晚期癌症患者本土化尊严模型的建构和量表的编制及应用

发布时间：2018-03-15 10:06

  本文选题：晚期癌症患者　切入点：本土化尊严　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究旨在做三方面的研究:首先,通过半结构式访谈,结合扎根理论的资料分析方法,探索本土晚期癌症患者的尊严内涵,构建本土晚期癌症患者尊严的理论模型,为有效开展临终关怀和安宁疗护提供理论支持;其次,以建构的晚期癌症患者尊严模型为理论基础,编制本土化的晚期癌症患者尊严量表,为临床实践提供方便有效的评估工具;最后,将编制好的晚期癌症患者尊严量表应用到临床,探索晚期癌症患者的尊严状况以及影响因素,为下一步的干预研究奠定前期基础。方法:⑴质性研究:采用目的性抽样,对符合入组标准的晚期癌症患者进行半结构式访谈;访谈的同时,通过扎根理论的方法对访谈资料进行编码分析,访谈资料理论达到饱和时停止访谈。最终形成晚期癌症患者尊严主题编码表,并获得建构的晚期癌症患者尊严模型。⑵量表编制:依据构建的尊严模型,编制晚期癌症患者尊严量表条目池;经过专家评判和被试易读性评判形成初始量表;对155名晚期癌症患者初测,继而对回收的数据进行项目分析和探索性因素分析,最终得到16个条目的晚期癌症患者尊严量表;将尊严量表对148名晚期癌症患者进行正式施测,对回收的数据进行信效度检验。⑶调查研究:采用自编一般资料调查表、自编晚期癌症患者尊严量表、跨文化(中国人)个性测量表、生命意义感量表中文修订版、心理痛苦温度计对160名晚期癌症患者进行施测,回收有效问卷151份。采用描述性统计、相关分析、多元逐步回归分析等方法进行统计学分析。结果:⑴通过对29名晚期癌症患者访谈资料的三级编码,最终获得了晚期癌症患者尊严内涵的四大因素,即躯体尊严、社会尊严、心理尊严和灵性尊严,并形成了尊严内涵模型。⑵以建构的尊严模型为理论基础,初步建立90个条目的条目池;经过专家评判和被试易读性评判形成32个条目的初测版本;继而对量表进行初测,经过项目分析和探索性因素分析,最终保留16个条目。⑶信效度检验结果显示:验证性因素分析获得的四维结构模型拟合指数良好;维量分析中,因子之间基本处于中等程度的相关,因子与总分之间处于中等偏上程度的相关;自编的晚期癌症患者尊严量表与西方患者尊严量表呈显著负相关,与幸福感指数呈显著正相关;并且自编的晚期癌症患者尊严量表比西方患者尊严量表显著多预测患者幸福感程度的6%。问卷的ɑ系数和分半信度均在0.7以上。该问卷信效度较好。⑷调查研究结果显示:尊严总分在性别(t=2.09,p=0.038)、不同痛苦程度(t=6.15,p0.000)、不同文化程度(F=3.41,p=0.006)、不同年龄分组(F=3.97,p=0.021)和不同经济压力状况(F=8.37,p0.000)上有显著差异;在居住地、有无宗教信仰、对病情的了解程度、疾病分期、是否化疗、是否转移和病情持续时间上无显著差异。⑸尊严总分与需要关注、自卑自信和心理痛苦程度呈显著负相关,与生命意义感总分及分量表和内外控制点呈显著正相关。⑹晚期癌症患者尊严的主要影响因素为经济压力、性别、自卑自信、拥有意义感、心理痛苦程度,这些因素可以解释晚期癌症患者尊严感变异的42.1%。结论:⑴中国传统文化背景下尊严的内涵有其独特性,在晚期癌症患者尊严理论和模型的研究中应注重中西文化差异的敏感性和本土文化的独特性。⑵自编的晚期癌症患者尊严量表信效度良好,符合心理测量学要求,可用于我国晚期癌症患者尊严水平的评估。⑶不同背景的晚期癌症患者尊严状况差异明显,经济压力、性别、自卑自信、拥有意义感、心理痛苦程度可以预测患者的尊严状况。
[Abstract]:Objective: This study aims to do research on three aspects: first, through semi-structured interviews, combined with the grounded theory method of data analysis and exploration of the connotation of the dignity of local advanced cancer patients, the theoretical model of advanced cancer patients with local dignity, for the effective implementation of hospice and palliative care to provide theoretical support; secondly, the dignity of late cancer patients model as the theoretical foundation, the native dignity of patients with advanced cancer scale, to provide convenient and effective assessment tool for clinical practice; finally, will prepare the dignity of patients with advanced cancer scale applied to clinical factors in patients with advanced cancer, explore the dignity of status and influence, will lay the foundation for the intervention of a step 1. Methods: qualitative research: by purposive sampling, semi-structured interviews of eligible patients with advanced cancer; interview at the same time, through the bar The theory of encoding method of root analysis of interview data, interview data stop reaches saturation. The final formation of the theory of advanced cancer patients dignity theme encoding tables, and obtain the dignity of patients with advanced cancer model construction. The scale of the model: on the basis of dignity, the dignity of patients with advanced cancer were compiled by experts scale items; evaluation and readability evaluation subjects formed the initial scale; on 155 patients with advanced cancer detection, analysis and recovery of the data item and exploratory factor, finally got 16 to advanced cancer patients with dignity scale; the dignity scale in 148 patients with advanced cancer of the formal test, test of the validity of the data. The recovery of investigation: using a self-designed questionnaire, the self dignity of patients with advanced cancer scale, cross culture (Chinese) personality questionnaire, the meaning of life Chinese scale revised edition, psychological distress thermometer on 160 patients with advanced cancer were tested, and 151 valid questionnaires were collected. Using descriptive statistics, correlation analysis, multiple stepwise regression analysis were used for statistical analysis. Results: the 29 patients with advanced cancer through the interview data of three level encoding, eventually won four dignity factors in patients with advanced cancer connotation, namely body dignity, social psychological and spiritual dignity dignity, dignity, dignity and the formation of the model. The connotation of dignity to construct model as the theoretical foundation, the initial establishment of a 90 item pool; after expert evaluation and test readability evaluation form 32 a preliminary survey and then on the scale version; the initial test, through the project analysis and exploratory factor analysis, finally kept 16 items. The reliability and validity of the test results show: confirmatory factor analysis to obtain the quasi four dimensional structure model Good index; dimension analysis, the basic factors in the middle level, in the medium and high degree of correlation between factor score and total score; the dignity of patients with advanced cancer patients with dignity and the western scale scale was negatively correlated, and well-being index showed significant positive correlation; and the dignity of advanced cancer the patients scale than Western patients with dignity scale significantly more predictive coefficient alpha level of 6%. were happiness and split half reliability were above 0.7. The questionnaire has good reliability and validity. The survey results showed that: the total score of dignity in gender (t= 2.09, p=0.038), different degrees of pain (t=6.15, p0.000), different (F=3.41, p=0.006) level of culture, different age groups (F=3.97, p=0.021) and different economic pressure conditions (F=8.37, p0.000) there are significant differences; in the residence, there are no religious beliefs, the degree of understanding of the disease stage of disease, whether Chemotherapy, metastasis and disease duration had no significant difference. The total score and the dignity of concern, is negatively related to self confidence and psychological pain degree was positively correlated with the sense of the meaning of life score and subscale and locus of control. In patients with advanced cancer, the dignity of the main influencing factors are gender, economic pressure. Self confident, have a sense of meaning, psychological pain degree, 42.1%. conclusion these factors can explain the variation of the sense of dignity in patients with advanced cancer: the connotation of China dignity under the background of traditional culture has its unique characteristics, in the study of patients with advanced cancer dignity theory and model should focus on the unique cultural differences and the sensitivity of the local culture. The self dignity of patients with advanced cancer had good reliability and validity, in line with the requirements of psychometrics, can be used for the evaluation of our patients with advanced cancer. The level of dignity of different backgrounds There is a significant difference in the dignity of patients with advanced cancer, economic pressure, gender, self inferiority, sense of sense, and the degree of psychological distress that can predict the dignity of the patient.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：B848

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