乳腺癌术后淋巴水肿患者就医延迟现状及影响因素的混合研究

doi:10.3761/j.issn.0254-1769.2026.15.014

摘要/Abstract

摘要： 目的了解乳腺癌术后淋巴水肿患者就医延迟现状并探讨其影响因素，为构建有效的干预策略提供理论依据。方法采用平行混合方法设计，采用便利抽样法，选取2024年11月—2025年9月在杭州市某三级甲等医院就诊的280例乳腺癌术后淋巴水肿患者作为调查对象，采用多因素Logistic回归探讨就医延迟的影响因素；采用目的抽样法，选取同期就诊的20例乳腺癌术后淋巴水肿患者进行半结构式访谈，采用Colaizzi 7步分析法分析访谈资料。将单因素分析差异具有统计学意义（P<0.05）的变量及多因素Logistic回归中的影响因素，与质性访谈提炼的主题及亚主题进行逐项映射并整合分析。结果量性结果显示，回收有效问卷273份。乳腺癌术后淋巴水肿患者就医延迟率为52.01%；其中较高的自我管理行为支持（P<0.001， OR=0.914）、社会支持（P=0.003，OR=0.871）是乳腺癌术后淋巴水肿患者就医延迟的关键保护性因素。质性研究提炼出5个主题和12个亚主题。整合结果显示：在个人特质与行为特征层面，质性研究结果解释了量性研究结果的内在机制；人际网络层面，质性研究结果与量性研究结果高度一致；生活工作条件及政策环境层面，质性研究结果对量性研究结果具有解释与互补作用。结论乳腺癌术后淋巴水肿患者就医延迟受认知、心理、社会支持、地理经济及制度保障等多因素影响。未来应构建多维度综合促进体系，推动患者就医行为转化，提升及时就医率与术后生存质量。

Abstract:

Objective To investigate the current of healthcare-seeking delay among patients with breast cancer-related lymphedema（BCRL） after surgery，and to identify its influencing factors，thereby providing a theoretical basis for developing effective intervention strategies. Methods This study employed a parallel mixed-methods design. Convenience sampling was used to enroll 280 patients with postoperative BCRL who visited a tertiary hospital in Hangzhou，Zhejiang Province from November 2024 to September 2025. Multivariate logistic regression was used to analyze the factors influencing healthcare-seeking delay. For the qualitative component，purposive sampling was used to recruit 20 patients with BCRL treated during the same period for semi-structured interviews. The interview data were organized and analyzed following Colaizzi’s seven-step method. Variables showing statistical significance in the univariate analysis（P<0.05） and the influencing factors identified in the multivariate Logistic regression were mapped item-by-item against the themes and subthemes extracted from the qualitative interviews for integrated analysis. Results Quantitative results showed that 273 valid questionnaires were returned，and the healthcare-seeking delay rate among patients with postoperative BCRL was 52.01%. Higher scores for lymphedema self-management behavior support（P<0.001，OR=0.914） and social support（P=0.003，OR=0.871） were identified as key protective factors against healthcare-seeking delay. The qualitative analysis yielded 5 themes and 12 subthemes. The integrated findings showed that at the level of individual characteristics and behaviors，the qualitative results explained the underlying mechanisms of the quantitative findings；at the level of interpersonal networks，the qualitative and quantitative findings were highly consistent；at the level of living，working，and policy environments，the qualitative results provided both explanatory and complementary insights to the quantitative data. Conclusion Healthcare-seeking delay in patients with postmastectomy BCRL is influenced by multiple factors，including cognition，psychological status，social support，geo-economic conditions，and institutional policies. Future efforts should focus on establishing a multidimensional integrated support to promote timely healthcare-seeking behaviors，and improve the postoperative quality of life.

Key words: Breast Cancer-Related Lymphedema, Healthcare-Seeking Delay, Mixed Methods Research, Root Cause Analysis, Nursing Care

郑欢, 陈芳, 邵乐文, 操凯, 赵小燕. 乳腺癌术后淋巴水肿患者就医延迟现状及影响因素的混合研究[J]. 中华护理杂志, 2026, 61(15): 2117-2125.

ZHENG Huan, CHEN Fang, SHAO Lewen, CAO Kai, ZHAO Xiaoyan. Influencing factors of healthcare-seeking delay in patients with breast cancer-related lymphedema after surgery：a mixed-methods study[J]. Chinese Journal of Nursing, 2026, 61(15): 2117-2125.

图/表 3

表1 乳腺癌术后淋巴水肿患者一般资料及就医延迟的单因素分析（n=273）

Table 1 General characteristics of patients with breast cancer-related lymphedema and univariate analysis between the delayed and non-delayed healthcare-seeking groups（n=273）

表2 乳腺癌术后淋巴水肿患者就医延迟的多因素Logistic回归分析（n=273）

Table 2 Multivariate Logistic regression analysis of delayed healthcare-seeking among breast cancer patients with postoperative lymphedema（n=273）

表3 基于健康生态学模型的混合研究整合结果

Table 3 Integrated findings from mixed-methods research based on the health ecology mode

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