肺癌患者病耻感及社会支持与生活质量结构方程模型的构建
|
摘要
目的 :分析肺癌患者病耻感、社会支持及生活质量现状,通过构建结构方程模型明确三个变量相互作用的关系。方法 :采用患者一般情况调查表、肺癌患者病耻感评价量表、社会支持评定量表及癌症治疗功能评价系统-肺癌模块,对2017年1-8月期间在某省级三级甲等肿瘤医院就诊的264名肺癌患者进行问卷调查。结果:肺癌患者病耻感总分为(71.11±14.91)分;社会支持总分为(39.10±11.53)分;生活质量总分为(85.39±23.48)分。病耻感与社会支持及生活质量均呈负相关(P<0.01)。结构方程模型结果显示:病耻感对生活质量有直接负向效应(β=-0.301,P<0.01)和间接负向效应(β=-0.100),社会支持对生活质量仅有直接正向效应(β=0.250,P<0.01)。结论 :肺癌患者病耻感处于中等偏高水平,临床医务工作者应采取有效措施降低肺癌患者病耻感水平,提高其社会支持水平,以达到提高患者生活质量的目的。
Objective: To investigate the status of stigma, social support and quality of life in patients with lung cancer, and to establish a structural equation model to clarify the relationships between these three variables. Methods: A questionnaire survey was conducted among 264 lung cancer patients in a provincial tertiary cancer hospital from January to August in 2017. Cataldo Lung Cancer Stigma Scale, Social Support Rating Scale, and Functional Assessment of Cancer Therapy-Lung were included in the questionnaire. Results: The total score of stigma in lung cancer patients was(71.11±14.91);the total score of social support was(39.10±11.53); the total score of quality of life was(85.39±23.48). Stigma was negatively correlated with social support and quality of life(P<0.01). The results of structural equation modeling showed that stigma had a direct negative effect(β=-0.301, P<0.01) and an indirect negative effect(β=-0.100) on quality of life. Social support only had a direct positive effect on quality of life(β=0.250, P<0.01). Conclusion: The stigma of lung cancer patients was at medium to high level. Health care professionals should take effective measures to alleviate lung cancer patients' stigma and increase their social support level, so as to improve their quality of life.
Objective: To investigate the status of stigma, social support and quality of life in patients with lung cancer, and to establish a structural equation model to clarify the relationships between these three variables. Methods: A questionnaire survey was conducted among 264 lung cancer patients in a provincial tertiary cancer hospital from January to August in 2017. Cataldo Lung Cancer Stigma Scale, Social Support Rating Scale, and Functional Assessment of Cancer Therapy-Lung were included in the questionnaire. Results: The total score of stigma in lung cancer patients was(71.11±14.91);the total score of social support was(39.10±11.53); the total score of quality of life was(85.39±23.48). Stigma was negatively correlated with social support and quality of life(P<0.01). The results of structural equation modeling showed that stigma had a direct negative effect(β=-0.301, P<0.01) and an indirect negative effect(β=-0.100) on quality of life. Social support only had a direct positive effect on quality of life(β=0.250, P<0.01). Conclusion: The stigma of lung cancer patients was at medium to high level. Health care professionals should take effective measures to alleviate lung cancer patients' stigma and increase their social support level, so as to improve their quality of life.
引文
[1] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016,66(2):115-132.
[2]石春雷,娄培安,石菊芳,等.中国1996-2014年肺癌经济负担研究系统评价.中国公共卫生,2017,33(12):1767-1774.Shi CL, Lou PA, Shi JF, et al. A systematic evaluation on the economic burden of lung cancer in China from 1996 to 2014. China Public Health,2017,33(12):1767-1774.
[3]于媛,刘均娥.肺癌患者病耻感的研究进展.中华护理杂志,2014,49(11):1386-1390.Yu Y, Liu JE. Research progress on stigma of lung cancer. Chinese Journal of Nursing, 2014,49(11):1386-1390.
[4]邹小农,贾漫漫,王鑫,等.中国肺癌和烟草流行及控烟现状.中国肺癌杂志,2017,20(8):505-510.Zou XN, Jia MM, Wang X, et al. The current situation of lung cancer and tobacco epidemic and tobacco control in China. Chinese Journal of Lung Cancer, 2017,20(8):505-510.
[5] Ernst J, Mehnert A, Taubenheim S, et al.Stigmatization in employed patients with breast,intestinal, prostate and lung cancer. Psychother Psychosom Med Psychol, 2017,67(7):304-311.
[6] Marlow LA, Waller J, Wardle J. Does lung cancer attract greater stigma than other cancer types?. Lung Cancer, 2015,88(1):104-107.
[7]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.中国心理卫生杂志,2016,30(2):97-101.Xu FF, Yu WH, Wang SQ. The correlation between stigma and quality of life in enterostomy patients. Chinese Journal of Mental Health, 2016,30(2):97-101.
[8] Chambers SK, Baade P, Youl P, et al.Psychological distress and quality of life in lung cancer:the role of health-related stigma, illness appraisals and social constraints. Psychooncology,2015,24(11):1569-1577.
[9]王红爱,曹枫林,李洁,等.肺癌患者积极心理品质、社会支持与生活质量的关系研究.护理学杂志,2015,30(17):23-25.Wang HA, Cao FL, Li J, et al. The relationship between positive psychological quality, social support and quality of life in lung cancer patients.Journal ofNursing Science, 2015,30(17):23-25.
[10]杨茜茜,刘化侠,田靖,等.肺癌患者病耻感现状及其影响因素的调查分析.中国实用护理杂志,2015,31(35):2708-2711.Yang XX, Liu HX, Tian J, et al. Investigation and analysis of the status of stigma and its influencing factors in lung cancer patients. Chinese Journal of Practical Nursing, 2015,31(35):2708-2711.
[11]于媛,王黎,张娜,等.肺癌患者病耻感水平及其影响因素调查分析.中国护理管理,2016,16(2):256-259.Yu Y, Wang L, Zhang N, et al. Investigation and analysis of the stigma level of lung cancer patients and its influencing factors. Chinese Nursing Management, 2016,16(2):256-259.
[12] Cataldo JK, Slaughter R, Jahan TM, et al.Measuring stigma in people with lung cancer:psychometric testing of the Cataldo Lung Cancer Stigma Scale. Oncology Nursing Forum, 2011,38(1):46-54.
[13]杨茜茜,刘化侠,杨春玲,等.中文版Cataldo肺癌污名量表的信效度研究.护理学杂志,2014,29(5):17-19.Yang XX, Liu HX, Yang CL, et al. Reliability and validity of Chinese version of Cataldo Lung Cancer Stigma Scale. Journal of Nursing Science,2014,29(5):17-19.
[14]肖水源.《社会支持评定量表》的理论基础与研究应用.临床精神医学杂志,1994(2):98-100.Xiao SY. Theoretical basis and research application of Social Support Rating Scale. Journal of Clinical Psychiatry, 1994(2):98-100.
[15] Cella DF, Tulsky DS, Gray G, et al. The functional assessment of cancer therapy scale:developmentandvalidationofthegeneral measure. J Clin Oncol, 1993,11(3):570-579.
[16]万崇华,张灿珍,宋元龙,等.肺癌患者生存质量测定量表FACT-L中文版.中国肿瘤,2000(3):109-110.Wan CH, Zhang CZ, Song YL, et al. Quality of Life Scale for lung cancer patients FACT-L Chinese version. Chinese Cancer, 2000(3):109-110.
[17] Cataldo JK, Brodsky JL. Lung cancer stigma,anxiety,depressionandsymptomseverity.Oncology, 2013,85(1):33-40.
[18]何明珠,李新辉.新疆某医院肿瘤化疗患者癌因性疲乏程度与社会支持的相关性研究.医学与社会,2016,29(2):87-89.He MZ, Li XH. Correlation between cancerrelatedfatigueandsocialsupportincancer patients undergoing chemotherapy in a hospital of Xinjiang. Medicine and Society, 2016,29(2):87-89.
[19]雷霁,唐宁玉.面子观、自我效能与寻求帮助行为的关系研究.中国人力资源开发,2015(13):13-20.Lei J, Tang NY. The relationship between face view, self-efficacy and help-seeking behavior.Human Resource Development of China, 2015(13):13-20.
[20]张苏梅,顾炜,高苗,等.自我效能感在肺癌化疗患者社会支持与生存质量间的中介效应.中国健康心理学杂志,2015,29(2):1310-1314.Zhang SM, Gu W, Gao M, et al. Mediating effectofself-efficacyonsocialsupportand quality of life in lung cancer patients undergoing chemotherapy. Chinese Journal of Health Psychology, 2015,29(2):1310-1314.
[21] Brown Johnson CG, Brodsky JL, Cataldo JK. Lung cancer stigma, anxiety, depression, and quality of life. J Psychosoc Oncol, 2014,32(1):59-73.
[22] Carter-Harris L. Lung cancer stigma as a barrier to medical help-seeking behavior:practice implications. Journal of the American Association of Nurse Practitioners, 2015,27(5):240-245.
[23]陈文政,张春华,王晓松,等.肺癌患者营养状况与放疗不良反应的相关性研究.实用癌症杂志,2018,33(9):1439-1441,1460.Chen WZ, Zhang CH, Wang XS, et al. Study on the correlation between nutritional status of lung cancer patients and adverse reactions to radiotherapy. Journal of Practical Cancer, 2018,33(9):1439-1441,1460.
[24]张誉华,龙麟,杨婕,等.肺癌靶向药物相关皮肤不良反应的中西医治疗进展.中国中医基础医学杂志,2016,22(2):287-289.Zhang YH, Long L, Yang J, et al. Progress in the treatment of skin adverse reactions related to targeted drugs for lung cancer. Chinese Journal of Basic Medicine of Traditional Chinese Medicine,2016,22(2):287-289.
[25]李楠楠,陈芬荣,朱惠瑛,等.肺癌患者化疗前后症状群的调查研究.解放军护理杂志,2017,34(23):34-38.Li NN, Chen FR, Zhu HY, et al. Investigation of symptoms of lung cancer patients before and after chemotherapy. Nurs J Chin PLA, 2017,34(23):34-38.
[26] Carter-Harris L, Hermann CP, Schreiber J, et al.Lung cancer stigma predicts timing of medical help-seeking behavior. Oncol Nurs Forum, 2014,41(3):E203-210.
[27]王黎,于媛,张娜,等.肺癌患者病耻感体验的质性研究.中华现代护理杂志,2016,22(30):4358-4362.Wang L, Yu Y, Zhang N, et al. Qualitative study on shame experience of lung cancer patients.Chinese Journal of Modern Nursing, 2016,22(30):4358-4362.
[28] Gu W, Xu YM, Zhong BL. Health-related quality of life in Chinese inpatients with lung cancer treated in large general hospitals:a crosssectional study. BMJ Open, 2018,8(4):e019873.
[29]李丹,张洁,张黎黎,等.非小细胞肺癌患者社会支持与生存质量的相关性研究.重庆医学,2016,45(4):501-503,507.Li D, Zhang J, Zhang LL, et al. Study on the correlation between social support and quality of life in patients with non-small cell lung cancer.Chongqing Medicine, 2016,45(4):501-503,507.
[30]王君.社区管理模式对肺癌患者社会支持度及生活质量的影响.南京:南京中医药大学,2018.Wang J. The impact of community management model on social support and quality of life of lung cancer patients. Nanjing:Nanjing University of Traditional Chinese Medicine, 2018.
[2]石春雷,娄培安,石菊芳,等.中国1996-2014年肺癌经济负担研究系统评价.中国公共卫生,2017,33(12):1767-1774.Shi CL, Lou PA, Shi JF, et al. A systematic evaluation on the economic burden of lung cancer in China from 1996 to 2014. China Public Health,2017,33(12):1767-1774.
[3]于媛,刘均娥.肺癌患者病耻感的研究进展.中华护理杂志,2014,49(11):1386-1390.Yu Y, Liu JE. Research progress on stigma of lung cancer. Chinese Journal of Nursing, 2014,49(11):1386-1390.
[4]邹小农,贾漫漫,王鑫,等.中国肺癌和烟草流行及控烟现状.中国肺癌杂志,2017,20(8):505-510.Zou XN, Jia MM, Wang X, et al. The current situation of lung cancer and tobacco epidemic and tobacco control in China. Chinese Journal of Lung Cancer, 2017,20(8):505-510.
[5] Ernst J, Mehnert A, Taubenheim S, et al.Stigmatization in employed patients with breast,intestinal, prostate and lung cancer. Psychother Psychosom Med Psychol, 2017,67(7):304-311.
[6] Marlow LA, Waller J, Wardle J. Does lung cancer attract greater stigma than other cancer types?. Lung Cancer, 2015,88(1):104-107.
[7]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.中国心理卫生杂志,2016,30(2):97-101.Xu FF, Yu WH, Wang SQ. The correlation between stigma and quality of life in enterostomy patients. Chinese Journal of Mental Health, 2016,30(2):97-101.
[8] Chambers SK, Baade P, Youl P, et al.Psychological distress and quality of life in lung cancer:the role of health-related stigma, illness appraisals and social constraints. Psychooncology,2015,24(11):1569-1577.
[9]王红爱,曹枫林,李洁,等.肺癌患者积极心理品质、社会支持与生活质量的关系研究.护理学杂志,2015,30(17):23-25.Wang HA, Cao FL, Li J, et al. The relationship between positive psychological quality, social support and quality of life in lung cancer patients.Journal ofNursing Science, 2015,30(17):23-25.
[10]杨茜茜,刘化侠,田靖,等.肺癌患者病耻感现状及其影响因素的调查分析.中国实用护理杂志,2015,31(35):2708-2711.Yang XX, Liu HX, Tian J, et al. Investigation and analysis of the status of stigma and its influencing factors in lung cancer patients. Chinese Journal of Practical Nursing, 2015,31(35):2708-2711.
[11]于媛,王黎,张娜,等.肺癌患者病耻感水平及其影响因素调查分析.中国护理管理,2016,16(2):256-259.Yu Y, Wang L, Zhang N, et al. Investigation and analysis of the stigma level of lung cancer patients and its influencing factors. Chinese Nursing Management, 2016,16(2):256-259.
[12] Cataldo JK, Slaughter R, Jahan TM, et al.Measuring stigma in people with lung cancer:psychometric testing of the Cataldo Lung Cancer Stigma Scale. Oncology Nursing Forum, 2011,38(1):46-54.
[13]杨茜茜,刘化侠,杨春玲,等.中文版Cataldo肺癌污名量表的信效度研究.护理学杂志,2014,29(5):17-19.Yang XX, Liu HX, Yang CL, et al. Reliability and validity of Chinese version of Cataldo Lung Cancer Stigma Scale. Journal of Nursing Science,2014,29(5):17-19.
[14]肖水源.《社会支持评定量表》的理论基础与研究应用.临床精神医学杂志,1994(2):98-100.Xiao SY. Theoretical basis and research application of Social Support Rating Scale. Journal of Clinical Psychiatry, 1994(2):98-100.
[15] Cella DF, Tulsky DS, Gray G, et al. The functional assessment of cancer therapy scale:developmentandvalidationofthegeneral measure. J Clin Oncol, 1993,11(3):570-579.
[16]万崇华,张灿珍,宋元龙,等.肺癌患者生存质量测定量表FACT-L中文版.中国肿瘤,2000(3):109-110.Wan CH, Zhang CZ, Song YL, et al. Quality of Life Scale for lung cancer patients FACT-L Chinese version. Chinese Cancer, 2000(3):109-110.
[17] Cataldo JK, Brodsky JL. Lung cancer stigma,anxiety,depressionandsymptomseverity.Oncology, 2013,85(1):33-40.
[18]何明珠,李新辉.新疆某医院肿瘤化疗患者癌因性疲乏程度与社会支持的相关性研究.医学与社会,2016,29(2):87-89.He MZ, Li XH. Correlation between cancerrelatedfatigueandsocialsupportincancer patients undergoing chemotherapy in a hospital of Xinjiang. Medicine and Society, 2016,29(2):87-89.
[19]雷霁,唐宁玉.面子观、自我效能与寻求帮助行为的关系研究.中国人力资源开发,2015(13):13-20.Lei J, Tang NY. The relationship between face view, self-efficacy and help-seeking behavior.Human Resource Development of China, 2015(13):13-20.
[20]张苏梅,顾炜,高苗,等.自我效能感在肺癌化疗患者社会支持与生存质量间的中介效应.中国健康心理学杂志,2015,29(2):1310-1314.Zhang SM, Gu W, Gao M, et al. Mediating effectofself-efficacyonsocialsupportand quality of life in lung cancer patients undergoing chemotherapy. Chinese Journal of Health Psychology, 2015,29(2):1310-1314.
[21] Brown Johnson CG, Brodsky JL, Cataldo JK. Lung cancer stigma, anxiety, depression, and quality of life. J Psychosoc Oncol, 2014,32(1):59-73.
[22] Carter-Harris L. Lung cancer stigma as a barrier to medical help-seeking behavior:practice implications. Journal of the American Association of Nurse Practitioners, 2015,27(5):240-245.
[23]陈文政,张春华,王晓松,等.肺癌患者营养状况与放疗不良反应的相关性研究.实用癌症杂志,2018,33(9):1439-1441,1460.Chen WZ, Zhang CH, Wang XS, et al. Study on the correlation between nutritional status of lung cancer patients and adverse reactions to radiotherapy. Journal of Practical Cancer, 2018,33(9):1439-1441,1460.
[24]张誉华,龙麟,杨婕,等.肺癌靶向药物相关皮肤不良反应的中西医治疗进展.中国中医基础医学杂志,2016,22(2):287-289.Zhang YH, Long L, Yang J, et al. Progress in the treatment of skin adverse reactions related to targeted drugs for lung cancer. Chinese Journal of Basic Medicine of Traditional Chinese Medicine,2016,22(2):287-289.
[25]李楠楠,陈芬荣,朱惠瑛,等.肺癌患者化疗前后症状群的调查研究.解放军护理杂志,2017,34(23):34-38.Li NN, Chen FR, Zhu HY, et al. Investigation of symptoms of lung cancer patients before and after chemotherapy. Nurs J Chin PLA, 2017,34(23):34-38.
[26] Carter-Harris L, Hermann CP, Schreiber J, et al.Lung cancer stigma predicts timing of medical help-seeking behavior. Oncol Nurs Forum, 2014,41(3):E203-210.
[27]王黎,于媛,张娜,等.肺癌患者病耻感体验的质性研究.中华现代护理杂志,2016,22(30):4358-4362.Wang L, Yu Y, Zhang N, et al. Qualitative study on shame experience of lung cancer patients.Chinese Journal of Modern Nursing, 2016,22(30):4358-4362.
[28] Gu W, Xu YM, Zhong BL. Health-related quality of life in Chinese inpatients with lung cancer treated in large general hospitals:a crosssectional study. BMJ Open, 2018,8(4):e019873.
[29]李丹,张洁,张黎黎,等.非小细胞肺癌患者社会支持与生存质量的相关性研究.重庆医学,2016,45(4):501-503,507.Li D, Zhang J, Zhang LL, et al. Study on the correlation between social support and quality of life in patients with non-small cell lung cancer.Chongqing Medicine, 2016,45(4):501-503,507.
[30]王君.社区管理模式对肺癌患者社会支持度及生活质量的影响.南京:南京中医药大学,2018.Wang J. The impact of community management model on social support and quality of life of lung cancer patients. Nanjing:Nanjing University of Traditional Chinese Medicine, 2018.