開腹・開胸術を受ける患者の術前認知的評価尺度の妥当性・信頼性

Validity and Reliability of the Pre-operative Cognitive Appraisal Scale for Surgical Patient

要旨

　本研究は手術患者の術前認知的評価尺度（以下，POCASとする）の洗練を目的とし，その妥当性・信頼性の検討を行った．本研究はLazarus＆Folkmanの「心理的ストレスと認知的評価と対処に関する理論」を基盤としている．本研究では開腹術・開胸術を受ける手術患者203名（年齢23～83歳）からの回答を得て，4下位尺度29項目の尺度に再構成された．構成概念妥当性は因子分析と理論的予測に基づく妥当性から支持され，信頼性は内的整合性の視点から支持された．第Ⅰ因子は「好機的認知」，第Ⅱ因子は「楽観的自己防衛的認知」，第Ⅲ因子は「覚悟を決めようとする対処選択への認知」，第Ⅳ因子「抑圧的脅威的認知」である．「好機的認知」「楽観的自己防衛的認知」「抑圧的脅威的認知」は一次的評価と考えられ，「覚悟を決めようとする対処選択への認知」は二次的評価と考えられた．POCAS全体の信頼性はCronbach's α係数で.86，下位尺度は.81～.85と高い値を示した．再構成されたPOCASは術前患者の心理的ストレスをアセスメントするためにツールとして有用である．

Abstract

　The purpose of this study was to test validity and reliability of the Preoperative Cognitive Appraisal Scale (POCAS). This study was based on the theory of appraisal, stress and coping of Lazarus ＆ Folkman. Responses to the initial POCAS were obtained from sample of 203preoperative in-patients with laparotomy or thoracotomy.The age of subjects ranged from 23to 83years. The reconstructed POCAS was composed of four factors and 29items. Construct validity was tested through factor analysis and based on the theoretical estimate. Reliability was calculated using Cronbach's alpha coefficient to measure internal consistency. Factor 1was demonstrated to be positive emotion of a good opportunity and toward a good life following this event. Factor 2was demonstrated to be optimistic and self-defense emotion that relies on medical treatment or comparison with other patients. Factor 3was demonstrated to be emotions toward to prepared coping. Factor 4was demonstrated to be emotions of depression and threat. Factor 1, factor 2, and factor 4could be explained in terms of primary appraisal, while factor 3was understood as secondary appraisal. Consequently, the reconstructed POCAS nearly matches Lazarus's theory. Cronbach's alpha coefficient was .86for the whole of the POCAS and ranged from .81to .85for the subscales. This indicates a high reliability of the scale. Validity and reliability of the POCAS were supported. The results suggest that the POCAS may be used as part of assessment of psychological stress in preoperative in-patients.