消化道癌症患者两个化疗阶段心理弹性及其影响因素的研究

发布时间：2018-08-13 20:28

【摘要】：目的调查消化道癌症患者两个化疗阶段心理弹性的水平及变化情况,探讨其两个化疗阶段心理弹性的影响因素,为描述消化道癌症患者两个化疗阶段的心理弹性及其变化情况,制定针对性的干预方案提供参考。方法选取2015年10月至2016年11月在某医科大学第一、第二附属医院的214名化疗期消化道癌症患者进行6个月随访,采用统一设计的调查表,调查患者一般社会人口学和疾病相关资料,采用心理弹性量表(Resilience Scale-14,RS-14)评估患者的心理弹性水平,测量患者心理弹性的影响因素由医学应对方式问卷(Medical Coping Modes Questionnaire,MCMQ)、社会支持评定量表(Social Support Rating Scale,SSRS)、家庭功能APGAR问卷、安德森症状评估量表(M.D.Anderson Symptom Inventory,MDASI)、中文版疾病不确定感量表(Mish-el’s Uncertainty In Illness Scale-Adult,MUIS-A)、Herth希望量表(Herth Hope Inder,HHI)组成。使用Epi Data3.1建立数据库,SPSS17.0统计软件进行统计分析。对心理弹性及其各维度得分进行描述性分析,并进行单因素和相关分析,应用多元线性回归法分析患者两个化疗阶段心理弹性的影响因素,运用配对检验比较患者两个化疗阶段心理弹性水平的变化。结果1.首次化疗后共发放问卷214份,首次化疗六个月后随访有效问卷177份,消化道癌症患者首次化疗后和首次化疗六个月后心理弹性得分分别为72.64±7.91、76.00±7.01,处于中等以上水平;2.消化道癌症患者首次化疗后心理弹性总分、个人能力、对自我和生活的接纳得分分别是72.64±7.91、52.42±5.77、20.22±2.96;首次化疗六个月后的得分分别为76.00±7.01、54.42±5.03、21.58±2.60。首次化疗六个月后的心理弹性及各维度得分均高于首次化疗后且差异具有统计学意义(P=0.000,P=0.000,P=0.000)。3.多元线性回归分析显示,性别、家庭所在地、疾病分期、屈服、社会支持、家庭功能、症状严重度和症状困扰、希望是化疗期消化道癌症患者心理弹性的影响因素。其中首次化疗后患者心理弹性的影响因素为性别、家庭所在地、疾病分期、社会支持、家庭功能、症状严重度、希望。首次化疗六个月后患者心理弹性的影响因素为性别、屈服、社会支持、家庭功能、症状困扰、希望,其中希望对患者心理弹性的影响作用最大。结论消化道癌症患者在首次化疗后和首次化疗六个月后的心理弹性得分处于中等偏上水平;首次化疗六个月后的心理弹性及各维度的得分均高于首次化疗后,心理弹性呈现上升状态。消化道癌症患者两个化疗阶段心理弹性的影响因素不同,其中要特别关注的是希望和保护性因素对心理弹性的重要影响。探讨这些影响因素可为消化道癌症患者构建不同阶段心理弹性的整体结构及针对性的心理弹性干预提供科学依据。
[Abstract]:Objective to investigate the level and changes of psychological elasticity in two stages of chemotherapy in patients with cancer of digestive tract, and to explore the influencing factors of the two stages of chemotherapy, so as to describe the changes of psychological elasticity in two stages of chemotherapy in patients with cancer of digestive tract. To provide reference for the development of targeted intervention programs. Methods A total of 214 patients with digestive tract cancer in the first and second affiliated hospital of a medical university from October 2015 to November 2016 were followed up for 6 months. The general socio-demographic and disease-related data of the patients were investigated, and the level of mental resilience was evaluated by Resilience Scale-14 RS-14. The influencing factors of measuring patient's psychological elasticity were (Medical Coping Modes questionnaire (Medical coping style questionnaire), Social support scale (Social Support Rating scale), Family function questionnaire (APGAR), Family function questionnaire (APGAR), Social support scale (Social Support Rating), Family function questionnaire (APGAR). The M.D.Anderson Symptom inventory (M.D.Anderson Symptom inventory) and the Chinese version of Mish-el's Uncertainty In Illness scale (Mish-el's Uncertainty In Illness scale Adult- MUIS-A) were composed of (Herth Hope Inderma (HHI). The statistical software SPSS 17.0 was used to build the database with Epi Data3.1 for statistical analysis. A descriptive analysis was made on the scores of psychological elasticity and its dimensions, and a single factor and a correlation analysis were carried out, and the influencing factors of the patients' psychological elasticity in the two stages of chemotherapy were analyzed by multiple linear regression method. A pair test was used to compare the changes of psychoelasticity in two stages of chemotherapy. Result 1. A total of 214 questionnaires were sent out after the first chemotherapy and 177 effective questionnaires were followed up six months after the first chemotherapy. The scores of psychological elasticity of the patients with digestive tract cancer were 72.64 卤7.91 卤76.00 卤7.01 after the first chemotherapy and 76.00 卤7.01 after the first chemotherapy respectively, which were above the average level. The scores of total psychological elasticity, personal ability, self acceptance and life acceptance were 72.64 卤7.91 卤5.77 卤20.22 卤2.96 and 76.00 卤7.01 卤54.42 卤5.03 卤21.58 卤2.60 respectively after the first chemotherapy. The scores of psychological elasticity and dimension after the first chemotherapy were significantly higher than those after the first chemotherapy (P = 0.000, P = 0.000, P = 0.000, P = 0.000, P = 0.000, P = 0.000, P = 0.000, P = 0.000, P = 0.000, P = 0.000). Multiple linear regression analysis showed that sex, family location, disease stage, yield, social support, family function, symptom severity and symptom distress were the factors influencing the psychological elasticity of patients with digestive tract cancer during chemotherapy. The influencing factors of psychological elasticity after the first chemotherapy were gender, family location, disease stage, social support, family function, symptom severity and hope. Six months after the first chemotherapy, the influencing factors of patients' psychological elasticity were gender, yield, social support, family function, symptom distress, hope, among which, hope had the greatest effect on the patient's psychological elasticity. Conclusion the scores of psychological elasticity of patients with digestive tract cancer after the first chemotherapy and six months after the first chemotherapy were higher than those after the first chemotherapy, and the scores of the resilience and the dimensions after the first chemotherapy were higher than those after the first chemotherapy. Resilience showed an upward state. The influencing factors of psychological elasticity in two stages of chemotherapy in patients with digestive tract cancer are different, among which the important influence of hope and protective factors on psychological elasticity should be paid special attention to. The study of these influencing factors can provide scientific basis for the patients with digestive tract cancer to construct the whole structure of psychological elasticity in different stages and to provide scientific basis for the targeted intervention of psychological elasticity.
【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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