乳腺癌保乳手术病人术后生存质量的研究
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摘要
[目的]
1.了解乳腺癌保乳治疗病人对生存质量的主观评价与真实体验；
2.探讨保乳病人术后1年内生存质量的变化规律；
3.分析保乳病人术后生存质量及其影响因素,为乳腺癌保乳病人术前健康教育及术后康复护理干预提供理论支持。
[方法]
运用质性研究与量性研究相结合的方法。
1.质性研究：采用现象学研究法对12例保乳病人进行深度访谈,对获得的访谈资料进行内容分析、提炼主题,从生存质量生理、情感、社会/家庭、功能4个层面分析保乳病人生存质量状况。
2.量性研究：随机选取260例保乳手术的住院病人和门诊复查病人为研究对象,以中文版乳腺癌病人生命质量测量表(FACT-B, V4.0)为测量评价分别对术后1周、1个月、3个月、6个月、1年的保乳病人进行调查,并对其乳房美容效果与患肢功能进行测评并记录。
[结果]
1.乳腺癌保乳病人对生存质量的主观评价：内涵多样化,健康体现最佳生存质量,保乳手术提高生存质量；生存质量4个层面主题包括,生理层面：病情轻,创伤小、恢复快,患肢功能受限,化疗反应难耐；情感层面：正性情绪：积极面对,自信,庆幸；负性情绪：悲观,焦虑(担心复发和转移,后续治疗复杂,子女问题)；社会/家庭层面：家庭支持,知识缺乏,经济支持,医疗支持；功能层面：渴望融入社会,自我角色改变,自我效能改变。
2.保乳病人术后生存质量呈现先下降后上升的变化趋势,术后1周、1月、3月、6月、1年的生存质量及各维度差异具有统计学意义(P<0.05)。随着术后时间的延长,保乳病人生存质量于术后1周-1月下降,1月-3月期间最差,3月后上升,术后1年呈现较好状态。
3.Spearman相关分析结果显示：保乳病人总体生存质量与文化程度、婚姻状况、家庭月收入、手术方式、免疫组化和患肢活动功能成正相关,与职业、医疗费用支付方式、临床分期、慢性病史、肿瘤最大直径、乳房美容效果、自我参与决策、拔管天数、患肢水肿、患肢上举水平、外展水平、SAS、社交活动、性格类型、家务劳动、户外活动和食欲呈负相关。
4.多元逐步回归分析结果：保乳病人总体生存质量的相关因素(按Beta值由大到小)：SAS、患肢外展水平、户外活动、食欲、婚姻状况、性格类型、医疗费用支付方式、肿瘤最大直径、临床分期、慢性病史。(R2=0.627,F=42.181,P=0.000)
[结论]
1.保乳病人缺乏全面的治疗知识,化疗时期生存质量最差,担心复发是保乳病人最大的心理障碍,自我效能的改变使生存质量降低,社会支持能够提高保乳病人生存质量。
2.乳腺癌保乳病人生存质量的研究对护理工作的启示：我们在护理科研和工作中,要提倡质性研究与量性研究相结合的研究方法,提倡连续护理的护理模式,采取多种措施,提高保乳病人生存质量,包括加强宣传教育；加强心理护理；注重个性护理；提高患肢功能,防止患肢水肿；改善化疗期间生存质量；增强家庭与社会支持。
[Objective]
1. To understand the subjective assessment and real experience of quality of life (QOL) with breast conserving therapy (BCT) patients;
2. To study the variation of BCT patients about QOL within 1 year after surgery;
3. To analyze the influencing factors of QOL, for providing theoretical support both preoperative health education and postoperative nursing rehabilitation interventions for BCT patients.
[Methods]
Combining with the qualitative and quantitative research methods.1.Qualitative research: A phenomenological study on 12 cases of BCT patients, data were collected by in-depth interview with 12 BCT patients and the contents of the talks were analyzed and the themes were extracted, data were analyzed from physical, emotional, social/family and functional dimensions of QOL
2. Quantitative research:260 BCT patients were randomly selected and assessed with Functional Assessment of Cancer Therapy-Breast (FACT-B V4.0) after operation about 1 week,1 month,3 months,6 months,1 year one week, recording the cosmetic results of their breast and limb function.
【Results】
1. BCT patients'subjective assessment of their own QOL: the content of BCT is diverse, good health is the best QOL, and breast-conserving surgery improves QOL; themes were refined from the four dimensions, physical dimension:mild injury and short recovery, upper limb dysfunction, chemotherapeutic response:emotional dimension:positive emotion:positive attitude, self-confidence, good luck; negative emotion:pessimism, anxiety (be anxious of recurrence and metastasis, complex follow-up treatment and children); social/family dimension:family support, lack of knowledge, financial support, medical support; function levels:desire to return society,change of self-role and self-efficacy.
2. The QOL of BCT patients was first decreased and then increased.1 week,1 month,
3 months,6 months,1 year after surgery. QOL in all dimensions had statistically significant differences (P<0.05). With the time goes by, QOL dropped from 1 week to 1 month and was worst in the 3th month period, while rised after 3 month later, and showed good condition 1 year after surgery.
3.Spearman correlation analysis showed that:BCT patients'QOL was positively correlated with education level, marital status, family income, surgical methods, immunohistochemistry and function of limb activity, and negative correlated with employment, payment of medical expenses, clinical stage, diseases, tumor diameter, breast cosmetic results, self-participation in decision making, pulling days, limb edema, limb uplift and outreach level, SAS, social activities, personality type, household chores, outdoor activities and appetite.
4. Multiple regression analysis showed that:the related factors of QOL were (according to Beta value from large to small):SAS, limbs reaching the level of outdoor activity, appetite, marital status, personality type, payment of medical expenses, tumor diameter, clinical stage, history of chronic diseases. (R 2=0.627, F= 42.181, P= 0.000)
[Conclusions]
1. BCT patients were lack of comprehensive knowledge of breast conservation surgery. And had the worst QOL during chemotherapy period. Worrying about recurrence is the largest psychological obstacle of BCT patients. Lower self-efficacy made QOL down, while social support could enhance QOL
2.The study of QOL with BCT showed some revelations on the care of nursing: we should recommend the combining study methods with qualitative and quantitative, and recommend continuous nursing care model, and take various measures to improve the QOL of BCT patients, including strengthening publicity and education, psychosocial care, and personal care, improve limb function and prevent limb edema, improve QOL during chemotherapy period, and enhance family and social support.
1.了解乳腺癌保乳治疗病人对生存质量的主观评价与真实体验；
2.探讨保乳病人术后1年内生存质量的变化规律；
3.分析保乳病人术后生存质量及其影响因素,为乳腺癌保乳病人术前健康教育及术后康复护理干预提供理论支持。
[方法]
运用质性研究与量性研究相结合的方法。
1.质性研究：采用现象学研究法对12例保乳病人进行深度访谈,对获得的访谈资料进行内容分析、提炼主题,从生存质量生理、情感、社会/家庭、功能4个层面分析保乳病人生存质量状况。
2.量性研究：随机选取260例保乳手术的住院病人和门诊复查病人为研究对象,以中文版乳腺癌病人生命质量测量表(FACT-B, V4.0)为测量评价分别对术后1周、1个月、3个月、6个月、1年的保乳病人进行调查,并对其乳房美容效果与患肢功能进行测评并记录。
[结果]
1.乳腺癌保乳病人对生存质量的主观评价：内涵多样化,健康体现最佳生存质量,保乳手术提高生存质量；生存质量4个层面主题包括,生理层面：病情轻,创伤小、恢复快,患肢功能受限,化疗反应难耐；情感层面：正性情绪：积极面对,自信,庆幸；负性情绪：悲观,焦虑(担心复发和转移,后续治疗复杂,子女问题)；社会/家庭层面：家庭支持,知识缺乏,经济支持,医疗支持；功能层面：渴望融入社会,自我角色改变,自我效能改变。
2.保乳病人术后生存质量呈现先下降后上升的变化趋势,术后1周、1月、3月、6月、1年的生存质量及各维度差异具有统计学意义(P<0.05)。随着术后时间的延长,保乳病人生存质量于术后1周-1月下降,1月-3月期间最差,3月后上升,术后1年呈现较好状态。
3.Spearman相关分析结果显示：保乳病人总体生存质量与文化程度、婚姻状况、家庭月收入、手术方式、免疫组化和患肢活动功能成正相关,与职业、医疗费用支付方式、临床分期、慢性病史、肿瘤最大直径、乳房美容效果、自我参与决策、拔管天数、患肢水肿、患肢上举水平、外展水平、SAS、社交活动、性格类型、家务劳动、户外活动和食欲呈负相关。
4.多元逐步回归分析结果：保乳病人总体生存质量的相关因素(按Beta值由大到小)：SAS、患肢外展水平、户外活动、食欲、婚姻状况、性格类型、医疗费用支付方式、肿瘤最大直径、临床分期、慢性病史。(R2=0.627,F=42.181,P=0.000)
[结论]
1.保乳病人缺乏全面的治疗知识,化疗时期生存质量最差,担心复发是保乳病人最大的心理障碍,自我效能的改变使生存质量降低,社会支持能够提高保乳病人生存质量。
2.乳腺癌保乳病人生存质量的研究对护理工作的启示：我们在护理科研和工作中,要提倡质性研究与量性研究相结合的研究方法,提倡连续护理的护理模式,采取多种措施,提高保乳病人生存质量,包括加强宣传教育；加强心理护理；注重个性护理；提高患肢功能,防止患肢水肿；改善化疗期间生存质量；增强家庭与社会支持。
[Objective]
1. To understand the subjective assessment and real experience of quality of life (QOL) with breast conserving therapy (BCT) patients;
2. To study the variation of BCT patients about QOL within 1 year after surgery;
3. To analyze the influencing factors of QOL, for providing theoretical support both preoperative health education and postoperative nursing rehabilitation interventions for BCT patients.
[Methods]
Combining with the qualitative and quantitative research methods.1.Qualitative research: A phenomenological study on 12 cases of BCT patients, data were collected by in-depth interview with 12 BCT patients and the contents of the talks were analyzed and the themes were extracted, data were analyzed from physical, emotional, social/family and functional dimensions of QOL
2. Quantitative research:260 BCT patients were randomly selected and assessed with Functional Assessment of Cancer Therapy-Breast (FACT-B V4.0) after operation about 1 week,1 month,3 months,6 months,1 year one week, recording the cosmetic results of their breast and limb function.
【Results】
1. BCT patients'subjective assessment of their own QOL: the content of BCT is diverse, good health is the best QOL, and breast-conserving surgery improves QOL; themes were refined from the four dimensions, physical dimension:mild injury and short recovery, upper limb dysfunction, chemotherapeutic response:emotional dimension:positive emotion:positive attitude, self-confidence, good luck; negative emotion:pessimism, anxiety (be anxious of recurrence and metastasis, complex follow-up treatment and children); social/family dimension:family support, lack of knowledge, financial support, medical support; function levels:desire to return society,change of self-role and self-efficacy.
2. The QOL of BCT patients was first decreased and then increased.1 week,1 month,
3 months,6 months,1 year after surgery. QOL in all dimensions had statistically significant differences (P<0.05). With the time goes by, QOL dropped from 1 week to 1 month and was worst in the 3th month period, while rised after 3 month later, and showed good condition 1 year after surgery.
3.Spearman correlation analysis showed that:BCT patients'QOL was positively correlated with education level, marital status, family income, surgical methods, immunohistochemistry and function of limb activity, and negative correlated with employment, payment of medical expenses, clinical stage, diseases, tumor diameter, breast cosmetic results, self-participation in decision making, pulling days, limb edema, limb uplift and outreach level, SAS, social activities, personality type, household chores, outdoor activities and appetite.
4. Multiple regression analysis showed that:the related factors of QOL were (according to Beta value from large to small):SAS, limbs reaching the level of outdoor activity, appetite, marital status, personality type, payment of medical expenses, tumor diameter, clinical stage, history of chronic diseases. (R 2=0.627, F= 42.181, P= 0.000)
[Conclusions]
1. BCT patients were lack of comprehensive knowledge of breast conservation surgery. And had the worst QOL during chemotherapy period. Worrying about recurrence is the largest psychological obstacle of BCT patients. Lower self-efficacy made QOL down, while social support could enhance QOL
2.The study of QOL with BCT showed some revelations on the care of nursing: we should recommend the combining study methods with qualitative and quantitative, and recommend continuous nursing care model, and take various measures to improve the QOL of BCT patients, including strengthening publicity and education, psychosocial care, and personal care, improve limb function and prevent limb edema, improve QOL during chemotherapy period, and enhance family and social support.
引文
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