叙事医学对乳腺癌根治手术病人病耻感的影响
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摘要
目的探寻叙事医学对乳腺癌根治术后病人病耻感的作用及影响,以期为改善病人生活质量提供理论依据和临床循证途径。方法采用分级抽样法从2016年1月至2017年12月在西安交通大学第一、二附属医院及陕西省肿瘤医院乳腺病科选取住院期间行乳腺癌根治手术病人489例,2017年1—12月收治的乳腺癌根治手术病人244例设为观察组,行叙事医学式护理干预;2016年1—12月收治的乳腺癌根治手术病人245例设为对照组,给予常规式护理干预,两组均采用社会影响量表(SIS)于出院后第1、3、6、12个月进行病耻感评定。结果两组出院时和出院后1个月的SIS得分均差异无统计学意义(P>0.05);但是,在出院第3、6、12个月时,对照组SIS得分[(62.5±10.4)、(58.2±11.2)、(55.2±11.3)分]高于观察组[(67.9±11.2)、(67.3±11.1)、(67.1±11.4)分],差异有统计学意义(P<0.05)。结论叙事医学通过科学的方法诱导乳腺癌根治术病人宣泄不良情绪,从而改善了病人的身心状况,提高了病人的生活质量。
Objective To explore the effect of narrative medicine on radical mastectomy patients,in order to provide theoretical basis for improving the quality of life of radical mastectomy patients.Methods A Total of 489 patients with radical mastectomy were convenient sampled from the First and the Second Affiliated Hospital of Xi′an Jiaotong University and Oncology Hospital in Shaanxi Province from January 2016 to December 2017.The 244 recruited patients from February to December 2017 were recognized as observation group which was treated with narrative medicine,while 245 patients recruited from January to December 2016 were recognized as control group which was given normal health education and consultation.The Social Impact Scale(SIS) was used to assess sense of stigma at the time of discharge and on the first,the third,the sixth and the twelfth month after intervention.Results There was no significant difference in SIS scores between the two groups at the time of discharge and after a month(P>0.05).On the third,the sixth and the twelfth month after discharge,the SIS score of the observation group was significantly lower than that of the control group [(62.5±10.4),(58.2±11.2),(55.2±11.3)]vs. [(67.9±11.2),(67.3±11.1),(67.1±11.4)](P<0.05).Conclusion The narrative medicine can not only reduce psychological burden for radical mastectomy patients,but also promote the recovery of disease and improve the quality of life.
Objective To explore the effect of narrative medicine on radical mastectomy patients,in order to provide theoretical basis for improving the quality of life of radical mastectomy patients.Methods A Total of 489 patients with radical mastectomy were convenient sampled from the First and the Second Affiliated Hospital of Xi′an Jiaotong University and Oncology Hospital in Shaanxi Province from January 2016 to December 2017.The 244 recruited patients from February to December 2017 were recognized as observation group which was treated with narrative medicine,while 245 patients recruited from January to December 2016 were recognized as control group which was given normal health education and consultation.The Social Impact Scale(SIS) was used to assess sense of stigma at the time of discharge and on the first,the third,the sixth and the twelfth month after intervention.Results There was no significant difference in SIS scores between the two groups at the time of discharge and after a month(P>0.05).On the third,the sixth and the twelfth month after discharge,the SIS score of the observation group was significantly lower than that of the control group [(62.5±10.4),(58.2±11.2),(55.2±11.3)]vs. [(67.9±11.2),(67.3±11.1),(67.1±11.4)](P<0.05).Conclusion The narrative medicine can not only reduce psychological burden for radical mastectomy patients,but also promote the recovery of disease and improve the quality of life.
引文
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[22] 张莉,于蕊,郑秋华,等.乳腺癌患者病耻感及家庭功能与生命质量的关系模型研究[J].护理研究,2017,31(11):1333-1336.
[23] 李荣.宫颈癌根治术后患者的病耻感及其与生活质量的相关性[D].济南:山东大学,2015.
[2] 黄辉.三级甲等医院护理人员叙事护理知识、态度、行为研究[D].武汉:华中科技大学,2016.
[3] 刘联,蓝云.国内外叙事医学研究综述[J].锦州医科大学学报(社会科学版),2017,15(1):55-57.
[4] 赫捷,陈万青.2012中国肿瘤登记年报[M].北京:军事医学科学出版社,2012:125-132.
[5] HE J,CHEN WQ.Chinese Cancer Registry Annual Report[ M].Beijing:Military Medical Science Press,2012:125-132.
[6] 李新君.曼月乐干预对乳腺癌术后口服他莫昔芬患者子宫内膜病变的影响[D].石家庄:河北医科大学,2016.
[7] 邓煜,许林勇,张敏,等.人文关怀护理对乳腺癌围手术期患者自我护理能力的影响 [J].安徽医药,2017,Feb,21(2):380-384.
[8] 李玉芳,李月,张竞怡,等.乳腺癌患者术后病耻感现状及影响因素研究[J].肿瘤药学,2017,7(5):636-640.
[9] CORRIGAN PW,KERR A,KNUDSEN L.The stigma of mental illness:Explanatory models and methods for change [J].ApplPrev Psychl,2005,11(3):179-190.
[10] 李孝鹏,白光平,王章桂.乳腺癌术后放疗患者生活质量的影响因素分析[J].安徽医药,2017,21(7):1281-1283.
[11] DEY S,SHARMA S,MISHRA A,et al.Breast cancer awarenessand prevention behavior among women of delhi,india:identifying barriers to early detection[J].Breast Cancer(Auckl),2016,10:147-156.
[12] HU ES,PUSIC AL,WALJEE JF,et al.Patient-reported aestheticsatisfaction with breast reconstruction during thelong-term survivorship Period[J].Plast Reconstr Surg,2009,124(1):1-8.
[13] 孔荣华.年轻乳腺癌患者病耻感现状及其影响因素分析[D].济南:山东大学,2015.
[14] WALJEE JF,HU ES,UBEL PA,et al.Effect of esthetic outcomeafter breast-conserving surgery on psychosocial functioningand quality of life[J].J Clin Oncol,2008,26(20):3331-3337.
[15] KONG RH.The Status and influencing factors of stigma inyoung patients with breast cancer[D].Jinan:Shandong University,2015.
[16] FIFE BL,WRIGHT ER.The Dimensionality of Stigma:A Comparison of its Impact on the Self of Persons with HIV/AIDS and Cancer [J].J Health Soc Behav,2000,41(1):50-67.
[17] PAN AW,CHUNG L,FIFE BL,et al.Evaluation of the psychometrics of the Social Impact Scale:a measure of stigmatization [J].Int J Rehabil Res,2007,30(3):235-238.
[18] 徐芳芳,于卫华,王胜琴.肠造口患者病耻感与生活质量的相关性[J].中国心理卫生杂志.2016,30(2):97-101.
[19] KAUR R.Cultural beliefs,cancer and stigma:experiencesof patients from punjab (India)[J].Studies Ethno-Med,2015,9(2):247-254.
[20] OW CY,LEE BO.Relationships between perceived stigma,copingorientations,self esteem,and quality of life in patients with schizophrenia[J].Asia Pac J Public Health,2012,1(1):1-10.
[21] 茅玲,刘芳芳,尹刚,等.完全植入性中心静脉输液港植入术在乳腺癌患者中的应用[J].安徽医药,2017,21(4):683-687.
[22] 张莉,于蕊,郑秋华,等.乳腺癌患者病耻感及家庭功能与生命质量的关系模型研究[J].护理研究,2017,31(11):1333-1336.
[23] 李荣.宫颈癌根治术后患者的病耻感及其与生活质量的相关性[D].济南:山东大学,2015.