癌症患者社会疏离体验的质性研究

doi:10.3761/j.issn.0254-1769.2023.06.004

摘要/Abstract

摘要：

目的描述癌症患者社会疏离的体验，旨在为该人群护理支持方案的制订提供参考依据。方法采用描述性质性研究，按照目的抽样法，于2021年11月—12月选取在上海市某三级甲等肿瘤医院复诊治疗的20例癌症患者进行半结构式深入访谈，并以内容分析法归纳和提炼主题。结果将癌症患者社会疏离的体验提炼为3个主题：社交退缩（癌因性症状的困扰、健康受损的忧虑、病耻感的影响、社交兴趣缺乏）；隐匿心声（自我忍受痛苦、担心影响他人、沟通交流不畅）；渴望支持（依赖家庭支持、感恩朋友支持、亟需专业支持）。结论癌症患者由于生理健康受损、心理状况不良、社会支持不足等存在社会疏离，医护人员应加强对该人群的症状管理和心理疏导，强化家庭及社会支持，以帮助其重返和适应社会。

关键词: 癌症患者, 社会疏离, 质性研究, 内容分析法, 肿瘤护理

Abstract:

Objective This study aimed to describe social isolation-related psychological experiences of cancer patients，in order to provide practicable references for developing relevant nursing support programs. Methods This descriptive qualitative study，involving a semi-structured in-depth interview of 20 cancer patients based on purposive sampling，was conducted from November to December 2021 at a tertiary A tumor hospital in Shanghai. The qualitative content analysis was performed in order to summarize and extract themes from the interview texts. Results The cancer isolation-related psychological experiences of cancer patients were extracted and classified into 3 themes，which should be dealt in a positive and comprehensive way in order to produce a supportive environment for survivors：social withdrawal（distress of cancer-related symptoms，worries regarding health impairment，stigma regarding change of body image and social prejudice，lack of interest in social activities）；hiding of inner feelings （the psychological distress tolerated by oneself，worries about influencing others，failure to communicate with others）；eagerness for support（reliance on family support，feelings of gratefulness for the support of friends，eagerness for seeking professional support）. Conclusion The study found that cancer patients suffered social isolation because of their impaired physical health，poor psychological status and insufficient social support. Medical staff should strengthen the symptom management and psychological counseling provided to these survivors and enhance their family and social support，in order to help cancer survivors return and adapt to society.

Key words: Cancer Patients, Social Isolation, Qualitative Research, Content Analysis, Oncology Nursing

董朝晖, 卢惠娟, 陆箴琦, 张晓菊, 张玉侠. 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.

DONG Zhaohui, LU Huijuan, LU Zhenqi, ZHANG Xiaoju, ZHANG Yuxia. Experiences of social isolation in cancer patients：a qualitative research[J]. Chinese Journal of Nursing, 2023, 58(6): 670-675.

参考文献 23

[1]	苏闪闪, 郑蔚, 王丹丹, 等. 癌症患者社会疏离的概念分析[J]. 中华护理杂志, 2022, 57(9):1088-1093. DOI
	Su SS, Zheng W, Wang DD, et al. Social isolation in cancer patients:an evolutionary concept analysis[J]. Chin J Nurs, 2022, 57(9):1088-1093.
[2]	张林, 张园. 关于弱势群体社会疏离问题的研究述评[J]. 长春理工大学学报(社会科学版), 2015, 28(6):45-50.
	Zhang L, Zhang Y. A review of research on social isolation of vulnerable groups[J]. J Chang Univ Sci Technol Soc Sci Ed, 2015, 28(6):45-50.
[3]	Moore S, Leung B, Bates A, et al. Social isolation:impact on treatment and survival in patients with advanced cancer[J]. J Clin Oncol, 2018, 36(34_suppl):156.
[4]	Takemura T, Kataoka Y, Ashi N, et al. Influence of social isolation and loneliness on the prognosis of advanced lung cancer patients:a prospective cohort study[J]. Support Care Cancer, 2022, 30(7):6045-6053. DOI
[5]	郑楹楹, 吕宏英, 陈正飞, 等. 宫颈癌根治术后患者康复期症状体验及心理感受的质性研究[J]. 中华护理杂志, 2020, 55(4):569-573. DOI
	Zheng YY, Lü HY, Chen ZF, et al. Symptoms and psychological experience of cervical cancer patients after radical hysterectomy:a qualitative research[J]. Chin J Nurs, 2020, 55(4):569-573.
[6]	van Roij J, Brom L, Youssef-El Soud M, et al. Social consequences of advanced cancer in patients and their informal caregivers:a qualitative study[J]. Support Care Cancer, 2019, 27(4):1187-1195. DOI
[7]	Elo S, Kyngäs H. The qualitative content analysis process[J]. J Adv Nurs, 2008, 62(1):107-115. DOI PMID
[8]	Jakobsen K, Magnus E, Lundgren S, et al. Everyday life in breast cancer survivors experiencing challenges:a qualitative study[J]. Scand J Occup Ther, 2018, 25(4):298-307. DOI PMID
[9]	Ma YX, He B, Jiang MY, et al. Prevalence and risk factors of cancer-related fatigue:a systematic review and Meta-analysis[J]. Int J Nurs Stud, 2020, 111:103707. DOI URL
[10]	Hauken MA, Larsen TMB. Young adult cancer patients’ experiences of private social network support during cancer treatment[J]. J Clin Nurs, 2019, 28(15/16):2953-2965. DOI URL
[11]	Suwankhong D, Liamputtong P. Breast cancer treatment:experiences of changes and social stigma among Thai women in southern Thailand[J]. Cancer Nurs, 2016, 39(3):213-220. DOI PMID
[12]	Currin-McCulloch J, Kaushik S, Jones B. “When will I feel normal?”:disorienting grief responses among young adults with advanced cancer[J]. Cancer Nurs, 2022, 45(2):E355-E363. DOI URL
[13]	Heidary M, Heshmati R, Hayes J. Effect of group logotherapy on anxiety about death and existential loneliness in patients with advanced cancer:a randomized controlled trial[J]. Cancer Nurs, 2022:221-227.
[14]	王贞, 唐莉, 吴彩云. 乳腺癌治疗期患者自我表露现状与影响因素调查研究[J]. 中国预防医学杂志, 2019, 20(11):1076-1080.
	Wang Z, Tang L, Wu CY. Self-disclosure and its influencing factors in patients with breast cancer during treatment[J]. Chin Prev Med, 2019, 20(11):1076-1080.
[15]	姜永志, 张海钟. 中国人自我的本土化心理研究:“忍”的和谐思想[J]. 延边大学学报(社会科学版), 2010, 43(2):113-116.
	Jiang YZ, Zhang HZ. A psychological study of the localization of Chinese people’s self-identity[J]. J Yanbian Univ Soc Sci, 2010, 43(2):113-116.
[16]	Lidington E, Vlooswijk C, Stallard K, et al. ‘This is not part of my life plan’:a qualitative study on the psychosocial experiences and practical challenges in young adults with cancer age 25 to 39 years at diagnosis[J]. Eur J Cancer Care(Engl), 2021, 30(5):e13458.
[17]	Raque-Bogdan TL, Lamphere B, Kostiuk M, et al. Unpacking the layers:a Meta-ethnography of cancer survivors’ loneliness[J]. J Cancer Surviv, 2019, 13(1):21-33. DOI PMID
[18]	Lu Q, Dong L, Wu IHC, et al. The impact of an expressive writing intervention on quality of life among Chinese breast cancer patients undergoing chemotherapy[J]. Support Care Cancer, 2019, 27(1):165-173. DOI PMID
[19]	McInally W, Gray-Brunton C, Chouliara Z, et al. Life interrupted:experiences of adolescents,young adults and their family living with malignant melanoma[J]. J Adv Nurs, 2021, 77(9):3867-3879. DOI PMID
[20]	吴子敬, 刘叶, 李小寒. 乳腺癌患者心理韧性保护因素的质性研究[J]. 解放军护理杂志, 2018, 35(2):7-12.
	Wu ZJ, Liu Y, Li XH. A qualitative research on protective factors of psychological resilience among patients with breast cancer[J]. Nurs J Chin LA, 2018, 35(2):7-12.
[21]	张妍欣, 杨丽, 李家燕, 等. 鼻咽癌病人疾病心理社会适应现状及其影响因素分析[J]. 护理研究, 2022, 36(5):896-901.
	Zhang YX, Yang L, Li JY, et al. Analysis of psycho-social adaptation of patients with nasopharyngeal carcinoma and its influencing factors[J]. Chin Nurs Res, 2022, 36(5):896-901.
[22]	Kudjawu S, Agyeman-Yeboah J. Experiences of women with breast cancer undergoing chemotherapy:a study at Ho Teaching Hospital,Ghana[J]. Nurs Open, 2021, 8(6):3161-3169. DOI URL
[23]	宋鹏娟, 刘均娥, 陈少华, 等. 回归家庭干预对乳腺癌术后患者康复效果的影响[J]. 中华护理杂志, 2022, 57(2):133-139. DOI
	Song PJ, Liu JE, Chen SH, et al. Effect of regression family intervention on rehabilitation effect of breast cancer patients after surgery[J]. Chin J Nurs, 2022, 57(2):133-139.