乳腺癌患者生命意义感、经验性回避与创伤后成长水平的纵向调查

发布时间：2018-01-07 12:37

本文关键词：乳腺癌患者生命意义感、经验性回避与创伤后成长水平的纵向调查　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的(1)初步探索乳腺癌患者的生命意义感、经验性回避以及创伤后成长的现状及其随时间的动态变化;(2)初步探索乳腺癌患者不同疾病阶段生命意义感、经验性回避与创伤后成长的相关关系;(3)为临床上更有效地激发创伤后成长从而恢复和提升乳腺癌患者的身心机能提供有益的指导。研究方法运用方便抽样的方法抽取2015年9月-2016年9月于大连医科大学附属第一医院就诊且初次确诊为原发性乳腺癌,拟行乳腺癌简化根治术、术后常规化疗的患者80例。研究工具包括一般资料调查表(General Information Questionnaire)、生命意义感量表汉化版(China Meaning in Life Questionnaire,C-MLQ)、接纳与行动问卷第二版(Acceptance Action Questionnaire,AAQ-II)以及创伤后成长评定量表(Chinese-post-traumatic growth inventory,C-PTGI)。于手术前一天(T_1)向患者介绍本次调查研究的目的、意义及配合要点,待患者同意后,签署知情同意书,随后,发放本课题的研究者设计的一般资料调查表,C-MLQ,AAQ-II与C-PTGI量表进行问卷调查;分别于手术后第三天(T_2)、术后28天即患者第一次化疗期间(T_3)以及患者完成末次(第四/六/八次)化疗期间(T_4)发放C-MLQ,AAQ-II与C-PTGI量表进行纵向调查。问卷当场发放,当场收回,建立医患交流微信群,以利于回答患者治疗和康复期间的问题,便于与研究对象形成良性的护患关系,体现人性化与个性化护理;大幅度改善患者的依从性。双人录入所得数据,通过SPSS19.0统计软件进行数据的整合、处理和分析。应用的统计方法包括(1)描述性统计分析、(2)X2检验、(3)单因素方差分析和独立样本T检验、(4)重复测量方差分析、(5)Pearson相关分析、(6)多元线性回归方程等统计分析方法。结果1.乳腺癌患者生命意义感水平的动态变化情况本研究选取的80例乳腺癌患者T_1生命意义感得分为47.08±9.44,其中存在生命意义感得分为27.44±5.73,寻找生命意义感得分为19.64±4.66;T_2时间段患者的生命意义感总分为49.21±7.66;T_3时间段的得分为44.99±9.88;T_4为49.81±9.31,经重复测量方差分析得知四次生命意义感总分呈现出波动性上升的变化且差异显著(P0.05)。2.乳腺癌患者经验性回避的动态变化情况经调查可得乳腺癌患者T_1时间段经验性回避得分为18.51±7.19;T_2得分最高,为19.21±9.72;T_3时期得分为18.01±6.91;T_4时期得分最低,为15.65±5.58。经重复方差测量可知乳腺癌患者四个时间段的经验性回避水平差异具有显著意义,除手术后经验性回避得分略高于手术前外,大体呈现逐步下降趋势。3.乳腺癌患者创伤后成长的动态变化情况80例研究对象T_1-T_4的创伤后成长得分依次为:83.04±20.90;62.84±19.21;59.58±13.78;67.85±13.51。数据显示患者的创伤后成长呈现出先下降后上升的趋势,T_3(第一次化疗)时期创伤后成长水平最低,而随着治疗的进行,患者的创伤后成长逐步提升,且差异具有统计学意义(P0.05)。4.乳腺癌患者生命意义感、经验性回避与创伤后成长的相关性分析对乳腺癌患者的生命意义感、经验性回避与创伤后成长进行Pearson相关分析得乳腺癌患者的生命意义感与创伤后成长呈正相关,r=0.470,0.513,0.416,0.640,T_2时间段乳腺癌患者的生命意义感总分与经验性回避成负相关,r=-0.36(P0.01);将生命意义感与创伤后成长进行多重线性回归分析可得R2=0.203,0.244,0.156,0.399(P0.01),预示乳腺癌患者的生命意义感是创伤后成长的影响因素。结论1.诊断、手术与化疗阶段乳腺癌患者的生命意义感呈波动性上升,在第一次化疗时生命意义感得分最低,而后逐渐升高,直至化疗末期生命意义感最高,表明患癌这一事实可能使患者生命意义感下降,在手术与第一次化疗阶段表现的最为明显,而随着化疗的进行,患者的生命意义感逐步提升;故医务人员应加强对术后与第一次化疗期患者生命意义感的干预;2.乳腺癌患者除手术后经验性回避得分略高于手术前外,乳腺癌患者的经验性回避程度逐渐下降,表明随着时间的流逝,患者能够正视疾病,自我接纳的程度逐步提高,医务人员应重点关注术后患者的经验性回避,并进行合理的指导;3.乳腺癌患者的创伤后成长呈现先下降后上升的趋势,表明手术及化疗会对患者的创伤后成长造成一定的影响,但随着治疗的顺利进行,患者的创伤后成长呈上升趋势,表明手术及化疗阶段医务人员对其进行的健康宣教等护理干预能提升患者创伤后成长水平;4.乳腺癌患者的生命意义感是创伤后成长影响因素,提高患者的生命意义感有助于提高患者的创伤后成长。
[Abstract]:The purpose of the study is to explore (1) breast cancer patients with the sense of the meaning of life, the dynamic change situation of experiential avoidance and post-traumatic growth and over time; (2) a preliminary exploration of breast cancer patients in different stages of life meaning, experiential avoidance relationship with posttraumatic growth; (3) provide a useful guide to to restore and improve the physical and mental function of breast cancer patients for clinical more effectively stimulate posttraumatic growth. Research methods used convenient sampling methods from September 2015 -2016 year in September in the First Affiliated Hospital of Dalian Medical University hospital and diagnosed as primary breast cancer, breast cancer underwent simplified radical operation, 80 cases received chemotherapy after operation. The research tools included general information questionnaire (General Information Questionnaire), the meaning of life scale Chinese Version (China Meaning in Life Questionnaire, C-MLQ), acceptance and action The questionnaire (Acceptance Action version second Questionnaire, AAQ-II) and post-traumatic growth Rating Scale (Chinese-post-traumatic growth inventory, C-PTGI). On the day before surgery (T_1) were introduced to the research purpose, significance and matching points, when the patients consent signed informed consent, then design and research grant the general information questionnaire, C-MLQ, AAQ-II and C-PTGI questionnaire; respectively in third days after surgery (T_2), the 28 day postoperatively in patients during the first chemotherapy (T_3) and the patients completed the last (fourth / six / eight) during chemotherapy (T_4) issued C-MLQ. AAQ-II and C-PTGI scale longitudinal survey questionnaires were distributed and collected on the spot, the establishment of doctor-patient communication WeChat groups, in order to answer patients during treatment and rehabilitation, to facilitate the formation of benign relationship between nurse and the object of study, reflect the humanity and Individualized nursing care; improve patient compliance greatly. The data of double entry, data integration through SPSS19.0 statistical software, processing and analysis. The application of statistical methods including descriptive statistical analysis (1), (2) X2 (3) test, single factor variance analysis and independent sample T test, (4) repeated measurement of variance analysis, Pearson correlation analysis (5), (6) multiple linear regression equations and statistical analysis method. The dynamic change of the meaning of life in 1. breast cancer patients. The level of this study selected 80 cases of breast cancer patients with T_1 sense of the meaning of life score was 47.08 + 9.44, the sense of the meaning of life score of 27.44 5.73, find the meaning of life score was 19.64 + 4.66; T_2 time with sense of the meaning of life score was 49.21 + 7.66; T_3 time score was 44.99 + 9.88; T_4 = 49.81 + 9.31, the repeated measures analysis of variance was four times the meaning of life The total score showed rising volatility changes and the difference was significant (P0.05) the dynamic changes of breast cancer patients with.2. experience can be avoided through the investigation of breast cancer patients with T_1 time period of experiential avoidance score was 18.51 + 7.19; the highest score is 19.21 + T_2, 9.72; T_3 score was 18.01 + 6.91 T_4 period; the lowest score, significant is 15.65 + 5.58. by repeated variance measured in patients with breast cancer in four periods of experiential avoidance level difference, except the operation after the experiential avoidance scores slightly higher than before surgery, generally presents the dynamic changes of a declining trend in.3. breast cancer patients with posttraumatic growth of 80 cases of T_1-T_4 studied posttraumatic growth score as follows: 83.04 + 20.90; 62.84 + 19.21; 59.58 + 13.78; 67.85 + 13.51. data showed that patients with posttraumatic growth showed a upward trend after the first drop, T_3 (for the first time a period of chemotherapy) After injury, the lowest level of growth, and with the treatment, patients with posttraumatic growth increased gradually, and the difference was statistically significant (P0.05) in patients with breast cancer.4. the sense of meaning of life, experiential avoidance and posttraumatic growth correlation analysis of breast cancer patients with the sense of the meaning of life, experiential avoidance and posttraumatic growth by Pearson analysis to breast cancer patients life meaning and posttraumatic growth was positively related to r=0.470,0.513,0.416,0.640, T_2 period in patients with breast cancer the meaning of life scores and experiential avoidance negatively related to r=-0.36 (P0.01); the meaning of life and posttraumatic growth were analyzed using multiple linear regression analysis was R2=0.203,0.244,0.156,0.399 (P0.01) in patients with breast cancer, indicating the meaning of life is the influencing factors of posttraumatic growth. Conclusion 1. diagnosis, surgery and chemotherapy for breast cancer patients life meaning sense of a wave Dynamic rise during the first chemotherapy when the meaning of life the lowest score, and then gradually increased until the end of chemotherapy, the meaning of life, shows the fact that cancer patients may make sense of the meaning of life decline, in the first stage of surgery and chemotherapy is the most obvious, but with the chemotherapy of patients with the meaning of life feeling gradually increased; therefore medical staff should strengthen the meaning of life and the first postoperative patients sense of intervention; 2. breast cancer patients after surgery in addition to experiential avoidance scores slightly higher than before surgery, breast cancer patients showed that the degree of experiential avoidance decreased gradually with the passage of time, patients can face disease, self acceptance gradually increase the level of medical personnel, should focus on the postoperative patients with experiential avoidance and reasonable guidance; and 3. breast cancer patients with posttraumatic growth decreased first and increased later, That surgery and chemotherapy will cause a certain impact on the patients with posttraumatic growth, but with the success of treatment, patients with posttraumatic growth showed an upward trend, that of the surgery and chemotherapy stage medical personnel health education and nursing intervention can improve patients with posttraumatic growth; 4. patients with breast cancer of the meaning of life is posttraumatic growth factors, improve the patient's sense of the meaning of life is helpful to improve the patients with posttraumatic growth.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.73

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