心理干预对晚期化疗乳腺癌患者心理状态及生活质量的影响

发布时间：2018-06-26 06:30

本文选题：乳腺癌 + 心理特征　；参考：《济南大学》2017年硕士论文

【摘要】：目的评价及分析晚期化疗乳腺癌患者心理特征和生活质量状况;评估心理干预对晚期化疗乳腺癌患者心理状态及生活质量的影响。方法本研究收集了山东省肿瘤医院2016年2月-2017年2月收治的晚期化疗乳腺癌患者89例,分为干预组(45例)和对照组(44例)。干预组予常规化学治疗和心理干预治疗,对照组仅行常规化学治疗。评价两组患者心理干预前、干预后(即初次测评和再次测评)的心理状态和生活质量,比较心理干预后(即再次测评)干预组和对照组心理状态及生活质量的差异,分析心理干预的效果。心理干预方法包括心理教育干预、团体心理干预和个体心理干预。使用的调查工具有:生活质量调查问卷(European Organization for Research and Treatment Quality of Life Questionnare-Core30,EORTC QLQ-C30)、抑郁自评量表(Self-rating depression scale,SDS)、焦虑自评量表(Self-Rating Anxiety Scale,SAS)和创伤后成长评定量表(Posttraumatic Growth Inventory,PTGI)。结果1.干预组和对照组在年龄、婚姻状况、职业、医疗付费方式、文化程度、KPS评分方面没有统计学差异(P0.05),具有可比性。2.收录入组的乳腺癌患者初次测评时,总体健康状况得分对照组为7.26±1.33,干预组为7.89±1.73;功能领域中,角色功能、认知功能、社会功能,对照组和干预组得分分别为[1.50±1.49;1.67±1.30]、[3.34±1.02;3.56±1.10]、[4.55±1.56;4.76±1.61];躯体功能、情绪功能得分对照组和干预组分别为[8.23±2.89;8.97±3.01]、[7.41±2.15;7.76±2.23]。气促、便秘、腹泻维度的得分相对较少,表明这方面问题相对较少。3.初次测评时,干预组和对照组所有患者,抑郁总体占44.9%,其中轻度抑郁为28.1%,中度抑郁为16.8%。干预组和对照组晚期化疗乳腺癌患者总体焦虑比率为40.4%,其中,轻度焦虑为22.5%,中度焦虑为17.9%。4.干预组患者PTGI结果显示,创伤后成长总分为66.28±14.084,最大值为93分,最小值为32分。其中,“与他人关系”得分为23.31±5.107,“新的可能性”得分为15.73±4.245,“个体的力量”得分为12.20±4.230,“精神信仰上的变化”得分为6.87±1.853,“对生活的欣赏”得分为8.64±2.630。5.QLQ-C30再次测评和初次测评相比,在角色功能、认知功能、情绪功能、总体健康状况、疲倦、失眠方面的差异有统计学意义(P0.05),在躯体功能、社会功能、恶心呕吐、疼痛、气促、食欲丧失、便秘、腹泻、经济困难方面差异无统计学意义。6.干预组患者,初次测评时抑郁总体占44.4%,再次测评时占24.4%,干预后患者抑郁的比率明显下降,差异有统计学意义(P0.05)。对照组抑郁患者,初次测评时占45.5%,再次测评时占50%,再次测评和初次测评相比,患者抑郁所占的比率反而上升。干预组患者,初次测评时焦虑总体占42.2%,再次测评时占24.4%,再次测评和初次测评相比,焦虑比率下降,但差异没有统计学意义(P0.05)。对照组焦虑患者,初次测评时总体占38.6%,再次测评占36.4%,前后两次测评焦虑患者所占比率变化不大,差异没有统计学意义。结论1.晚期化疗乳腺癌患者总体健康状况处于中等水平,功能领域得分整体处于中低水平,功能状况较差;症状领域中除气促、便秘、腹泻得分较低(问题较少)外,其余领域问题较多,生活质量较差。2.晚期化疗乳腺癌患者存在抑郁、焦虑的心理障碍,且主要是轻中度。3.心理干预后对干预组患者进行创伤后成长评定量表测评,患者存在一定成长。4.心理干预后,患者在角色功能、认知功能、情绪功能、总体健康状况、疲倦、失眠方面,较初次测评时(即干预前)有明显改善,有显著性差异。表明心理干预在一定程度上改善了患者的生活质量。5.心理干预可以改善患者的抑郁状态,干预组患者心理干预后,抑郁者所占比率较前下降,且差异有统计学意义。
[Abstract]:Objective to evaluate and analyze the psychological characteristics and quality of life of patients with advanced chemotherapy of breast cancer, and to evaluate the psychological status and quality of life of breast cancer patients with advanced chemotherapy. Methods 89 cases of advanced treatment of breast cancer treated in February -2017 February 2016 in Shandong cancer hospital were collected and divided into intervention group (45 cases). And the control group (44 cases). The intervention group was treated with routine chemical therapy and psychological intervention, and the control group was only treated with routine chemical therapy. The psychological state and quality of life were evaluated before the intervention of the two groups. The psychological state and quality of life in the intervention group and the control group were compared with the psychological intervention group and the control group. The results of psychological intervention included psychological education intervention, group psychological intervention and individual psychological intervention. The survey tools used were the quality of life questionnaire (European Organization for Research and Treatment Quality of Life Questionnare-Core30, EORTC QLQ-C30), and the self rating Depression Scale Ng depression scale, SDS), the self rating Anxiety Scale (Self-Rating Anxiety Scale, SAS) and the post traumatic growth assessment scale (Posttraumatic Growth Inventory, PTGI). Results there was no statistical difference between the 1. intervention group and the control group in age, marital status, occupation, medical pay, cultural range, and score. In the first evaluation of the breast cancer patients, the total health status score was 7.26 + 1.33 in the control group and 7.89 in the intervention group. In the functional field, the scores of role function, cognitive function and social function were [1.50 + 1.49, 1.67 1.30], [3.34 + 1.02, 3.56 + 1.10], [4.55 + 1.56 and 4.76 + 1.61], body function and emotional work. The score in the control group and the intervention group were [8.23 2.89, 8.97 + 3.01], [7.41 + 2.15, 7.76 + 2.23]. and constipation, and the scores of diarrhoea were relatively less. It showed that in the first evaluation of.3., all the patients in the intervention group and the control group accounted for 44.9% of the depression, of which the mild depression was 28.1%, and the moderate depression was the 16.8%. intervention group. The overall anxiety ratio of the patients with advanced chemotherapy in the control group was 40.4%, of which the mild anxiety was 22.5%, and the moderate anxiety in the 17.9%.4. intervention group showed that the total score was 66.28 + 14.084, the maximum was 93, and the minimum was 32. The score of "the relationship with him" was 23.31 + 5.107, and the "new possibility" was obtained. The score was 15.73 + 4.245. The score of "individual strength" was 12.20 + 4.230. The score of "spiritual belief change" was 6.87 + 1.853. The score of "appreciation of life" was 8.64 + 2.630.5.QLQ-C30. Compared with the first assessment, there were statistical differences in role function, cognitive function, emotional function, overall health condition, fatigue and insomnia. Learning significance (P0.05), in the body function, social function, nausea and vomiting, pain, breath, loss of appetite, constipation, diarrhea, and economic difficulties, there was no significant difference in the.6. intervention group. The total depression was 44.4% in the first assessment, 24.4% in the second evaluation, and the rate of depression after the intervention was significantly decreased (P0.05). In the group of depressed patients, the first evaluation was 45.5% and the second assessment was 50%. Compared with the first evaluation, the rate of depression was increased. The anxiety in the intervention group was 42.2% in the first assessment and 24.4% in the second evaluation. The anxiety rate was decreased compared with the first assessment, but the difference was not statistically significant. P0.05). In the control group, the primary assessment was 38.6% in the control group and 36.4% for the second assessment. The ratio of the two times before and after the assessment of anxiety patients was not significant, and the difference was not statistically significant. Conclusion the overall health status of the 1. advanced chemotherapy breast cancer patients was at the middle level, the score of the functional field was in the middle and low level, and the functional status was poor. In the field of symptoms, the scores of Qi, constipation and diarrhea were lower (less problems), and there were more problems in the rest of the field. The poor quality of life.2. advanced chemotherapy for breast cancer patients had depression, anxiety mental disorder, and the main reason was that after the mild and moderate.3. psychological intervention, the patients in the intervention group were evaluated by the post traumatic growth assessment scale, and the patients had a certain growth of.4. Psychological intervention, patients in role function, cognitive function, emotional function, overall health status, fatigue, insomnia, compared with the first assessment (before intervention), there are significant differences. It shows that psychological intervention improves the quality of life of the patients to some extent.5. psychological intervention can improve the patient's depression, intervention group After psychological intervention, the proportion of depressive patients was lower than before, and the difference was statistically significant.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.73

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