肺癌患者支持性照护需求预测模型的构建

发布时间：2018-03-16 08:39

本文选题：肺肿瘤　切入点：支持性照护需求　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：近年来,关注癌症患者的支持性照护需求以针对性地为患者提供支持性照护逐渐成为研究的热点之一。研究表明,采取有效的措施促进患者支持性照护需求的满足不仅可以增加患者对疾病的认识,促进患者参与决策,减少不确定感,提高生命质量、主观幸福感、对护理服务的满意水平,并且能够建立良好的医患关系。肺癌患者由于生存率较低、躯体症状及心理社会问题较多,因而支持性照护需求较为突出。而现有的关于癌症患者支持性照护需求的研究,关注肺癌患者支持性照护需求及其影响因素相对较少,明确肺癌患者支持性照护需求的现状、主要影响因素及作用机制,有助于针对性地为肺癌患者提供支持性照护,促进其支持性照护需求的满足。目的(1)描述肺癌患者支持性照护需求的现状;(2)探究肺癌患者支持性照护需求的预测因素及各变量间的路径关系,阐明影响肺癌患者支持性照护需求的主要因素,为临床针对性地给予患者有效的支持性照护提供依据。方法运用横断面描述性研究设计,采用便利抽样法于2016年5月~9月选取在安徽省三所三级甲等医院就诊的370例住院肺癌患者作为研究对象。采用一般资料调查表、癌症患者护理专业性社会支持需求量表(Nursing Professional Social Support Needs Scale,NPSSNS)、领悟社会支持量表(Perceived Social Support Scale,PSSS)、心理困扰温度计(Distress Thermometer,DT)、中文版安德森症状评估表(Chinese Version of the M.D.Anderson Symptom Inventory,MDASI-C)、D型人格量表(Type D Personality Scale,DS-14)、肺癌患者病耻感量表(Cataldo Lung Cancer Stigma Scale,CLCSS)、医学应对方式问卷(Medical Coping Modes Questionnaire,MCMQ)、事件影响量表(The Impact of Events Scale-Revised,IES-R)、临床结局简版问卷(the 36-item Medical Outcomes Study Short Form,SF-36)、纽卡斯尔病人对护理服务满意度量表(The Newcastle Satisfaction with Nursing Scales,NSNS)、疾病进展恐惧简化量表(the Fear of Progression Questionnaire,Fo P-Q-SF)对肺癌患者进行调查。采用Epi Data3.1软件进行资料的录入,SPSS23.0软件对资料进行描述性分析,AMOS21.0软件对结构方程模型进行构建和验证。结果肺癌患者支持性照护需求的共性模块得分为3.06(1.16),特异型模块得分为2.60(1.50),各维度的得分以技术需求维度得分最高,其次是信息需求维度,情感/心理需求维度得分最低;排在前10位的需求以技术需求维度所占比例最高,无情感/心理需求;一般人口学及疾病资料中女性、具有D型人格、年龄较轻、经济水平较低、患病时间较长、疾病转移、分期为Ⅳ期的肺癌患者支持性照护需求水平较高;心理困扰、症状困扰、社会支持、疾病进展恐惧、侵扰性思想、病耻感、护理服务满意度及面对应对均与患者的支持性照护需求呈正相关;生理功能与患者的支持性照护需求水平呈负相关;结构方程模型中对支持性照护需求具有直接显著性预测作用的变量为症状困扰、护理服务满意度、疾病进展恐惧、社会支持及面对应对;具有间接显著性预测作用的变量为D型人格、病耻感及屈服应对。其中,疾病进展恐惧对支持性照护需求具有正向预测作用,路径系数β=0.403(t=6.180,P0.001),进一步分解其对支持性照护需求的标准化效应后发现,疾病进展恐惧对支持性照护需求的总效应为0.427,其中直接效应为0.403,通过护理服务满意度及面对应对的间接效应为0.024;症状困扰对支持性照护需求具有正向的预测作用,路径系数β=0.158(t=2.607,P0.01),总效应为0.302,直接效应为0.158,通过疾病进展恐惧的间接效应为0.144;护理服务满意度对支持性照护需求具有正向预测作用,路径系数β=0.135(t=2.553,P0.05),总效应为0.159,直接效应为0.135,通过面对应对的间接效应为0.024;社会支持对支持性照护需求具有正向的预测作用,路径系数β=0.177(t=2.909,P0.01),对支持性照护需求的总效应为0.247,其中直接效应为0.177,通过面对应对的间接效应为0.070;面对应对对支持性照护需求具有正向预测作用,路径系数β=0.215(t=3.858,P0.001);D型人格对支持性照护需求不具有直接预测效应,但可通过疾病进展恐惧及社会支持对支持性照护需求产生正向的间接效应,间接效应为0.047;病耻感对支持性照护需求不具有直接预测效应,但可通过疾病进展恐惧及护理服务满意度对支持性照护需求产生正向的间接效应,间接效应为0.073;屈服应对对支持性照护需求不具有直接效应,但可通过面对应对对支持性照护需求产生负向的间接效应,间接效应为-0.034。上述预测因素共解释支持性照护需求33.0%的变异。结论肺癌患者存在信息、技术、情感/心理、照护协调与沟通、肺癌特异性方面的支持性照护需求,并且主要为技术需求方面的需求。疾病进展恐惧、症状困扰、社会支持、护理服务满意度及面对应对对支持性照护需求具有直接正向预测作用,并且疾病进展恐惧可通过护理服务满意度及面对应对对支持性照护需求产生间接作用;症状困扰可通过疾病进展恐惧对支持性照护需求产生间接作用;护理服务满意度及社会支持可通过面对应对对支持性照护需求产生间接作用;D型人格可通过疾病进展恐惧及社会支持对支持性照护需求产生正向的间接效应;病耻感可通过疾病进展恐惧及护理服务满意度对支持性照护需求产生正向的间接效应;屈服应对可通过面对应对对支持性照护需求产生负向的间接效应。明确肺癌患者支持性照护需求的预测因素及各因素之间的路径关系,可为进一步制定支持性照护干预方案以满足肺癌患者的需求、改善其生命质量提供参考依据。
[Abstract]:In recent years, attention and support of cancer patient care needs in order to provide patients with supportive care has gradually become one of the hotspots in the research. The study shows that to take effective measures to promote patients with supportive care needs not only can increase the understanding of disease, promote the patients to participate in decision-making, reduce uncertainty and improve the life the quality, subjective well-being, satisfaction of nursing service, and to establish a good doctor-patient relationship. The lung cancer patients because of lower survival rate, more somatic symptoms and psychosocial problems, and supportive care needs more prominent. But the existing research on the demand for care of cancer patients, attention to supportive care in patients with lung cancer demand and its influencing factors is relatively small, clear lung cancer patients care needs to support the status quo, the main influence factors and mechanism, helps to Provide supportive care for patients with lung cancer, promote the supportive care needs. (1) to describe the status quo of care needs of patients with lung cancer support; (2) to explore prognostic factors in patients with lung cancer supportive care needs and the path of the relationship among variables, clarify the main factors affecting the demand for care of patients with lung cancer. For clinical targeted support of patients with effective care provided. Methods a cross-sectional descriptive study design, using convenience sampling method in May 2016 ~9 month in Anhui province were selected three from three hospitals in 370 cases of lung cancer patients as the research object. The general information questionnaire, social support demand for nursing professional cancer (Nursing Professional Social Support Needs table Scale, NPSSNS), perceived social support scale (Perceived Social Support Scale, PSSS), psychological distress temperature Meter (Distress Thermometer, DT), Chinese version of Anderson (Chinese Version of symptom assessment scale the M.D.Anderson Symptom Inventory, MDASI-C), type D personality scale (Type D Personality Scale, DS-14), the stigma of patients with lung cancer scale (Cataldo Lung Cancer Stigma Scale, CLCSS), medical coping mode questionnaire (Medical Coping Modes Questionnaire, MCMQ), the impact of Event Scale (The Impact of Events Scale-Revised, IES-R), clinical outcome questionnaire (the 36-item Medical version Outcomes Study Short Form, SF-36), Newcastle patients for nursing service satisfaction scale (The Newcastle Satisfaction with Nursing Scales, NSNS), disease progression fear scale (the Fear simplified of Progression Questionnaire, Fo P-Q-SF) were investigated in patients with lung cancer. The data by Epi Data3.1 software SPSS23.0 software entry, a descriptive analysis of the data, AM The structural equation model is established and verified in OS21.0 software. The general module of scores of care needs support in patients with lung cancer was 3.06 (1.16), specific module score of 2.60 (1.50), the score of each dimension to the technical requirements of the highest score, followed by the demand of information dimension, emotional / psychological needs of the lowest score; the top 10 needs to technical requirements of dimensions of the highest proportion, no emotional / psychological needs; female demographic and disease data, with type D personality, younger age, low economic level, longer duration of disease, metastatic disease, stage IV lung cancer supportive care needs higher level; psychological distress, symptom distress, social support, disease progression, fear, intrusive thoughts, stigma, nursing service satisfaction and coping with and supportive care needs of patients was positively correlated with patients with physiological function; To care demand levels are negatively correlated; the structural equation model of supportive care needs has direct significant predictor variables for symptom distress, nursing service satisfaction, disease progression, fear, social support and coping with; with indirect significant predictor variables for type D personality, stigma and coping style. The progression of the disease, fear has a positive predictive effect on supportive care needs, the path coefficient =0.403 (t=6.180, P0.001), the further decomposition of supportive care needs standardized effect after the discovery, the progression of the disease fear of the total effect of supportive care needs for 0.427, the direct effect is 0.403, and the satisfaction of nursing service the indirect effect of coping with 0.024; symptom distress has a positive predictive effect on supportive care needs, the path coefficient =0.158 (t=2.607, P0.01), the total effect is 0.302, straight The effect is 0.158, indirect effect through fear of disease progression was 0.144; nursing service satisfaction has a positive predictive effect on supportive care needs, the path coefficient =0.135 (t=2.553, P0.05), the total effect is 0.159, the direct effect is 0.135, by coping with the indirect effect was 0.024; social support has a positive predictive effect the supportive care needs, the path coefficient =0.177 (t=2.909, P0.01), the total effect of supportive care needs for 0.247, the direct effect is 0.177, through the indirect effect of confrontation is 0.070; the corresponding surfaces have positive effect on supportive care needs, the path coefficient =0.215 (t=3.858, P0.001); type D personality has no direct effect on supportive care needs, but the fear of disease progression and social support has indirect positive effect on supportive care needs, the indirect effect was 0.047; disease Sense of shame has a direct effect on supportive care needs, but can produce indirect positive effect on supportive care needs through the progression of the disease and nursing service satisfaction of fear, the indirect effect was 0.073; the yield response has no direct effect on supportive care needs, but by coping with the negative effect to the indirect support for care needs, the indirect effect is -0.034. the forecast factors can explain 33% of the variation of supportive care needs in patients with lung cancer. Conclusion the existence of information, technology, emotional / psychological care, coordination and communication, supportive care needs of lung cancer specific aspects, and the main technical requirements for the needs of the progression of the disease. Fear, symptom distress, social support, nursing service satisfaction and coping with positive predictive effect on supportive care needs, and fear of disease progression through the nursing service Satisfaction and coping with the influence of supportive care needs; symptom distress through fear of disease progression have an indirect effect on the supportive care needs; nursing service satisfaction and social support by coping with the influence of supportive care needs; type D personality through fear of disease progression and social support have indirect positive effect the supportive care needs; stigma can produce indirect positive effect on supportive care needs through the progression of the disease and nursing service satisfaction of fear; coping by coping with the negative indirect effect to supportive care needs in patients with lung cancer. A clear path between the predictors of support care needs and the various factors. For the further development of supportive care intervention programs to meet the needs of patients with lung cancer, improve the quality of life. Test the basis.

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

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