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【摘要】目的:探讨乳腺癌住院患者的不确定感状况及其主要影响因素。方法:采用问卷调查法,由实验者采用统一的调查语和调查问卷进行调查,所有问卷力求由患者亲自填写,若患者因体力或认知限制无法填写,则由本人在访谈后按患者的意愿代为填写,注意避免暗示患者。结果:在患者病情符合保乳手术指征的情况下开展保乳手术对稳定患者心态有重要的作用;乳腺癌住院患者的疾病不确定感与希望呈显著负相关;总体不确定感及两因子与“屈服”应对方式皆呈正相关,与“回避”应对方式皆呈负相关,说明“屈服”是乳腺癌患者的消极应对方式,会加重患者的不确定感,“回避”则是乳腺癌患者积极的应对方式,可减轻患者的不确定感。结论:乳腺癌住院患者普遍存在焦虑、抑郁情绪,不确定感与焦虑、抑郁呈显著正相关,护士应指导患者宣泄不良情绪,降低焦虑、抑郁水平,以降低患者的疾病不确定感�
【关键词】乳腺癌患者;不确定感状况;相关因素�
doi:10.3969/j.issn.1006-1959.2010.09.016文章编号:1006-1959(2010)-09-2315-02�
Uncertain feeling of breast cancer patient and their relevance factorZHUANG Jun,LIN Jian-weiCheng Dou City Qing Bai Jiang District people hospital 610300�
【Abstract】Objective:Investigation and discussion breast cancer is in hospital patient"s indeterminacy feels status and their main influencing factor.Methods:Adopt a questionnaire to inquire into law ,adopt the unified investigation language and investigation questionnaire to make an investigation by the experimentalist,all questionnaires make every effort to be filled in in person by patient,are to filled in as an agent behind the interview according to patient"s wish by self,pay attention to avoiding dropping a patient a hint if the patient has no way to fill in because physical power or cognition restricts.Results:The operation carrying out guarantor milk under the situation that patient state of illness accords with guarantor milk operation indication has the important effect to the psychology stabilizing a patient;Breast cancer is in hospital patient"s uncertain feeling of disease and hope assume the negative notable relevance;Uncertain feeling of population and two factors answer way with “knuckling under” all presenting being related to,all present to shoulder a relevance with “avoiding answering way”,explain that “knuckling under” is that inactivity of breast cancer patient answers way,indeterminacy that can aggravate a patient feels“,the indeterminacy ”avoiding being that the breast cancer patient answers way,but lightens a patient actively then“ feels.Conclusions:The adenocarcinoma is in hospital common existence of patient is extremely anxious,depressed mood,uncertain feeling and the extremely anxious,depressed memorial are notable be being related to,should guide a patient to get the bad mood,lessening off the chest feeling anxious,depressed nurse level,to reduce uncertain feeling of patient"s disease�
【Key words】Breast cancer patient;Uncertain feeling situation;Relevance factor
乳腺癌已在我国女性所患癌症中患病率居首位,每年以3%-6%的速度递增,发病日趋年轻化,比西方国家平均提前10-15年��[1]�。有报道��[2]�将不确定感定义为缺乏判定与疾病有关事物的能力。本文旨在通过调查乳腺癌住院患者的疾病不确定感、希望水平、应对方式及焦虑、抑郁状况,了解乳腺癌住院患者的不确定感状况及其主要影响因素,从而为制订护理干预措施提供方向和理论基础。�
1.材料与方法�
1.1一般资料:随机选择2008年1月-2010年2月在我院胸外科住院的乳腺癌患者50例作为实验对象。纳入标准:①
经临床、影像学和病理学检查确诊为乳腺癌;②年龄≥20岁;③对病情知情,并自愿参加本次调查;④患者神志清楚、能阅读文字或可以正确回答问题。排除标准:①乳腺癌出院患者;②年龄 1.2.3中文版Herth的希望量表(Herth hope index,HHI)由中国医科大学��[4]�翻译引入我国,内部一致性信度Cronbach"sα值为0.85。量表共12题,包括3个方面的内容:对现实与未来的积极态度(temporality and future,以下简写为T);采取的积极行动(positive readiness and expectancy,以下简写为P);与他人保持亲密的关系(interconnectedness,以下简写为I)。总分12-48分,其中12-23分者定义为低水平;24-35分者定义为中等水平;3648分者定义为高水平��[5]�。�
1.2.4医学应对问卷(medical coping modes questionaire,MCMQ)��[3]�包括面对(8项)、回避(7项)、屈服(5项)3个维度。�
1.2.5焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表self-rating depression scale,SDS)��[5]�。SDS和SDS均包括20个条目,主要评定依据为项目所定义的症状出现的频度。所应用量表中,MCMQ、SDS、SAS量表经大样本人群测试后证明具有较好的信度与效度,在国内心身医学领域应用已较为广泛。�
1.3数据处理:所有数据在SPSS11、12软件中进行分析。采用的统计方法包括:描述性统计方法t单因素方差分析、成组t检验、spear-man直线相关分析、多元线性逐步回归分析。�
2.结果�
2.1患者一般资料:患者未婚2例占4%,配偶健在39例占78%,离婚3例占6%,丧偶6例占12%。文化程度:初中及以下23例占46%,高中15例占30%,大学及以上12例占24%;家庭关系和睦者42例占甾84%,一般3例占6%,差5例占10%;术前患者20例占40%,术后化疗前21例占42%,化疗9例占18%;改良根治术40例占80%,保乳术10例占20%。�
2.2疾病不确定感状况:疾病不确定感总分47-98分,平均(67.8±12.42)分,单题平均得分(22.75±0.51)分,不明确性因素得分28-67分,平均(44.1±8.77)分,单题平均得分(22.94±0.58)分,复杂性因素得分17-37分,平均(24.37±4.13)分,单题平均得分(22.45±0.42)分。处于低水平不确定感的患者8例占16%,中等水平39例占78%,高水平3例占6%。经单因素方差分析,结果显示,不同治疗阶段患者的不确定感水平差异有统计学意义(P
