癌症患者失志状况及影响因素研究
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摘要
目的:调查癌症患者失志现状,并探讨其影响因素。方法:采用横断面调查方法,应用失志量表、患者健康问卷、医学应对问卷、Mc Gill生存质量问卷以及自设的一般资料调查表对某2所三级甲等肿瘤医院住院523例癌症患者进行问卷调查。结果:癌症患者的失志总分为(33.53±15.09)分;单因素分析结果显示,癌症患者的失志水平在不同职业、文化程度、家庭月收入、付费方式、居住地及疾病分期存在差异(P<0.05);Pearson相关分析表明,癌症患者抑郁、屈服应对、生活质量的心理维度与失志呈显著正相关(r=0.623、0.589、0.572,均P<0.05),癌症患者整体生活质量、生活质量的个人存在维度及社会支持维度与失志呈显著负相关(r=-0.379、-0.572、-0.453,均P<0.05);多元线性回归分析结果显示,癌症患者失志的影响因素有职业、文化程度、抑郁、屈服应对、回避应对、生活质量的心理维度与个人存在维度(β=0.596、1.373、0.744、1.265、-0.512、1.083、-1.411,均P<0.05)。结论:针对中国内地系统开展的癌症患者失志调查结果显示,内地癌症患者失志水平较高,其职业、文化程度、抑郁、屈服应对、回避应对、生活质量的心理维度与个人存在维度是影响失志的重要因素。
Objective:To describe the status quo of demoralization among cancer patients,and to explore its influencing factors. Methods:A cross-sectional survey was conducted. The Demoralization Scale-Mandarin Version(DS-MV),the Medical Coping Modes Questionnaire,Patient Health Questionnaire-9(PHQ-9),Mc Gill Quality of Life Questionnaire were delivered to 523 cancer patients. Results:The overall demoralization score for cancer patients was 33.53±15.09. The single factor analysis showed that there were statistical significant differences among scores of cancer patients with different demoralization status,occupations,education,family income,payment methods,habitats and disease stages(P<0.05). The Pearson correlation analysis showed that the demoralization of cancer patients was positively correlated with depression,resignation coping style,psychological dimension of quality of life(r=0.623,0.589,0.572,P<0.05),but negative correlated with the overall quality of life,the individual existence dimension and the social support dimension of quality of life(r=-0.379,-0.572,-0.453,P<0.05). Multiple linear regression results showed that factors influencing demoralization including occupation,education,depression,resignation coping style,avoidance coping style,psychological and individual existence dimension of quality of life(β =0.596,1.373,0.744,1.265,-0.512,1.083,-1.411,P <0.05). Conclusion:Cancer patients have high demoralization. Occupation,education,depression,avoidance coping style,resignation coping style,psychological and individual existence dimension of quality of life are important influencing factors.
Objective:To describe the status quo of demoralization among cancer patients,and to explore its influencing factors. Methods:A cross-sectional survey was conducted. The Demoralization Scale-Mandarin Version(DS-MV),the Medical Coping Modes Questionnaire,Patient Health Questionnaire-9(PHQ-9),Mc Gill Quality of Life Questionnaire were delivered to 523 cancer patients. Results:The overall demoralization score for cancer patients was 33.53±15.09. The single factor analysis showed that there were statistical significant differences among scores of cancer patients with different demoralization status,occupations,education,family income,payment methods,habitats and disease stages(P<0.05). The Pearson correlation analysis showed that the demoralization of cancer patients was positively correlated with depression,resignation coping style,psychological dimension of quality of life(r=0.623,0.589,0.572,P<0.05),but negative correlated with the overall quality of life,the individual existence dimension and the social support dimension of quality of life(r=-0.379,-0.572,-0.453,P<0.05). Multiple linear regression results showed that factors influencing demoralization including occupation,education,depression,resignation coping style,avoidance coping style,psychological and individual existence dimension of quality of life(β =0.596,1.373,0.744,1.265,-0.512,1.083,-1.411,P <0.05). Conclusion:Cancer patients have high demoralization. Occupation,education,depression,avoidance coping style,resignation coping style,psychological and individual existence dimension of quality of life are important influencing factors.
引文
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[13]方俊凯.概述失志症候群[J].安宁疗护杂志,2011,16(3):371-379.
[14]Robinson S,Kissane DW,Brooker J,et al.A systematic review of the demoralization syndrome in individuals with progressive disease and cancer:a decade of research[J].J Pain Symptom Manage,2015,49(3):595-610.
[15]Vehling S,Lehmann C,Oechsle K,et al.Global meaning and meaning-related life attitudes:exploring their role in predicting depression,anxiety,and demoralization in cancer patients[J].Support Care Cancer,2011,19(4):513-520.
[2]Juliao M,Nunes B,Barbosa A.Prevalence and factors associated with demoralization syndrome in patients with advanced disease:results from a cross-sectional Portuguese study[J].Palliat Support Care,2016,14(5):468-473.
[3]Clarke DM,Kissane DW.Demoralization:its phenomenology and importance[J].Aust N Z J Psychiatry,2002,36(6):733-742.
[4]Li YC,Ho CH,Wang HH.Demoralization in cancer patients and related factors in Taiwan[J].Cancer Nurs,2017,40(1):E54-60.
[5]洪晓琪,陈虹汶,张义芳,等.癌症病人失志量表中文版之信效度检测[J].内科学志,2010,21:427-435.
[6]王贝蒂.PHQ-9和GAD-7在恶性肿瘤患者中的应用研究[D].长沙:中南大学,2013.
[7]汪向东,王希林,马弘.心理卫生评定量表手册[M].北京:中国心理卫生杂志社,1999:109.
[8]胡莉亚,梅齐,陈元,等.Mc Gill生活质量量表在中国内地癌症患者中的信效度检验[J].癌症进展,2014,12(4):312-316,333.
[9]Costantini A,Picardi A,Brunetti S,et al.Italian version of Demoralization Scale:a validation study[J].Riv Psichiatr,2013,48(3):234-239.
[10]Lee CY,Fang CK,Yang YC,et al.Demoralization syndrome among cancer outpatients in Taiwan[J].Support Care Cancer,2012,20(10):2259-2267.
[11]Mehnert A,Vehling S,Hocker A,et al.Demoralization and depression in patients with advanced cancer:validation of the German version of the demoralization scale[J].J Pain Symptom Manage,2011,42(5):768-776.
[12]Kissane DW,Wein S,Love A,et al.The Demoralization Scale:a report of its development and preliminary validation[J].J Palliat Care,2004,20(4):269-276.
[13]方俊凯.概述失志症候群[J].安宁疗护杂志,2011,16(3):371-379.
[14]Robinson S,Kissane DW,Brooker J,et al.A systematic review of the demoralization syndrome in individuals with progressive disease and cancer:a decade of research[J].J Pain Symptom Manage,2015,49(3):595-610.
[15]Vehling S,Lehmann C,Oechsle K,et al.Global meaning and meaning-related life attitudes:exploring their role in predicting depression,anxiety,and demoralization in cancer patients[J].Support Care Cancer,2011,19(4):513-520.