肺癌患者家庭照顾者获益感的潜在剖面分析及护理对策

doi:10.3761/j.issn.0254-1769.2023.11.008

摘要/Abstract

摘要：

目的探究肺癌患者家庭照顾者获益感的潜在类别及其特征差异，分析相关影响因素，提出护理对策。方法该研究为横断面研究，采用便利抽样法选取2021年9月—2022年8月在武汉市某三级甲等医院治疗的肺癌患者及其家庭照顾者作为调查对象。使用一般资料调查表、家庭环境量表、疾病获益感量表修订版、一般自我效能感量表进行调查。使用潜在剖面分析探索肺癌患者家庭照顾者获益感的潜在类别，采用有序多分类Logistic回归分析探讨相关影响因素。结果共纳入261名肺癌患者家庭照顾者，其获益感分为3个类别，分别命名为“低获益-感知支持缺乏组”（n=170，65.13%）、“中等获益-接受现实组”（n=73，27.97%）和“高获益-个人成长组”（n=18，6.90%）。有序多分类Logistic回归分析结果显示，家庭照顾者有无工作、患者的疾病分期、患者是否采用联合治疗、患者确诊时长、家庭照顾者的年龄、家庭照顾者的一般自我效能感量表得分是肺癌患者家庭照顾者获益感的影响因素。结论肺癌患者家庭照顾者的获益感存在明显的分类特征，建议护理人员采取个性化心理干预、信息支持、正向激励等方法，着重提高其自我效能，提升其获益感。

关键词: 肺癌, 家庭照顾者, 获益感, 潜在剖面分析, 影响因素分析, 心理护理, 肿瘤护理

Abstract:

Objective To explore the potential categories and characteristics of benefit finding in family caregivers of lung cancer patients，and to analyze the related influencing factors. Methods This was a cross-sectional study，and a convenient sampling method was used to select lung cancer patients and their family caregivers who were treated in a tertiary care hospital in Wuhan from September 2021 to August 2022. General demographic information questionnaire，Family Environment Scale（FES），Benefit Finding Scale（BFS），and General Self-Efficacy Scale（GSES） were conducted for investigation. Latent profile was analyzed using the categories of benefit finding，ordinal and multinomial Logistic regression analysis to identify the factors associated with the potential categories of benefit finding. Results According to the results of latent profile analysis，the benefit finding of family caregivers of lung cancer patients were classified into 3 categories，defined as low benefit finding-lack of perceived support group（n=170，65.13%），medium benefit finding-acceptance of reality group（n=73，27.97%），and high benefit finding-personal growth group（n=18，6.90%）. The result of ordinal and multinomial logistic regression analysis showed that work status of caregivers，tumor stage of patients，combined treatment status of patients，duration of diagnosis of patients，age of caregivers and the score of GSES were the influencing factors of the potential categories of benefit finding. Conclusion Family caregivers of lung cancer patients have obvious differences in characteristics by benefit finding. It is suggested that medical staff should adopt verbal persuasion，personalized psychological intervention，information support，positive incentive and other methods to focus on improving their self-efficacy and enhancing their benefit finding.

Key words: Lung Cancer, Family Caregiver, Benefit Finding, Latent Profile Analysis, Root Cause Analysis, Psychological Nursing, Oncologic Nursing

马丽, 史崇清, 陈向荣. 肺癌患者家庭照顾者获益感的潜在剖面分析及护理对策[J]. 中华护理杂志, 2023, 58(11): 1330-1337.

MA Li, SHI Chongqing, CHEN Xiangrong. Latent profile analysis and nursing countermeasures of benefit finding in family caregivers of lung cancer patients[J]. Chinese Journal of Nursing, 2023, 58(11): 1330-1337.

图/表 4

表1 肺癌患者家庭照顾者获益感潜在类别模型拟合指标

Table 1 Potential categories of benefit finding among family caregivers of lung cancer patients

图1 肺癌患者家庭照顾者获益感3个潜在类别的特征分布

Figure 1 The characteristic distribution of 3 potential categories of benefit finding among family caregivers of lung cancer patients

表2 肺癌患者家庭照顾者获益感潜在类别的单因素分析（n=261)

Table 2 Univariate analysis of potential categories of benefit finding among family caregivers of lung cancer patients（n=261)

表3 肺癌患者家庭照顾者获益感潜在类别影响因素的有序多分类Logistic回归分析

Table 3 Results of ordered multiple logistic regression of potential category influencing factors among family caregivers of lung cancer patients

参考文献 28

[1]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249. DOI URL
[2]	Barello S, Castiglioni C, Bonanomi A, et al. The Caregiving Health Engagement Scale(CHE-s):development and initial validation of a new questionnaire for measuring family caregiver engagement in healthcare[J]. BMC Public Health, 2019, 19(1):1562. DOI PMID
[3]	王瑞博, 董诗奇, 崔盼盼, 等. 癌症患者家庭照顾者负担评估工具的研究进展[J]. 中华护理杂志, 2021, 56(10):1584-1588. DOI
	Wang RB, Dong SQ, Cui PP, et al. Research progress of assessment tools for family caregiver burden of cancer patients:a lite-rature review[J]. Chin J Nurs, 2021, 56(10):1584-1588.
[4]	Saimaldaher ZH, Wazqar DY. Relationships between caregiving stress,mental health and physical health in family caregivers of adult patients with cancer:implications for nursing practice[J]. Scand J Caring Sci, 2020, 34(4):889-898. DOI
[5]	Hartnett J, Thom B, Kline N. Caregiver burden in end-stage ovarian cancer[J]. Clin J Oncol Nurs, 2016, 20(2):169-173. DOI PMID
[6]	Taylor SE, Kemeny ME, Reed GM, et al. Psychological resources,positive illusions,and health[J]. Am Psychol, 2000, 55(1):99-109. DOI PMID
[7]	Bi WY, Wang HN, Yang GT, et al. A longitudinal cohort study on benefit finding evolution in Chinese women breast cancer survivals[J]. Sci Rep, 2021, 11(1):20640. DOI PMID
[8]	王如婷, 章亚平, 吕小英, 等. 疾病获益感量表在缺血性脑卒中病人照顾者中的信效度检验[J]. 护理研究, 2020, 34(15):2655-2659.
	Wang RT, Zhang YP, Lü XY, et al. Reliability and validity test of the Benefit Finding Scale in caregivers of ischemic stroke patients[J]. Chin Nurs Res, 2020, 34(15):2655-2659.
[9]	王孟成, 毕向阳. 潜变量建模与Mplus应用:进阶篇[M]. 重庆: 重庆大学出版社, 2018:13-15.
	Wang MC, Bi XY. Latent variable modeling and Mplus application-advanced chapter[M]. Chongqing: Chongqing University Press, 2018:13-15.
[10]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[11]	赵丽华, 屈欢, 李娇娇, 等. 晚期癌症患者的替代决策者姑息照护决策冲突的调查研究[J]. 中华护理杂志, 2022, 57(14):1683-1690. DOI
	Zhao LH, Qu H, Li JJ, et al. Analysis on status and influencing factors of palliative care decisions conflict among substitutive decision-makers of advanced cancer patients[J]. Chin J Nurs, 2022, 57(14):1683-1690. DOI
[12]	Liu W, Unick J, Galik E, et al. Barthel Index of activities of daily living:item response theory analysis of ratings for long-term care residents[J]. Nurs Res, 2015, 64(2):88-99. DOI URL
[13]	费立鹏, 沈其杰, 郑延平, 等. “家庭亲密度和适应性量表”和“家庭环境量表”的初步评价:正常家庭与精神分裂症家庭成员对照研究[J]. 中国心理卫生杂志, 1991, 5(5):198-202,238.
	Fei LP, Shen QJ, Zheng YP, et al. Preliminary evaluation of Chinese version of FACES Ⅱ and FES:comparison of normal families and families of schizophrenic patients[J]. Chin Ment Health J, 1991, 5(5):198-202,238.
[14]	Antoni MH, Lehman JM, Kilbourn KM, et al. Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer[J]. Health Psychol, 2001, 20(1):20-32. DOI PMID
[15]	边静, 张兰凤, 刘谆谆, 等. 疾病获益感量表修订版在癌症家庭照顾者中应用的信效度检验[J]. 中国全科医学, 2018, 21(17):2091-2096. DOI
	Bian J, Zhang LF, Liu ZZ, et al. Reliability and validity of the revised Chinese version of Benefit Finding Scale in family caregivers of cancer patients[J]. Chin Gen Pract, 2018, 21(17):2091-2096.
[16]	Schwarzer R, Born A, Iwawaki S, et al. The assessment of optimistic self-beliefs:comparison of the Chinese,Indonesian,Japanese,and Korean versions of the General Self-Efficacy Scale[J]. Psychologia, 1997, 40(1):1-13.
[17]	王才康, 胡中锋, 刘勇. 一般自我效能感量表的信度和效度研究[J]. 应用心理学, 2001, 7(1):37-40.
	Wang CK, Hu ZF, Liu Y. Evidences for reliability and validity of the Chinese version of General Self Efficacy Scale[J]. Chin J Appl Psychol, 2001, 7(1):37-40.
[18]	周丹, 蒋小平, 陈澜, 等. 恶性肿瘤患儿家庭管理特征的潜在剖面分析[J]. 中华护理杂志, 2022, 57(20):2493-2501. DOI
	Zhou D, Jiang XP, Chen L, et al. Latent profile analysis of family management characteristics in children with malignant tumor[J]. Chin J Nurs, 2022, 57(20):2493-2501. DOI
[19]	Jiang Y, Liu C, Li JY, et al. Different attitudes of Chinese patients and their families toward truth telling of different stages of cancer[J]. Psychooncology, 2007, 16(10):928-936. DOI PMID
[20]	Barakat LP, Madden RE, Vega G, et al. Longitudinal predictors of caregiver resilience outcomes at the end of childhood cancer treatment[J]. Psychooncology, 2021, 30(5):747-755. DOI PMID
[21]	张青月, 肖珊, 魏婷婷, 等. 癌症患者照顾者益处发现现状及其影响因素研究[J]. 中国实用护理杂志, 2017, 33(8):598-602.
	Zhang QY, Xiao S, Wei TT, et al. Benefit finding and its influencing factors for caregivers of patients with cancer[J]. Chin J Pract Nurs, 2017, 33(8):598-602.
[22]	柯丹丹, 罗洁, 洪轶颖, 等. 膀胱全切术后行腹壁造口患者照顾者创伤后成长体验的质性研究[J]. 中华护理杂志, 2022, 57(3):294-300. DOI
	Ke DD, Luo J, Hong YY, et al. A qualitative research on post-traumatic growth experience of family members in patients with abdominal wall stoma after radical cystectomy[J]. Chin J Nurs, 2022, 57(3):294-300. DOI
[23]	Longacre ML, Valdmanis VG, Handorf EA, et al. Work impact and emotional stress among informal caregivers for older adults[J]. J Gerontol B Psychol Sci Soc Sci, 2017, 72(3):522-531. DOI PMID
[24]	Akpan-Idiok PA, Anarado AN. Perceptions of burden of caregiving by informal caregivers of cancer patients attending University of Calabar Teaching Hospital,Calabar,Nigeria[J]. Pan Afr Med J, 2014, 18:159. DOI PMID
[25]	Peng XC, Su YL, Huang WX, et al. Status and factors related to posttraumatic growth in patients with lung cancer:a STROBE-compliant article[J]. Medicine(Baltimore), 2019, 98(7):e14314.
[26]	Kangas M, McDonald S, Williams JR, et al. Acceptance and commitment therapy program for distressed adults with a primary brain tumor:a case series study[J]. Support Care Cancer, 2015, 23(10):2855-2859. DOI PMID
[27]	Cassidy T, Giles M, McLaughlin M. Benefit finding and resi-lience in child caregivers[J]. Br J Health Psychol, 2014, 19(3):606-618. DOI PMID
[28]	谭琳, 罗珊, 佘秋群, 等. 老年脑卒中患者照顾者自我效能感与益处发现的相关性[J]. 中国老年学杂志, 2020, 40(19):4213-4216.
	Tan L, Luo S, She QQ, et al. Correlation between self-efficacy and benefit discovery of caregivers of elderly stroke patients[J]. Chin J Gerontol, 2020, 40(19):4213-4216.