短期医护社工一体化模式心理干预对永久性肠造口病人心理及生活质量的影响
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摘要
目的探讨短期医护社工一体化模式心理干预对永久性肠造口病人心理及生活质量的影响。方法选择2016年3月至2017年2月四川大学华西医院接受放化疗的永久性肠造口病人105例,按病区分为治疗组及对照组。对照组实施常规护理,治疗组在常规护理的同时增加医护社工一体化模式心理干预。使用心理痛苦筛查工具(DMSM)、医院焦虑抑郁量表(HADS)、生存质量量表(EORTC QLQ-C30)比较两组干预前后心理痛苦、焦虑、抑郁、生活质量的差异。结果干预后治疗组病人心理痛苦得分、焦虑得分、抑郁等分、生活质量中失眠得分分别为(3.04±1.84)、(6.62±4.03)、(6.18±4.11)、0.00(33.33)分,低于对照组,差异有统计学意义(均P<0.05),治疗组病人整体生活质量得分、情绪功能得分分别为75.00(16.67)、83.33(25.00)分,高于对照组,差异有统计学意义(均P<0.05)。结论医护社工一体化模式心理干预可以降低永久性造口放化疗病人的心理痛苦、焦虑、抑郁水平,缓解病人失眠症状。
Objective To evaluate the effect of short-term physician-nurse-social worker collaborative structural psychological intervention on emotional distress and quality of life in permanent colostomy patients in West China Hospital of Sichuan University.Methods A total of 105 patients with permanent colostomy undergoing chemoradiotherapy in West China Hospital of Sichuan University from March 2016 to February 2017 were recruited and randomly assigned into the experimental group and the control group according to different wards.The control group was given routine nursing,while the experimental group received physician-nurse-social worker collaborative structural psychological intervention on the basis of routine nursing.The differences of psychological pain,anxiety,depression and quality of life between the two groups were compared by distress management screening measure(DMSM),Hospital Anxiety and Depression Scale(HADS) and quality of life questionnaire-core 30(EORTC QLQ-C30) before and after intervention.Results After intervention,the scores of DMSM,HADS-A,HADS-D and insomnia in experimental group were(3.04±1.84),(6.62±4.03),(6.18±4.11),and 0.00(33.33),respectively,which were lower than those in the control group,and the differences were statistically significant(all P <0.05).The scores of quality of life,emotion function in experimental group were 75.00(16.67),83.33(25.00),respectively,which were higher than those in the control group,and the differences were statistically significant(all P<0.05).Conclusion Physician-nurse-social worker collaborative structural psychological intervention could reduce distress,anxiety and depression of permanent colostomy patients undergoing chemoradiotherapy,and alleviate the symptoms of insomnia.
Objective To evaluate the effect of short-term physician-nurse-social worker collaborative structural psychological intervention on emotional distress and quality of life in permanent colostomy patients in West China Hospital of Sichuan University.Methods A total of 105 patients with permanent colostomy undergoing chemoradiotherapy in West China Hospital of Sichuan University from March 2016 to February 2017 were recruited and randomly assigned into the experimental group and the control group according to different wards.The control group was given routine nursing,while the experimental group received physician-nurse-social worker collaborative structural psychological intervention on the basis of routine nursing.The differences of psychological pain,anxiety,depression and quality of life between the two groups were compared by distress management screening measure(DMSM),Hospital Anxiety and Depression Scale(HADS) and quality of life questionnaire-core 30(EORTC QLQ-C30) before and after intervention.Results After intervention,the scores of DMSM,HADS-A,HADS-D and insomnia in experimental group were(3.04±1.84),(6.62±4.03),(6.18±4.11),and 0.00(33.33),respectively,which were lower than those in the control group,and the differences were statistically significant(all P <0.05).The scores of quality of life,emotion function in experimental group were 75.00(16.67),83.33(25.00),respectively,which were higher than those in the control group,and the differences were statistically significant(all P<0.05).Conclusion Physician-nurse-social worker collaborative structural psychological intervention could reduce distress,anxiety and depression of permanent colostomy patients undergoing chemoradiotherapy,and alleviate the symptoms of insomnia.
引文
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[13] 薛盈川,刘晓鸿,陆薇,等.自我管理教育对永久性结肠造口患者自我护理能力的影响[J].中华护理杂志,2011,46(8):753-755.
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[18] 罗宇玲,敖强,周小平,等.放松训练联合情志疗法对肺癌患者睡眠障碍和抑郁状态的影响[J].中国老年学杂志,2017,37(13):3250-3253.
[19] 易鸣,庞英,唐丽丽,等.早中期结直肠癌患者情绪及生活质量的10周团体心理治疗[J].中国心理卫生杂志,2015,29(7):491-496.
[20] SCHNEIDER EC,MALIN JL,KAHN KL,et al.Surviving colorectal cancer:patient-reported symptoms 4 years after diagnosis[J].Cancer,2007,110(9):2075-2082.
[2] 张麒.老年结直肠癌患者手术并发症情况和影响因素分析[J].安徽医药,2015,19(6):1169-1170.
[3] BRINTZENHOFE-SZOC KM,LEVIN TT,LI YL,et al.Mixed anxiety/depression symptoms in a large cancer cohort:prevalence by cancer type[J].Psychosomatics,2009,50(4):383-391.
[4] 汪翠云,俞士卉,鲁慧兰,等.治疗性沟通系统对永久性肠造口患者自我护理能力的影响[J].安徽医药,2013,17(12):2164-2166.
[5] National Comprehensive Cancer Network.Distress management clinical practice guidelines[J].J Natl Compr Canc Netw,2003,1(3):344-374.
[6] HOLLAND JC,ANDERSEN B,BREITBART WS,et al.Distress Management[J].J Natl Compr Canc Netw,2010,8(4):448-485.
[7] JACOBSEN PB,JIM HS.Psychosocial interventions for anxiety and depression in adult cancer patients:achievements and challenges[J].CA Cancer J Clin,2008,58(4):214-230.
[8] 张丽.结构式心理干预对腹腔镜手术患者不良情绪和应激反应的影响[J].临床护理杂志,2017,16(2):19-21.
[9] 张凤,徐萍飞.结构式心理干预对诱导期血液透析患者负性情绪的影响[J].中国基层医药,2017,24(5):732-735.
[10] 陆美芹,张玲,陆勤美,等.结构式心理干预对中青年肝癌病人自我感受负担的影响[J].护理研究,2015,29(15):1847-1849.
[11] 齐越,秦杰,邱坤鹏,等.短信教育对直肠癌结肠造口术后患者焦虑和自理能力的影响[J].解放军护理杂志,2013,30(10):10-12,21.
[12] KINGSLEY L,SIMMON S.A view from here psychosocial issues in colostomy care[J].J Wound Ostomy Continence Nurs,2014,41(1):55-59.
[13] 薛盈川,刘晓鸿,陆薇,等.自我管理教育对永久性结肠造口患者自我护理能力的影响[J].中华护理杂志,2011,46(8):753-755.
[14] LI WW,LAM WW,AU AH,et al.Interpreting differences in patterns of supportive care needs between patients with breast cancer and patients with colorectal cancer[J].Psychooncology,2013,22(4):792-798.
[15] CHOW KM,CHAN CW,CHAN JC,et al.A feasibility study of a psychoeducational intervention program for gynecological cancer patients[J].Eur J Oncol Nurs,2014,18(4):385-392.
[16] SPIEGEL D,KRAEMER H,BLOOM J,et al.Effect of psychosocial treatment on survival of patients with metastatic breast cancer[J].The Lancet,1989,334(8668):888-891.
[17] 李一花.心理干预对直肠癌miles术后患者抑郁及应对能力的影响[D].衡阳:南华大学,2011.
[18] 罗宇玲,敖强,周小平,等.放松训练联合情志疗法对肺癌患者睡眠障碍和抑郁状态的影响[J].中国老年学杂志,2017,37(13):3250-3253.
[19] 易鸣,庞英,唐丽丽,等.早中期结直肠癌患者情绪及生活质量的10周团体心理治疗[J].中国心理卫生杂志,2015,29(7):491-496.
[20] SCHNEIDER EC,MALIN JL,KAHN KL,et al.Surviving colorectal cancer:patient-reported symptoms 4 years after diagnosis[J].Cancer,2007,110(9):2075-2082.