癌症患者心理痛苦预测模型的构建及验证

doi:10.3761/j.issn.0254-1769.2022.11.008

摘要/Abstract

摘要：

目的调查癌症患者心理痛苦的影响因素,分析心理痛苦的风险指标,构建列线图模型,并对模型进行验证。方法采用便利抽样法,选取2020年12月—2021年7月荆门市某三级甲等医院肿瘤科223例癌症患者作为研究对象;通过单因素分析和多因素Logistic回归分析,探索癌症患者心理痛苦的危险因素,建立风险预测模型,构建列线图进行可视化展示,应用受试者操作特征曲线检验模型预测效果。结果根据病理分期、主要陪护者、匹兹堡睡眠质量指数、疼痛数字评价量表、气质类型、应对方式、经济问题及运动≥30 min/d 8个影响因素构建预测模型。模型的受试者操作特征曲线下面积为0.924,最大约登指数为0.699时,最佳临界值为0.513,灵敏度为0.866,特异度为0.833;校准曲线为斜率近似于1的直线。结论该研究构建模型预测效果较好,可为医护人员快速识别癌症患者心理痛苦发生风险、及时采取预防性管理措施提供借鉴。

关键词: 癌症, 心理痛苦, 影响因素, 预测模型, 护理

Abstract:

Objective To explore the influencing factors of psychological distress in patients with cancer,to analyze the risk index of patients with psychological distress,and to develop a nomogram model to predict these risks. Methods In this cross-sectional study,a total of 223 patients with cancer from the oncology department of a tertiary A hospital in Jingmen were selected as the research subjects from December 2020 to July 2021,and the independent risk factors of psychological distress through univariate analysis and Logistic regression analysis were explored. According to these selected independent risk factors,a risk prediction model was established and incorporated into the nomogram,and the model power and its accuracy were evaluated by receiver operating characteristic. Results The risk prediction model was constructed based on 8 influencing factors,including pathological stage,primary caregivers,Pittsburgh sleep quality index score >9.5,numerical rating scale score （1 point for each increase）,temperament type,coping style,financial problems and exercise. The area under the predicted ROC curve was 0.924. When the Yoden index was 0.699,the optimal critical value was 0.513,the sensitivity was 0.866,and the specificity was 0.833. The slope of the calibration plot was close to 1. Conclusion The prediction model constructed in this study has good prediction effects which can provide references for medical staff to quickly identify the risk of psychological distress in cancer patients and timely take preventive management measures.

Key words: Cancer, Psychological Distress, Influencing Factors, Prediction Model, Nursing Care

石习习, 王静, 杨雪琴. 癌症患者心理痛苦预测模型的构建及验证[J]. 中华护理杂志, 2022, 57(11): 1330-1336.

SHI Xixi, WANG Jing, YANG Xueqin. Construction and validation of risk prediction model of psychological distress in patients with cancer[J]. Chinese Journal of Nursing, 2022, 57(11): 1330-1336.

图/表 6

表1 癌症患者心理痛苦的单因素分析

Table 1 Univariate analysis of psychological distress in cancer patients

表2 自变量赋值情况

Table 2 The assignment of the independent variable

表3 癌症患者心理痛苦的Logistic回归分析

Table 3 Logistic regression analysis of psychological distress in patients with cancer

图1 癌症患者心理痛苦预测列线图注：NRS为疼痛数字评价量表;PSQI为匹兹堡睡眠质量指数。

Figure 1 Nomogram of psychological distress in cancer patients

图2 癌症患者心理痛苦预测模型的受试者操作特征曲线

Figure 2 ROC curve for predictive models of psychological distress in cancer patients

图3 癌症患者心理痛苦预测模型的校准曲线

Figure 3 Calibration curves for predictive models of psychological distress in cancer patients

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