胸部恶性肿瘤患者放疗前心理痛苦及相关因素的研究
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摘要
目的通过对胸部肿瘤放疗患者心理疼痛程度现状调查及其相关因素的分析,为临床个体化心理护理提供依据。方法通过使用美国国立综合癌症网络推荐的心理痛苦温度计(DT)作为快速识别心理痛苦的筛查工具,对142例胸部肿瘤放疗患者,在放疗前进行筛查,并对其相关因素进行统计分析。结果胸部肿瘤患者中显著心理痛苦DT≥4分有24例(17.27%),DT<4分有115例(82.73%),以轻度痛苦为主。放疗前不同性别、年龄、诊断类型、学历水平和治疗方式的胸部恶性肿瘤患者显著心理痛苦的发生率比较差异均无统计学意义(均P>0.05);Spearman相关分析表明性别差异与心理痛苦程度DT评分相关(r=0.203,P=0.017);紧张、悲伤、睡眠问题、进食和手/脚麻木5个问题为心理痛苦的主要相关危险因素。结论 DT量表的评分能够反应出胸部肿瘤患者的心理痛苦情况,胸部肿瘤放疗患者女性心理痛苦程度高于男性,临床上医护人员应关注胸部肿瘤放疗患者放疗期间的心理状况,特别要关注患者紧张、悲伤、睡眠问题、进食和手/脚麻木5个问题,给予个体化的心理护理。
Objective To investigate the degree of psychological distress and to analyze the related factors of distress in patients with thoracic neoplasms radiotherapy. Methods One hundred and forty two patients with thoracic neoplasms scheduled to undergo radiotherapy were enrolled in the study. The psychological distress thermometer(DT) recommended by the national comprehensive cancer network was applied to evaluate the degree of psychological distress of patients before radiotherapy and the related factors were analyzed.Results There were 24 cases(17.27%) with significant psychological distress(DT≥4) and 115 cases(82.73%) with mild distress(DT<4).There were no significant differences in the incidence of psychological distress among patients with different genders, ages, diagnosis types,education levels and treatment methods(P >0.05). Spearman correlation analysis showed that gender difference was correlated with DT score of psychological distress(r=0.203, P=0.017). Nervousness, sadness, problems in sleep and eating, and tingling in hands/feet were the risk factors for psychological distress. Conclusion The score of the DT scale can reflect the psychological distress in patients with thoracic neoplasms before radiotherpy. The degree of psychological distress of female is higher than that of male patients. Special attention should be paid to patients with nervousness, sadness, problems in sleep and eating, and tingling in hands/feet.
Objective To investigate the degree of psychological distress and to analyze the related factors of distress in patients with thoracic neoplasms radiotherapy. Methods One hundred and forty two patients with thoracic neoplasms scheduled to undergo radiotherapy were enrolled in the study. The psychological distress thermometer(DT) recommended by the national comprehensive cancer network was applied to evaluate the degree of psychological distress of patients before radiotherapy and the related factors were analyzed.Results There were 24 cases(17.27%) with significant psychological distress(DT≥4) and 115 cases(82.73%) with mild distress(DT<4).There were no significant differences in the incidence of psychological distress among patients with different genders, ages, diagnosis types,education levels and treatment methods(P >0.05). Spearman correlation analysis showed that gender difference was correlated with DT score of psychological distress(r=0.203, P=0.017). Nervousness, sadness, problems in sleep and eating, and tingling in hands/feet were the risk factors for psychological distress. Conclusion The score of the DT scale can reflect the psychological distress in patients with thoracic neoplasms before radiotherpy. The degree of psychological distress of female is higher than that of male patients. Special attention should be paid to patients with nervousness, sadness, problems in sleep and eating, and tingling in hands/feet.
引文
[1]许亚萍,毛伟敏.胸部肿瘤放射治疗策略[M].北京:军事医学科学出版社,2013.
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[4]邵秋月,谢淑萍,沈佳琴,等.食管癌放疗联合化疗患者营养状况相关性因素分析[J].中华全科医学,2017,15(9):1589-1591,1608. DOI:10.16766/j.cnki.issn.1674-4152. 2017.09.041.
[5] Miljanovic M, Sindik J, Milunovic V, et al. Factor structure and cut-off scores of the hospital anxiety and depression scale(HADS)in a croatian sample of adult patients suffering from advanced cancer[J]. Psychiatr Danub,2017,29(4):451-458. DOI:10.24869/psyd.2017.451.
[6] Dai Y, Zhang B, Sun H, et al. Prevalence and correlates of psychological symptoms in chinese doctors as measured with the SCL-90-R:A meta-analysis[J]. Res Nurs Health, 2015, 38(5):369-383.DOI:10.1002/nur.21673.
[7] Hartung TJ, Friedrich M, Johansen C, et al. The hospital anxiety and depression scale(HADS)and the 9-item patient health questionnaire(PHQ-9)as screening instruments for depression in patients with cancer[J]. Cancer, 2017, 123(21):4236-4243.DOI:10.1002/cncr.30846.
[8] Zebrack B, Kayser K, Sundstrom L, et al. Psychosocial distress screening implementation in cancer care:An analysis of adherence, responsiveness, and acceptability[J]. Journal of Clinical Oncology,2015,10(10):1165-1170.DOI:10.1200/JCO.2014.57.4020.
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[10]牟倩倩,余春华,李俊英.肺癌初治患者心理痛苦的现状调查及相关因素分析[J].北京大学学报(医学版),2016,48(3):507-514.DOI:10.3969/j.issn.1671-167X. 2016.03.023.
[11]胡君莉,徐志香,程苗苗,等.住院治疗对癌症患者心理痛苦的影响及其相关因素分析[J].实用医药杂志,2013,30(9):814-817. DOI:10.3969/j.issn.1671-4008.2013. 09.032.
[12]韩静,刘均娥,孟洁,等.癌症患者心理困扰程度及相关原因分析[J].中华护理杂志,2008,43(6):516-518.DOI:10.3761/j.issn.0254-1769.2008.06.014.
[13]张叶宁,张海伟,宋丽莉,等.心理痛苦温度计在中国癌症患者心理痛苦筛查中的应用[J].中国心理卫生杂志,2010,24(12):897-902.DOI:10.3969/j.issn.1000-6729. 2010.12.004.
[14] Zabora J, Buzaglo J, Kennedy V, et al. Clinical perspective:Linking psychosocial care to the disease continuum in patients with multiple myeloma[J]. Palliat Support Care, 2015, 13(4):829-838.DOI:10.1017/S1478951514000649.
[15] Carlson LE, Zelinski EL, Toivonen KI, et al. Prevalence of psychosocial distress in cancer patients across 55 north american cancer centers[J]. J Psychosoc Oncol, 2019,37(1):5-21.DOI:10.1080/07347332.2018.1521490.
[16] Jacobsen PB, Norton WE. The role of implementation science in improving distress assessment and management in oncology:A commentary on"screening for psychosocial distress among patients with cancer:Implications for clinical practice, healthcare policy, and dissemination to enhance cancer survivorship"[J]. Transl Behav Med, 2019, 9(2):292-295.DOI:10.1093/tbm/ibz022.
[17]郑珊红.恶性肿瘤患者心理痛苦度及相关影响因素现状与癌症照护质量研究[D].济南:山东大学,2014.
[2] Holland JC, Jacobsen PB, Andersen B, et al. Distress management clinical practice guidelines in oncology[S]. National Comprehensive Cancer Network,2015:2.v.
[3] McDonagh PR, Slade AN, Anderson J, et al. Racial differences in responses to the NCCN distress thermometer and problem list:Evidence from a radiation oncology clinic[J]. Psychooncology,2018, 27(10):2513-2516.DOI:10.1002/pon.4846.
[4]邵秋月,谢淑萍,沈佳琴,等.食管癌放疗联合化疗患者营养状况相关性因素分析[J].中华全科医学,2017,15(9):1589-1591,1608. DOI:10.16766/j.cnki.issn.1674-4152. 2017.09.041.
[5] Miljanovic M, Sindik J, Milunovic V, et al. Factor structure and cut-off scores of the hospital anxiety and depression scale(HADS)in a croatian sample of adult patients suffering from advanced cancer[J]. Psychiatr Danub,2017,29(4):451-458. DOI:10.24869/psyd.2017.451.
[6] Dai Y, Zhang B, Sun H, et al. Prevalence and correlates of psychological symptoms in chinese doctors as measured with the SCL-90-R:A meta-analysis[J]. Res Nurs Health, 2015, 38(5):369-383.DOI:10.1002/nur.21673.
[7] Hartung TJ, Friedrich M, Johansen C, et al. The hospital anxiety and depression scale(HADS)and the 9-item patient health questionnaire(PHQ-9)as screening instruments for depression in patients with cancer[J]. Cancer, 2017, 123(21):4236-4243.DOI:10.1002/cncr.30846.
[8] Zebrack B, Kayser K, Sundstrom L, et al. Psychosocial distress screening implementation in cancer care:An analysis of adherence, responsiveness, and acceptability[J]. Journal of Clinical Oncology,2015,10(10):1165-1170.DOI:10.1200/JCO.2014.57.4020.
[9] Grassi L, Johansen C, Annunziata MA, et al. Screening for distress in cancer patients:a multicenter,nationwide study in Italy[J].Cancer,2013,119(9):1714-1721. DOI:10.1002/cncr.27902.
[10]牟倩倩,余春华,李俊英.肺癌初治患者心理痛苦的现状调查及相关因素分析[J].北京大学学报(医学版),2016,48(3):507-514.DOI:10.3969/j.issn.1671-167X. 2016.03.023.
[11]胡君莉,徐志香,程苗苗,等.住院治疗对癌症患者心理痛苦的影响及其相关因素分析[J].实用医药杂志,2013,30(9):814-817. DOI:10.3969/j.issn.1671-4008.2013. 09.032.
[12]韩静,刘均娥,孟洁,等.癌症患者心理困扰程度及相关原因分析[J].中华护理杂志,2008,43(6):516-518.DOI:10.3761/j.issn.0254-1769.2008.06.014.
[13]张叶宁,张海伟,宋丽莉,等.心理痛苦温度计在中国癌症患者心理痛苦筛查中的应用[J].中国心理卫生杂志,2010,24(12):897-902.DOI:10.3969/j.issn.1000-6729. 2010.12.004.
[14] Zabora J, Buzaglo J, Kennedy V, et al. Clinical perspective:Linking psychosocial care to the disease continuum in patients with multiple myeloma[J]. Palliat Support Care, 2015, 13(4):829-838.DOI:10.1017/S1478951514000649.
[15] Carlson LE, Zelinski EL, Toivonen KI, et al. Prevalence of psychosocial distress in cancer patients across 55 north american cancer centers[J]. J Psychosoc Oncol, 2019,37(1):5-21.DOI:10.1080/07347332.2018.1521490.
[16] Jacobsen PB, Norton WE. The role of implementation science in improving distress assessment and management in oncology:A commentary on"screening for psychosocial distress among patients with cancer:Implications for clinical practice, healthcare policy, and dissemination to enhance cancer survivorship"[J]. Transl Behav Med, 2019, 9(2):292-295.DOI:10.1093/tbm/ibz022.
[17]郑珊红.恶性肿瘤患者心理痛苦度及相关影响因素现状与癌症照护质量研究[D].济南:山东大学,2014.
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