the other two groups, the psychological threat of CD to prefer self of the positive group was lower than for the other two groups. (3) The recognition of illness of the exploration group was lower than for the other two groups. (4) The exploration group seemed more confused about self and CD, and indicated more difficulty coping. They probably need more attention and care. Conclusions: By combining the data regarding psychological threat and coping, the benefit of applying TI-T for clinical assessment and intervention is confirmed. The results support that patients with CD can be grouped by TI-T scores. TI-T is a practical instrument in clinical work.