心理一致感视角下晚期癌症患者疾病应对体验的质性研究

doi:10.3761/j.issn.0254-1769.2024.05.002

摘要/Abstract

摘要：

目的在心理一致感视角下，探索晚期癌症患者的疾病应对体验，为识别其应对资源、制订有效的应对策略提供参考依据。方法采用描述性质性研究法，通过目的抽样，于2023年3月—5月对广州市某三级甲等医院肿瘤中心收治的18例晚期癌症患者进行半结构式访谈，采用定向内容分析法对访谈结果进行归纳和提炼主题。结果共归纳出3个主题：①理解疾病经历，包括反思健康行为、正视患病事实、接受生命规律；②管理疾病威胁，包括应对多重困难、调动应对资源；③体会疾病应对意义，包括认同疾病应对意义、感知疾病获益、做好人生规划。结论有效的应对资源可帮助晚期癌症患者应对患病过程中的多重困难。医护人员应加强癌症相关知识宣教，帮助晚期癌症患者挖掘积极应对资源，并强化疾病应对意义，从而增强患者的疾病应对能力，促进其身心健康。

关键词: 心理一致感, 晚期癌症, 应对体验, 质性研究, 护理

Abstract:

Objective To explore the disease coping experience of patients with advanced cancer from the perspective of sense of coherence，in order to provide references for identifying their coping resources and formulating effective coping strategies. Methods A descriptive qualitative research method was used to conduct semi-structured interviews with 18 patients with advanced cancer who were hospitalized in the cancer center of a tertiary A hospital in Guangzhou from March to May 2023 by purposive sampling. The content analysis method was used to summarize and extract the interview results. Results A total of 3 themes were summarized，including comprehending the disease experience（reflecting on health behaviors，facing up to the fact of illness，accepting the law of life），managing disease threats（responding to multiple challenges，mobilizing coping resources），realizing the meaning of disease coping（acknowledging the meaning of disease coping，perceiving the benefits of disease，and making a life plan）. Conclusion Effective coping resources can help patients with advanced cancer cope with multiple challenges in the disease process. Medical staff should strengthen cancer knowledge education，help patients with advanced cancer to explore positive coping resources，and reinforce the meaning of disease coping，thereby enhancing patients’ disease coping ability and promoting their physical and mental health.

Key words: Sense of Coherence, Advanced Cancer, Coping Experience, Qualitative Study, Nursing Care

黄咏琪, 田霞, 王峥, 孙咪咪, 周丽群, 肖文莉. 心理一致感视角下晚期癌症患者疾病应对体验的质性研究[J]. 中华护理杂志, 2024, 59(5): 526-532.

HUANG Yongqi, TIAN Xia, WANG Zheng, SUN Mimi, ZHOU Liqun, XIAO Wenli. Disease coping experience of patients with advanced cancer from the perspective of sense of coherence：a qualitative study[J]. Chinese Journal of Nursing, 2024, 59(5): 526-532.

图/表 1

参考文献 25

[1]	Huda N, Shaw MK, Chang HJ. Psychological distress among patients with advanced cancer:a conceptual analysis[J]. Cancer Nurs, 2022, 45(2):E487-E503. DOI URL
[2]	Belar A, Martinez M, Centeno C, et al. Wish to die and hasten death in palliative care:a cross-sectional study factor analysis[J]. BMJ Support Palliat Care, 2021: bmjspcare-bmjsp2021-003080.
[3]	Antonovsky A. Unraveling the mystery of health:how people manage stress and stay well[M]. San Francisco: Jossey-Bass, 1987.
[4]	Kim HS, Nho JH, Nam JH. A serial multiple mediator model of sense of coherence,coping strategies,depression,and quality of life among gynecologic cancer patients undergoing chemotherapy[J]. Eur J Oncol Nurs, 2021, 54:102014. DOI URL
[5]	Zamanian H, Amini-Tehrani M, Mahdavi Adeli A, et al. Sense of coherence and coping strategies:how they influence quality of life in Iranian women with breast cancer[J]. Nurs Open, 2021, 8(4):1731-1740. DOI URL
[6]	Harrop E, Noble S, Edwards M, et al. Managing,making sense of and finding meaning in advanced illness:a qualitative exploration of the coping and wellbeing experiences of patients with lung cancer[J]. Sociol Health Illn, 2017, 39(8):1448-1464. DOI URL
[7]	Sharin UBM, Hwang CCJ, Ang WHD, et al. The haematopoietic stem cell transplant survivors’ sense of coherence about their experiences:a qualitative study[J]. Support Care Cancer, 2020, 28(9):4275-4283. DOI
[8]	杨莉萍, 亓立东, 张博. 质性研究中的资料饱和及其判定[J]. 心理科学进展, 2022, 30(3):511-521. DOI
	Yang LP, Qi LD, Zhang B. Concepts and evaluation of saturation in qualitative research[J]. Adv Psychol Sci, 2022, 30(3):511-521. DOI
[9]	Antonovsky A. The salutogenic model as a theory to guide health promotion[J]. Health Promot Int, 1996, 11(1):11-18. DOI URL
[10]	Hsieh HF, Shannon SE. Three approaches to qualitative content analysis[J]. Qual Health Res, 2005, 15(9):1277-1288. DOI URL
[11]	Antonovsky A. A somewhat personal odyssey in studying the stress process[J]. Stress Med, 1990, 6(2):71-80. DOI URL
[12]	王媛, 崔光成. 乳腺癌患者反刍性沉思与创伤后成长状况及其相互关系[J]. 中国健康心理学杂志, 2022, 30(5):678-683.
	Wang Y, Cui GC. Relationship between ruminant meditation and post:traumatic growth in breast cancer patients[J]. China J Health Psychol, 2022, 30(5):678-683.
[13]	Zhang LM, Liu XH, Tong F, et al. Cognitive behavioral therapy for anxiety and depression in cancer survivors:a meta-analysis[J]. Sci Rep, 2022, 12(1):21466. DOI
[14]	王心茹, 朱信雨, 贾玉玲, 等. 文化因素对安宁疗护实践影响的质性研究[J]. 中华护理杂志, 2023, 58(13):1552-1558. DOI URL
	Wang XR, Zhu XY, Jia YL, et al. A qualitative study on the specificity of cultural factors in palliative care practice[J]. Chin J Nurs, 2023, 58(13):1552-1558. DOI URL
[15]	石柳清, 刘玥, 彭稚琳, 等. 安心卡的文化调试及在晚期癌症患者中的应用[J]. 中华护理杂志, 2023, 58(13):1579-1584. DOI URL
	Shi LQ, Liu Y, Peng ZL, et al. The culture adjustment of heart to heart card and its application in patients with advanced cancer[J]. Chin J Nurs, 2023, 58(13):1579-1584. DOI URL
[16]	解荣, 罗瑞君, 李颖, 等. 恶性肿瘤病人免疫治疗并发中重度免疫相关不良反应体验的质性研究[J]. 护理研究, 2023, 37(11):2055-2060.
	Xie R, Luo RJ, Li Y, et al. Qualitative study on the experience of moderate and severe immune-related adverse events in patients with malignant tumors undergoing immunotherapy[J]. Chin Nurs Res, 2023, 37(11):2055-2060.
[17]	李晓慧, 章新琼, 潘玉芹, 等. 益处发现在晚期肺癌患者灵性健康与乐观及自尊间的中介作用[J]. 护理学杂志, 2020, 35(6):67-71.
	Li XH, Zhang XQ, Pan YQ, et al. Mediating role of benefit finding between spiritual well-being and self-esteem in patients with advanced lung cancer[J]. J Nurs Sci, 2020, 35(6):67-71.
[18]	Hinz A, Schulte T, Ernst J, et al. Sense of coherence,resilience,and habitual optimism in cancer patients[J]. Int J Clin Health Psychol, 2023, 23(2):100358. DOI URL
[19]	Glasdam S, Bjerström C, Engberg de Carvalho C. Coping strategies among patients with malignant lymphoma:a qualitative study from the perspectives of Swedish patients[J]. Eur J Oncol Nurs, 2020, 44:101693. DOI URL
[20]	董朝晖, 卢惠娟, 陆箴琦, 等. 癌症患者社会疏离体验的质性研究[J]. 中华护理杂志, 2023, 58(6):670-675. DOI URL
	Dong ZH, Lu HJ, Lu ZQ, et al. Experiences of social isolation in cancer patients:a qualitative research[J]. Chin J Nurs, 2023, 58(6):670-675.
[21]	吴媛, 张玉玺, 王楠楠, 等. 乳腺癌患者参与同伴支持体验质性研究的Meta整合[J]. 中华护理杂志, 2023, 58(7):800-808. DOI URL
	Wu Y, Zhang YX, Wang NN, et al. Meta-synthesis of qualitative research on the experience of peer support for breast cancer patients[J]. Chin J Nurs, 2023, 58(7):800-808. DOI URL
[22]	Li JM, Su XQ, Xu XP, et al. Influencing factors analysis of adaptability of cancer patients to return-to-work[J]. Support Care Cancer, 2023, 31(5):302. DOI
[23]	Sun FK, Long A, Tseng YS, et al. Exploring meaning of life in women with breast cancer in Taiwan:a phenomenological study[J]. J Nurs Res, 2022, 30(5):e236.
[24]	Reed PG. Self-transcendence:moving from spiritual disequi-librium to well-being across the cancer trajectory[J]. Semin On-col Nurs, 2021, 37(5):151212.
[25]	Fraguell-Hernando C, Limonero JT, Gil F. Psychological intervention in patients with advanced cancer at home through individual meaning-centered psychotherapy-palliative care:a pilot study[J]. Support Care Cancer, 2020, 28(10):4803-4811. DOI PMID