대장암 환자의 분노와 회복탄력성과의 관계

다국어 초록 (Multilingual Abstract)

This study is a descriptive correlation study to determine the degree of anger and resilience of patients with colorectal cancer and to identify the relationship between anger and resilience.
Korean version of STAXI(State-Trait Anger Expression Inventory) was used to measure anger, which was developed by Spielberger(1988), and revised and standardized by Chon(1997). In order to measure resilience, the Korean version of Connor-Davidson Resilience scale was used, which was developed by Connor & Davidson (2003), and revised and standardized by Baek(2010).
Data for this study was collected from September 29, 2017 to November 30, 2017. Participants were 108 adult patients aged 19 and over who were admitted to Y university hospital in Seoul for the diagnosis of colon cancer. On the day before surgery, 103 questionnaires were analyzed among 108 questionnaires distributed using structured self - report questionnaires.
The collected data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, and multiple linear regression using IBM SPSS statistics program 23.0.

1) The participants were 50.5% for males and 49.5% for females and the mean age was 58.57 years. Unemployed persons accounted for the highest percentage (38.8%), 75.9% of the participants had a high school education or higher and 59.2% had a job. 79.6% of the participants were married, and 74.8% of the main care giver was the spouse. Of the participants, 53.4% were rectal cancer, 46.6% were colon cancer. 74.8% experienced symptoms before colorectal cancer diagnosis, among them 72.8% experienced the most changes in stools such as hematochezia, constipation, thinning and diarrhea. 76.9% of the participants were diagnosed within 3 months before admission, and 85.4% were not metastasis status.

2) The average score for state anger of patients with colorectal cancer was 13.71 ± 4.94 out of 40. The average trait anger was 19.72 ± 6.48 out of 40 and anger expression was 47.38 ± 8.65 out of 96. The mean anger temperament was 10.61 ± 3.59 and anger response was 9.11 ± 3.26. The mean anger in was 16.57 ± 3.46, anger out was 15.05 ± 3.40, anger control was 15.76 ± 3.33. The average score for resilience of the participants was 65.95 ± 16.51 on the scale of 100.

3) State anger of the participants had higher male than female (t=2.329, p=.022), was higher who had no religion than who had religion(t=-2.683, p=.009), and which was higher when the main caregiver was family than not a family member(t=2.865, p=.013). The state anger was higher than that of the other cases, that cancer removal was possible by endoscopic procedure(F=2.967, p=.036) at the time of initial diagnosis, and was higher the patients who were not very much worried about forming stoma than who were not worried about forming stoma at all(F=3.213, p=.026).
Trait anger of participants was higher male than female(t=2.317, p=.023), was higher who had no religion than who had religion(t=-2.568, p=.013), and was higher the patients who were not very much worried about forming stoma than the other cases(F=4.134, p=.008).
Anger expression was higher in the group whose medical expenses was paid by children, parents, or workplace support than self or insurance(F=4.662, p=.012).

4) The relationship between the participants’ anger and resilience showed that the level of state anger(β = -. 392, p = .004) and anger out(β = -. 337, p = .019) were lower, and the level of anger control (β = 374, p = .005) was higher, the resilience was increased. The explanatory power was 13.8%.

In conclusion, state anger and trait anger were higher in men than in women and were higher who had no religion than who had religion. The resilience of patients with colorectal cancer was higher with lower level of state anger, anger out, and with higher level of anger control. Therefore, it is necessary to develop a nursing intervention effectively controlling the anger of patients with colorectal cancer to find ways to increase resilience.

국문 초록 (Abstract)

본 연구는 대장암 환자의 분노와 회복탄력성 정도를 확인하고, 분노와 회복탄력성의 관계를 파악하기 위한 서술적 상관관계 연구이다.
연구 도구로는 분노를 측정하기 위하여 Spielberger(1988)가 개발한 상태-특성 분노표현 척도(State-Trait Anger Expression Inventory, STAXI)를 전겸구 외(1997)가 번안, 표준화한 한국판 STAXI를 사용하였고, 회복탄력성을 측정하기 위하여 Connor & Davidson(2003)에 의해 개발된 Connor-Davidson Resilience scale을 백경숙 등(2010)이 번안, 표준화한 한국판을 사용하였다.
자료 수집은 서울 소재 Y대학병원에 대장암을 진단받고 수술을 받기 위해 입원한 만 19세 이상의 성인 환자 108명을 대상으로 2017년 9월 29일부터 2017년 11월 30일까지 이루어졌다. 수술 전날에 구조화된 자가보고식 설문지를 이용하여, 배부된 총 108부의 설문지 중 103부의 설문지를 분석하였다.
수집된 자료는 IBM SPSS statistics program 23.0을 이용하여 기술통계, 평균검정(independent t-test), 분산분석(one-way ANOVA), 다중회귀분석(multiple linear regression) 방법으로 분석하였다.


1) 대상자는 남자가 50.5%, 여자가 49.5%이고, 평균 연령은 58.57세였다. 무교가 38.8%으로 가장 많았고, 대상자의 75.9%가 고등학교 졸업이상의 학력이었고, 59.2%의 대상자가 직업이 있었다. 대상자의 79.6%가 기혼상태로, 주 돌봄 제공자도 배우자인 경우가 74.8%로 가장 많았다. 대상자의 53.4%가 직장암, 46.6%가 결장암이었고, 74.8%가 대장암 진단 전 증상을 경험하였으며, 그중 72.8%가 혈변, 변비, 가는 변, 설사 등의 대변양상의 변화를 가장 많이 경험하였다. 대상자의 76.9%가 입원일 기준으로 3개월 내에 진단을 받았으며, 85.4%가 전이되지 않은 상태였다.

2) 대상자의 상태분노는 40점 만점에 평균 13.71±4.94점이었고, 특성분노는 40점 만점에 평균 19.72±6.48점, 분노표현은 96점 만점에 평균 47.38±8.65점이었다. 특성분노의 하위 영역별로는 분노기질 평균 10.61±3.59점, 분노반응 평균 9.11 ±3.26점이었고, 분노표현의 하위 영역별로는 분노억제 평균 16.57±3.46점, 분노표출 평균 15.05±3.40점, 분노억제 평균 15.76±3.33점으로 나타났다. 대상자의 회복탄력성은 100점 만점에 평균 65.95±16.51점이었다.

3) 대상자의 상태분노는 여자보다 남자가(t=2.329, p=.022) 높았고, 무교인 경우가 종교가 있는 경우보다 높았으며(t=-2.683, p=.009), 주 돌봄 제공자가 가족이 아닌 경우보다 가족인 경우가 높았다(t=2.865, p=.013). 처음 진단받았을 당시 내시경 시술만으로도 암 제거가 가능하다고 진단받은 경우가 다른 경우들보다 상태분노가 높았으며(F=2.967, p=.036), 장루 형성에 대한 걱정과 두려움에 대해 거의 걱정하지 않는 대상자가 전혀 걱정하지 않는 대상자보다 상태분노가 높았다(F=3.213, p=.026).
특성분노는 여자보다 남자가 높았고(t=2.317, p=.023), 무교인 경우가 종교가 있는 경우보다 높았으며(t=-2.568, p=.013), 장루형성에 대한 걱정과 두려움에 대해 거의 걱정하지 않는 대상자가 가장 높았다(F=4.134, p=.008).
분노표현은 진료비를 본인이나 보험으로 부담하는 경우보다 자녀나 부모, 직장 등에서 지원받아 부담하는 경우가 높았다(F=4.662, p=.012).

4) 대상자의 분노와 회복탄력성의 관계는 상태분노(β=-.392, p=.004)와 분노표출(β=-.337, p=.019)의 수준이 낮을수록, 분노조절(β=.374, p=.005)의 수준이 높을수록 회복탄력성이 높아지며, 13.8%의 설명력을 보였다.

결론적으로 대장암 환자의 경우 남자가 여자보다, 종교가 없는 대상자가 종교가 있는 대상자보다 상태분노와 특성분노 모두 높았다. 대장암 환자의 회복탄력성은 상태분노, 분노표출이 낮을수록, 분노조절이 높을수록 높았다. 따라서 효과적으로 대장암 환자의 분노를 조절하여 회복탄력성을 높일 수 있는 방안을 모색하는 간호 중재의 개발이 필요하다.