癌症患者论文：癌症患者心理健康应对方式沟通

癌症患者论文：癌症患者 心理健康 应对方式 沟通

【中文摘要】20世纪以来,癌症成为威胁人类健康的疾病之一,近年来癌症的发病率不断上升。全世界每年新发病例约635万,是导致人类死亡的第二大疾病。随着医学模式由单纯生物医学模式向生物—心理—社会医学模式的转变,癌症患者的心理健康以及生活质量日益受到人们的关注。心理社会肿瘤学认为,癌症的发生、发展、预后及转归都与心理社会因素有密切关系。因此关注研究癌症患者的心理健康及其影响因素,实施各种有效手段提升其心理健康水平有重要意义。本研究旨在：1.探究癌症住院患者的情绪特征及相关因素。2.探索有效且有针对性的心理干预方法,以提升癌症患者情绪健康水平。研究一：住院癌症患者情绪特征及其相关因素研究研究方法：在省内某大型三甲医院随机抽取71名住院癌症患者进行问卷调查,应用非精神科住院患者心理状态评定(MSSNS),抑郁自评问卷(SDS)、医学应对方式问卷(MCMQ),需求评估问卷(NEQ)、患者-亲属癌症相关交流评估工具(患者版)(CCAT-P)等分别测量患者情绪特征,应对方式,患者需求及与亲属交流情况。运用统计描述对患者情绪特征进行描述。运用Pearson相关分析和多因素回归分析,考察患者情绪特征与各测量变量的相关性。研究结果：1.47.8%的患者其SDS得分符合抑郁标准；癌症患者MSSNS抑郁、焦虑、孤独得分与一般内外科患者无显著性差异,但其愤怒情绪显著高于内外科患者；患者MSSNS因子分由高到低得分依次为：孤独、焦虑、抑郁和愤怒。2.患者抑郁、焦虑、愤怒、孤独等负性情绪分别与其性别、文化程度、居住地、家庭月收

入、病程等一般特征有关,也与其信息需求、心理支持等需求的满足情况、与家属围绕疾病沟通、应对方式有关。3.患者年龄、病程,患者需求中的情感支持需求、辅助与照料需求,患者与家属围绕疾病的沟通,应对方式中的屈服、回避分别在对负性情绪的回归分析中达显著性水平。研究二：探索性认知干预提升心理健康水平的实验研究研究方法：通过与部分患者面谈了解患者心理问题根源,制定出针对性的干预方案,将干预内容印制成手册。将患者随机分为干预组和对照组,干预组发放干预手册并进行2次访谈,对照组无干预。干预前后两组分别收集问卷数据。研究结果：干预前基线数据两组不均等。干预组SDS得分、MSSNS孤独高于对照组、回避低于对照组,差异有统计学意义；干预后干预组与对照组比较,SDS得分、MSSNS孤独和回避得分无显著性差异,其余维度差异也无统计学意义；干预后干预组SDS得分降低,回避得分升高,差异有统计学意义,而干预后对照组变化无显著性。结论：1.近半数癌症患者达到抑郁诊断标准；癌症患者愤怒情绪较一般内外科患者显著；患者的主观孤独感受较抑郁、焦虑、愤怒等情绪强烈；2.相较于照料需求、心理情感支持需求和物质需求信息,患者的信息需求、关系需求更为显著；3.癌症情绪障碍的发生受到患者性别、文化程度、居住地区、家庭月收入、病程等患者一般社会特征因素的影响。女性、文化程度低、居住地偏远、家庭月收入低、患病时间较长的患者其情绪障碍发生的风险升高；4.患者的心理健康水平与患者信息需求、患者心理情感支持需求、家庭成员之间有关疾病的沟通、应对方式等因素相关。患者信息需求未得到满足、患者-

家属之间沟通不良、患者采用屈服应对方式是增加患者情绪困扰的危险因素。患者信息需求的不满足使患者更容易感受到焦虑、愤怒；不良的患-属沟通同样与患者的抑郁和愤怒水平有密切联系；屈服与患者的焦虑、抑郁、愤怒和孤独都有显著性的联系；积极获取心理情感支持、采用面对和回避应对方式有助于患者对疾病的适应；5.对患者进行简短的针对性认知干预可以缓解其部分负性情绪。

【英文摘要】Since the 20th century, cancer became one of the diseases that threaten human health. In recent years, with the increasing of cancer there are about 635 million new cases each year worldwide. Cancer became the second largest cause of death disease. With the medical model from a simple biomedical model to the bio-medical model of a psychological change in a society, the mental health of cancer patients and the quality of life have become an increasing concern. Psychosocial Oncology say that the incidence of cancer, development, prognosis and outcome are closely related with the social and psychological factors. So concerned about the mental health of cancer patients and its influencing factors, implementation of effective means to improve their mental health is important. This study aimed to:1. To explore the emotional characteristics of hospitalized patients with cancer and its influencing factors 2. Explore the simple and effective method of

psychological intervention to improve the emotional health of cancer patients.Study I:Emotional characteristics of hospitalized cancer patients and its influencing factorsMethods:a survey have been conducted in a large hospitals that contained a random sample of 71 hospitalized cancer patients and their relatives, by application of non-psychiatric inpatient mental state evaluation (MSSNS), depression self-test questionnaire (SDS), medical response Style Questionnaire (MCMQ) Needs Assessment Questionnaire (NEQ), and the Cancer Communication Assessment Tool for Patient (CCAT-P), measuring the characteristics of patients with mood, coping style, communication with the relative and emotional characteristics of relative caregivers, caregiver subjective burden.Us descriptive statistics to describe the emotional characteristics of patients.Us Pearson correlation analysis to study the correlations between patient characteristics and the relevance of measured variables. The use of multiple regression analysis is to study the measurement of variables on the contribution of emotional changes in

patients.Results:1.47.8%of the cancer patients have higher than the norms of the SDS scores; The cancer patients scored higher than general medical and surgical patient in anger of

MSSNS other than anxiety, depression and loneliness. The factor scores of cancer patient in MSSNS from high to low were loneliness, anxiety, depression and anger.2. Depression, anxiety, anger, loneliness and other negative emotions, respectively, associated with sex, educational level, residence, family income and other characteristics of the general sociology, but also on their unmet need, family communication and coping.3. The age, disease duration, emotional and care need, family communication and coping style of yield and avoid, respectively, come to the significant of the conditions of patient negative emotions.Study

Ⅱ:Exploratory cognitive intervention to enhance the patient’s mental HealthMethods:Referring to the patients’

psychological problem, extracting the relevant knowledge into a knowledge-bound manual as the main intervention tool. The patients were randomly divided into experimental and control group, experimental group get 2-time intervention, the control group was only given diet manual. The data of two groups were collected before and after intervention survey.Results:The baseline data of two groups were unequal before intervention; SDS score, MSSNS loneliness scores of the intervention group were higher than the control group, avoidance scores was lower

than the control group, the difference was statistically significant; After the intervention, the two groups had no significant differences in SDS scores, MSSNS scores and coping; The intervention group has decreasing scores in SDS and increasing scores in avoidance after the intervention while the control group had no significant difference.Conclusion:1. Nearly half of the cancer patients had depression problems; The anger of the cancer patients was higher than general medical and surgical patients in anger;. The loneliness of the cancer patients was the most highest compared with anxiety, depression and anger.2. With compared to the support or care needs, material needs and psychosocial support needs, the patient’s information needs and relation needs were in a prominent position,3. The patients with mood disorders were influenced by gender, educational level, residence, family income, illness, and patients’unmet need patients, patient-family communication and patient coping styles. Women, low educational level, residence in remote, low family income, longer duration of disease occur in patients had increased risk of mood disorders.4. Patients’unmet need, patient-family communication and patient coping style could influence mental health, when which come unmet would increase the risk of

depression, anger and anxiety; ill patient-family

communication had the same influence on the patient’s level of depression and anger; compared to the previous two, the role of coping styles are more prominent. The patients in distress who not positive in getting psychological help need active attention.5. A brief cognitive intervention on cognition of the cancer patients to alleviate their negative emotions is feasible.

【关键词】癌症患者 心理健康 应对方式 沟通

【英文关键词】cancer patients mental health coping style communication

【目录】住院癌症患者情绪特征与相关因素及干预研究中文摘要6-8一19-2923-2933-3437-3859-60

ABSTRACT8-10

符号说明11-12

前言12-19

研究

1 研究方法19-21研究二29-363 讨论34-36附录一38-43

2 研究结果21-233 讨论

1 研究方法30-332 研究结果

结论致谢

本研究的创新性和不足36-37附录二43-48

参考文献48-59

攻读学位期间发表的论文60-61学位论文评阅及答辩情

况表61

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