阶梯式心理护理对头颈肿瘤患者焦虑抑郁和生活质量的影响
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摘要
目的探讨阶梯式心理护理对头颈肿瘤患者焦虑与抑郁情绪和生活质量的影响。方法将86例有焦虑或抑郁情绪的头颈肿瘤住院患者随机分为干预组和对照组各43例,两组均给予常规健康教育和出院后随访,干预组在此基础上实施4步阶梯式心理护理方案,包括2周观察等待、4周指导性自助、6周面对面问题解决疗法、4周专业心理干预和(或)药物疗法,干预前后评估患者焦虑抑郁状况和生活质量。结果干预后干预组焦虑抑郁评分显著低于对照组,干预有效率显著高于对照组(均P <0. 01),干预组在疼痛、吞咽、感觉、发声和进食等生活质量方面有显著改善,与对照组比较,差异有统计学意义(P <0. 05,P <0. 01)。结论以阶梯式护理为指导的心理护理可有效改善头颈肿瘤患者的焦虑、抑郁状况,在一定程度上提升患者生活质量。
Objective To explore the effect of stepped psychological care on anxiety,depression and quality of life in patients with head and neck cancer. Methods Totally,86 hospitalized head and neck cancer patients with HADS-A or HADS-D score > 7 were randomly divided into an intervention group or a control group with 43 cases each. Both groups received routine care and follow-ups after discharge. The intervention group were additionally subjected to a stepped psychological care plan,which included 2 weeks of watchful waiting,4 weeks of guided self-help,6 weeks of face-to-face problem solving therapy sessions,and 4 weeks of specialized psychological intervention and/or drug therapy. Both groups were evaluated in terms of anxiety,depression and quality of life before and after intervention. Results The intervention group had lower anxiety and depression scores than the control group,with the effective rate significantly higher than the latter( P< 0. 01 for both). The intervention group also had significant improvements in pain,swallowing,sensory function,phonation,eating,etc.,than the controls( P < 0. 05,P < 0. 01). Conclusion Stepped psychological care could alleviate anxiety and depression levels of patients with head and neck cancer,and enhance the quality of life of them to some extent.
Objective To explore the effect of stepped psychological care on anxiety,depression and quality of life in patients with head and neck cancer. Methods Totally,86 hospitalized head and neck cancer patients with HADS-A or HADS-D score > 7 were randomly divided into an intervention group or a control group with 43 cases each. Both groups received routine care and follow-ups after discharge. The intervention group were additionally subjected to a stepped psychological care plan,which included 2 weeks of watchful waiting,4 weeks of guided self-help,6 weeks of face-to-face problem solving therapy sessions,and 4 weeks of specialized psychological intervention and/or drug therapy. Both groups were evaluated in terms of anxiety,depression and quality of life before and after intervention. Results The intervention group had lower anxiety and depression scores than the control group,with the effective rate significantly higher than the latter( P< 0. 01 for both). The intervention group also had significant improvements in pain,swallowing,sensory function,phonation,eating,etc.,than the controls( P < 0. 05,P < 0. 01). Conclusion Stepped psychological care could alleviate anxiety and depression levels of patients with head and neck cancer,and enhance the quality of life of them to some extent.
引文
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[13]庄丽萍,许玉,柯水燕,等.喉癌患者焦虑、抑郁情绪及其参与临床决策的状况分析[J].现代临床护理,2017,16(2):22-26.
[14]李燕玲,卢莹,靳小雯,等.分级心理护理干预对癌症住院患者心理影响的观察[J].贵州医药,2017,41(11):1212-1213.
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[17]吴沛霞,彭峥嵘.部分喉切除患者言语障碍及生存质量的调查研究[J].护理学杂志,2015,30(10):29-31.
[18]关妙珠,何东添.临床心理护理程序在甲状腺乳头状癌颈淋巴结转移行清扫术患者中的应用[J].齐鲁护理杂志,2017,23(22):77-79.
[2]Bjorklund M,Sarvimaki A,Berg A.Living with head and neck cancer:a profile of captivity[J].J Nurs Healthc Chron Ill,2010,2(1):22-31.
[3]Hong J S,Tian J.Prevalence of anxiety and depression and their risk factors in Chinese cancer patients[J].Support Care Cancer,2014,22(2):453-459.
[4]Oberaigner W,Sperner-Unterweger B,Fieg I M,et al.Increased suicide risk in cancer patients in Tyrol/Austria[J].Gen Hosp Psychiatry,2014,36(5):483-487.
[5]van Straten A,Hill J,Richards D A,et al.Stepped care treatment delivery for depression:a systematic review and meta-analysis[J].Psychol Med,2015,45(2):231-246.
[6]Seekles W,van Straten A,Beekman A,et al.Stepped care treatment for depression and anxiety in primary care.A randomized controlled trial[J].Trials,2011,12(1):1-10.
[7]孟群,刘爱民.国家疾病分类与代码应用指导手册(ICD-10)[M].北京:中国协和医科大学出版社,2017:759-799.
[8]Zigmond A S,Snaith R P.The Hospital Anxiety and Depression Scale[J].Acta Psychiatr Scand,1983,67(6):361-370.
[9]邹艳辉.头颈肿瘤外科护理手册[M].北京:化学工业出版社,2015:1-318.
[10]王建平,陈仲庚,林文娟,等.中国癌症病人生活质量的测定---EORTC QLQ-C30在中国的试用[J].心理学报,2000,32(4):438-442.
[11]de Vries M,Stiefel F.Psychotherapy in the oncology setting[M].Heidelberg:Springer Cham,2017:145-161.
[12]何诗雯,郭亚茹,童敏,等.老年肿瘤患者疾病认知、应对态度和就诊问题的调查[J].护理学杂志,2017,32(11):78-80.
[13]庄丽萍,许玉,柯水燕,等.喉癌患者焦虑、抑郁情绪及其参与临床决策的状况分析[J].现代临床护理,2017,16(2):22-26.
[14]李燕玲,卢莹,靳小雯,等.分级心理护理干预对癌症住院患者心理影响的观察[J].贵州医药,2017,41(11):1212-1213.
[15]Luckett T,Britton B,Clover K,et al.Evidence for interventions to improve psychological outcomes in people with head and neck cancer:a systematic review of the li-terature[J].Supportive Care Cancer,2011,19(7):871-881.
[16]Krebber A M,Jansen F,Witte B I,et al.Stepped care targeting psychological distress in head and neck cancer and lung cancer patients:a randomized controlled trial[J].Ann Oncol,2016,27(9):1754-1760.
[17]吴沛霞,彭峥嵘.部分喉切除患者言语障碍及生存质量的调查研究[J].护理学杂志,2015,30(10):29-31.
[18]关妙珠,何东添.临床心理护理程序在甲状腺乳头状癌颈淋巴结转移行清扫术患者中的应用[J].齐鲁护理杂志,2017,23(22):77-79.