TACE治疗原发性肝癌患者家庭照顾者生活质量及影响因素研究

发布时间：2018-04-23 03:14

本文选题：肝癌 + 照顾者　；参考：《复旦大学》2014年硕士论文

【摘要】：研究背景原发性肝癌(Primary liver cancer, PLC,以下简称肝癌)是世界范围内发病率最高的恶性肿瘤之一,发病率呈上升趋势,且一半以上发生在我国。指南推荐经导管动脉化疗栓塞(transcatheterhepatic arterial chemoembolization, TACE)是不能手术的患者最主要的姑息治疗手段。肝癌对于整个家庭是一件严重的创伤性事件,疾病本身和治疗引起的症状负担,严重影响患者和家庭照顾者(family caregiver, FCG)身心健康。在整个疾病的发展轨迹过程中,家庭照顾者面临多重挑战。研究表明,大部分FCG遭受震惊、沮丧、焦虑和抑郁等和照顾负担的影响。随着患者病情加重,持久的照顾患者,FCG的照顾能力会不断下降,从而影响照顾质量。所以,对FCG进行评估、缓解FCG照顾负担在患者的整体护理过程中不可或缺。而研究肝癌患者对照顾者生活质量的影响是解决上述问题的一种很好的方式。健康相关生活质量(Health related quality of life HRQOL,以下简称生活质量)是病人对生理、情感、精神、社会、行为等方面健康和功能的感知,受疾病、治疗状况、个人特征、社会经济地位的影响,是个多维概念。很少有研究同时研究患者和照顾,甚至未见研究TACE肝癌患者及其照顾者。本研究的目的是了解肝癌患者相关变量和照顾者反应之间的关系,这些关系随着时间的变化,及影响照顾者身心健康的潜在不良影响因素。本研究作者根据Lazarus与Folkman的观点,综合运用应激反应理论、癌症家庭照顾经验概念模型。这些理论提出了病人和照顾者的相关变量影响照顾经验,上述所以变量反过来影响照顾者的身心健康。因此,我们假设患者和照顾者相关变量影响照顾者反应,上述所有的又会影响照顾者心理和生理健康,并且通过结构方程模型方法来验证假设。研究目的构建照顾者生活质量的综合模型,验证并解释模型,分析各变量之间的因果关系及直接和间接的作用效果。研究方法采用横断面调查与纵向调查相结合的方法。通过理论研究,形成本研究的假设。收集501对介入治疗肝癌患者-家庭照顾者的资料,对假设进行验证。患者问卷包括：一般资料问卷、记忆症状评估量表(MSAS)、抑郁量表(CES-D)。照顾者问卷包括：一般资料问卷、照顾反应量表(CRA)、照顾负担量表(SRB)、社会支持问卷(SSRS)、抑郁量表(CES-D)、生活质量量表(QOL-scale FAMILY).研究结果1.本研究发展了介入治疗特异性症状条目和修订了QoLScale-FAMILY量表在肝癌患者家庭照顾者中的应用。新增3肝癌特异性条目(发热、眼睛皮肤发黄、隔逆),内容效度CVI为0.95。在QoLScale-FAMILY原量表的基础上,删除了条目5、18、21、23、24、30、31、32、34、35。探索性因素分析,得到4个因子：生理状况(1、2、3、4、6、9)、心理状况(7、8、10、11、12、36、37)、社会功能(24、26、27、28、29、33)、家庭困扰(13、14、15、16、17、19、20、22),覆盖27个条目的中文版肝癌患者家属生活质量表(QoLScale-FAMILY),验证性因素显示数据拟合良好(GFI=0.959,AGFI=0924, CFI=0.985, RMSEA=0.031, χ2/df=1.472)。2.构建了照顾者生活质量影响因素模型。照顾反应(时间受打扰维度,经济困扰,照顾总负担和自尊)在前因变量和结局指标之间(抑郁和生理健康)扮演者重要的中介作用。情景变量作为前因变量对照顾结局既有直接又有间接的影响作用,分别是患者的症状特征、患者抑郁、照顾者抑郁、社会支持。(1)结构方程模型显示,抑郁对生活质量有显著的负向影响作用(B=(-0.380)-(-0.490),P0.05)。其中,抑郁对生理维度和心理维度影响显著(B=(-0.214)一(-0.333),P0.05)。同时,照顾反应在抑郁和生活质量之间起中介作用B=(-0.157)-(-0.353)。(2)FCG抑郁多因素分析显示,社会支持、患者抑郁、患者总困扰、照顾负担、FCG时间受打扰进入回归方程,有显著影响(P0.05),解释24.7%的变异量。结构方程模型显示,消极反应(时间受打扰和经济问题)对FCG抑郁有显著的直接影响作用(标准化回归系数B=0.525,p0.05)。社会支持、患者抑郁、总困扰、照顾负担通过照顾反应的中介作用对抑郁起间接影响作用。(3)社会支持对照顾者抑郁和生活质量起间接影响,中介变量是照顾反应,社会支持与抑郁呈负相关,与生活质量呈正相关。(4)照顾反应(时间受打扰、经济问题、自尊维度)与社会支持呈正相关,与患者抑郁呈负相关。时间受打扰和经济问题与生活质量四个维度均成负相关；自尊维度与FCG生活质量的心理状况维度呈正相关,与家庭困扰维度呈负相关。研究结论1. QoLScale-FAMILY量表的因子载荷顺序、因子条目结构应考虑到不同癌症人群的特点进行修订。本研究修订的肝癌版家庭照顾者QoLScale-FAMILY量表信效度好,适用于此类人群,未来可尝试推广。2.研究结果建议医生、护士和其他健康提供者应认到照顾者的需求。定期对照顾者开展访谈,并评估其在照顾患者的过程中的感受、需求、和鼓励。旨在增强照顾者的应对能力从而保证照顾者为患者提供高质量照护。3.关注癌症患者的生活质量,提高社会支持,促进照顾者正向的感受,减轻照顾消极反应,从而提高FCG生活质量和照顾的质量。
[Abstract]:Background primary liver cancer (Primary liver cancer, PLC, hereinafter referred to as liver cancer) is one of the world's highest incidence of malignant tumors, and the incidence is on the rise, and more than half of them occur in China. The guide recommends that transcatheter arterial chemoembolization (transcatheterhepatic arterial chemoembolization, TACE) is Unoperable. The most important palliative treatment of the patient. Liver cancer is a serious traumatic event for the whole family, the disease itself and the burden of treatment, which seriously affect the physical and mental health of the patient and family caregivers (family caregiver, FCG). Most FCG suffers from shock, depression, anxiety and depression and the impact of care burden. As the patient's condition increases, the patient's care ability will continue to decline, and the care quality of the FCG will affect the quality of care. Therefore, the assessment of FCG is necessary to alleviate the burden of FCG care in the overall nursing process of the patients. The effect of the quality of life of the caregivers is a good way to solve these problems. Health related quality of life HRQOL (hereinafter referred to as the quality of life) is the patient's sense of health and function in physiological, emotional, mental, social, and behavioral aspects, disease, treatment, personal characteristics, and social economic status. The purpose of this study is to understand the relationship between the related variables of the liver cancer patients and the response of the caregivers, and the relationship between the patients with liver cancer and the care of the caregivers. These relationships have changed over time and the potential adverse effects on the physical and mental health of the TACE. According to the view of Lazarus and Folkman, the author combines the theory of stress response and the conceptual model of the family care experience of cancer. These theories suggest that the dependent variables of the patient and caregiver affect the care experience, so the variables in turn affect the physical and mental health of the caregivers. Therefore, we assume that the patients and the caregivers are dependent on the related variables. The response of the caregivers, all of the above will affect the psychological and physiological health of the caregivers, and through the structural equation model method to verify the hypothesis. The purpose of this study is to construct a comprehensive model of the quality of life of the caregivers, to verify and explain the model, to analyze the causal relationship between the variables and to the direct and indirect effects. A combination of cross-sectional survey and longitudinal investigation. Through theoretical study, the hypothesis of this study was formed. 501 cases of interventional therapy for liver cancer patients, family caregivers, were collected to verify the hypothesis. The questionnaire included the general data questionnaire, the memory symptom assessment scale (MSAS), the Depression Scale (CES-D). The caregiver questionnaire included general information. The questionnaire, the care response scale (CRA), the care burden scale (SRB), the social support questionnaire (SSRS), the Depression Scale (CES-D), the quality of life scale (QOL-scale FAMILY). The results of the 1. study developed the specific symptoms items of interventional therapy and the application of the revised QoLScale-FAMILY scale in the family caregivers of the liver cancer patients. 3 new liver cancer was added. Heterosexual items (fever, eye skin yellowish, inverse), content validity CVI was 0.95. based on the QoLScale-FAMILY original scale, deleted item 5,18,21,23,24,30,31,32,34,35. exploratory factor analysis, obtained 4 factors: physiological status (1,2,3,4,6,9), psychological status (7,8,10,11,12,36,37), social function (24,26,27,28,29,33), family distress ( 13,14,15,16,17,19,20,22), the quality of life (QoLScale-FAMILY) of the family members of the Chinese liver cancer patients was covered with 27 items. The confirmatory factor showed that the data fitted well (GFI=0.959, AGFI=0924, CFI=0.985, RMSEA=0.031, Chi 2/df=1.472).2. constructed the caregiver's life quality influence factor model. The care reaction (time disturbed dimension, economic distress) Disturbance, taking care of the total burden and self-esteem) is an important mediator between the antecedent variables and the outcome indicators (depression and physical health). The situational variables, as antecedents, have both direct and indirect effects on the outcome of care, respectively, the symptoms of the patients, the depression of the patients, the depression of the caregivers, and the social support. (1) the structural equation model Depression had a significant negative impact on quality of life (B= (-0.380) - (-0.490), P0.05). Among them, depression had significant effects on physiological and psychological dimensions (B= (-0.214) 1 (-0.333), P0.05). At the same time, the mediating effect of care between depression and quality of life (-0.157) - (-0.353). (2) multi factor analysis of FCG depression showed social support. Holding, patient depression, patient's total distress, burden of care, FCG time being disturbed to enter the regression equation, have significant influence (P0.05), explain 24.7% variation. The structural equation model shows that negative reaction (time being disturbed and economic problems) has a significant direct effect on FCG depression (standardized regression coefficient B=0.525, P0.05). Social support, patients Depression, total distress, care burden has an indirect effect on depression through the intermediary role of care response. (3) social support has an indirect effect on depression and quality of life, mediator variables are care response, social support is negatively related to depression, and the quality of life is positively related. (4) care response (time being disturbed, economic problems, self-esteem) Dimension) was positively correlated with social support and negatively correlated with depression. Time being disturbed and economic problems were negatively correlated with the four dimensions of quality of life; the dimension of self-esteem was positively correlated with the psychological status dimension of FCG quality of life, and negatively correlated with the dimension of family distress. The factor load sequence of the 1. QoLScale-FAMILY scale was the cause of the factor load. The subitem structure should be revised to take into account the characteristics of different cancer groups. The QoLScale-FAMILY scale of the family caregivers of the liver cancer version of this study is good in reliability and validity. It is suitable for this kind of people. In the future, the results of the.2. study can be tried to suggest that doctors, nurses and other health providers should recognize the needs of the caregivers. And assess the feelings, needs, and incentives in the process of caring for the patients. The aim is to enhance the coping ability of the caregivers to ensure that the caregivers provide the patients with high quality care for the.3. to pay attention to the quality of life of the cancer patients, improve social support, promote the positive feelings of the caregivers, reduce the negative reactions to the care of the patients, and thus improve the quality of life and the quality of life of the FCG. Quality of care.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R473.73

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