摘要
目的:评估美国国立综合癌症网络(NCCN)推荐的心理痛苦温度计(DT)在中国妇科恶性肿瘤患者及其照顾者中的应用,初步探索中国妇科恶性肿瘤患者的显著心理痛苦患病率及其影响因素,比较患者及其照顾者的心理痛苦和产生原因。方法:收集2012年4月2日至8月1日上海仁济医院东院妇科住院及门诊随访的102例妇科恶性肿瘤患者的人口社会学及临床资料,用DT进行心理痛苦筛查,采用医学应对方式问卷调查患者的面对、回避、屈服3种应对方式。分析我国妇科恶性肿瘤患者的显著心理痛苦(DT≥4)患病率以及年龄、婚姻状况、文化程度、癌症分期、治疗阶段、应对方式等因素对显著心理痛苦患病率的影响;比较患者及其照顾者的心理痛苦。结果:DT筛查显示,我国妇科恶性肿瘤患者的显著心理痛苦患病率为52.0%。医保患者的显著心理痛苦患病率小于自费患者(P=0.045)。门诊随访患者的显著心理痛苦患病率小于术前(P=0.028)及化疗期间(P<0.001)的患者。出现显著心理痛苦患者的屈服应对方式评分高于无显著心理痛苦者(P=0.030)。患者的照顾者DT评分高于患者本人(P=0.014)。引起患者心理痛苦的前3位原因为情绪问题(56.0%)、身体问题(41.3%)、实际问题(40.0%),引起照顾者心理痛苦前3位原因为情绪问题(57.3%)、实际问题(46.7%)、身体问题(20.0%)。患者显著心理痛苦与人口社会学资料分类(年龄、婚姻状况、子女个数、工作状况、学历、信仰、家庭人均月收入)、肿瘤类型、分期及化疗次数均无关。结论:DT应用于我国妇科恶性肿瘤患者的诊疗过程是可行的,其有助于及时发现患者心理痛苦的程度和原因。我国妇科恶性肿瘤患者显著心理痛苦的患病率高,需进一步关注患者及其照顾者的心理健康。
Objective：To evaluate the application of distress thermometer （DT） recommended by U. S. National Comprehensive Cancer Network （NCCN） in gynecological cancer pa- tients and their care-givers, to explore the prevalence rate of significant psychological distress in gynecological cancer patients and to compare psychological distress between patients and their care-givers. Methods：Socio-demographic and medical data of 102 gynecological cancer patients were collected in Shanghai Renji Eastern Hospital from Apr. 2 2012 to Aug. 1 2012. The Chinese versions of DT and problem lists （PL） were used to screen psychological distress and the causes. Medical coping mode questionnaire was used to screen the three coping mechanisms of the patients （confrontation, avoidance and acceptance ）. Descriptive statistics were adopted to analyze the prevalence rate of significant psychological distress （DT≥4） in gynecological cancer patients. Age, marital status, education level, cancer stage, treatment stage, coping style, and other factors which may influence distress level were analyzed through the ehi-square test. To compare psychological distress between patients and their care-givers. Results：A great percentage （52.0%） of these women experienced distress at significant level. The prevalence rate of psychological distress in the patients with insurance was less than the patients without insurance （ P = 0. 045 ）. The prevalence rate of distress in follow-up outpatients was less than those in preoperative patients （P = 0. 028 ） and the patients undergoing chemotherapy （P〈0. 001 ）. Patients with obvious psychological distress had higher acceptance coping mode scores （P = 0.＇030）. Care-givers of patients had higher DT score than the patients themselves （P= 0. 014）. The top three causes of psychological distress in patients were emotional problems （56.0%） , physical problems （41.3%） and practical problems （40.0%）. For the care-givers,the stress was due to emotional problems （57. 3% ） practical problems （46. 7% ） and physical problems （20.0%）. The patients＇ age, marital status, education level, cancer stage, chemotherapy cycles and confrontation, avoidance coping mechanism made no influence on the prevalence rate of significant psychological distress. Significant psychological distress is unrelated to socio-dcmographic data （ age, marital status, number of children, work status, education level, faith, family income）, cancer type, cancer stage and chemotherapy cycles. Conclusion：Application of DT in clinical setting is feasible, which helps to discover the extent and causes of the patients＇ psychological distress. Mental health of gynecological cancer patients and their care-givers needs further attention.
出处
《现代妇产科进展》
CSCD
2013年第4期269-273,共5页
Progress in Obstetrics and Gynecology
基金
上海市教委重点学科
上海市重中之重临床肿瘤重点学科
上海交通大学医学院附属仁济医院重点学科项目资助
