宫颈癌患者及其配偶疾病获益感的影响因素及路径分析

doi:10.3761/j.issn.0254-1769.2024.18.005

摘要/Abstract

摘要：

目的分析宫颈癌患者及其配偶疾病获益感的影响因素及因素间的作用路径，为制订针对性的临床干预提供依据。方法采用便利抽样法，选取2022年10月—2023年7月在太原市某三级甲等医院就诊或住院的245对宫颈癌患者及其配偶作为调查对象，使用一般资料调查表、痛苦表露指数量表、心理韧性量表、疾病获益感量表进行调查。采用单因素分析、Pearson相关分析、多元线性回归分析进行数据分析，并构建主客体互倚模型。结果宫颈癌患者及其配偶疾病获益感量表得分分别为（65.31±7.94）、（69.87±9.63）分。多元线性回归分析结果显示，患者的文化程度、是否放化疗、自我表露、心理韧性及配偶的文化程度是影响患者疾病获益感的因素；配偶的文化程度、职业状态、自我表露、心理韧性及患者的自我表露和心理韧性是配偶疾病获益感的影响因素。主客体互倚模型结果显示，宫颈癌患者的自我表露、心理韧性能正向预测自身及配偶的疾病获益感（路径系数分别为0.415、0.501、0.216、0.168，均P<0.05），但配偶的自我表露、心理韧性只能正向预测其自身的疾病获益感（路径系数分别为0.188、0.254，均P<0.05）。结论宫颈癌患者及配偶的疾病获益感均处中等水平且受多种因素影响；宫颈癌患者及其配偶的自我表露、心理韧性均对自身的疾病获益感有正向预测作用。医护人员应鼓励双方对疾病进行良性互动，采取措施提升二者的韧性水平，并最终挖掘更高水平的获益感。

关键词: 宫颈癌, 配偶, 自我表露, 心理韧性, 疾病获益感, 肿瘤护理

Abstract:

Objective This study aims to analyze the factors influencing benefit finding among cervical cancer patients and their spouses，as well as the interconnections between these factors. The goal is to provide a foundation for developing targeted clinical interventions. Methods Using the convenience sampling method， cervical cancer patients and spouses of 245 pairs who attended or were hospitalized in a tertiary-level hospital in Taiyuan City from October 2022 to July 2023 were selected as study subjects. Data were collected using a general information questionnaire，the Distress Disclosure Index，the Connor-Davidson Resilience Scale，and the Benefit Finding Scale. Univariate analysis，Pearson correlation analysis，and multiple linear regression were employed to scrutinize the data，leading to the establishment of Actor-Partner Interdependence Model. Results Benefit finding scores for cervical cancer patients and their spouses were（65.31±7.94） and（69.87±9.63），respectively. Multiple linear regression revealed that the educational level of patients and their spouses，whether or not they received chemotherapy or radiotherapy，self-disclosure and psychological resilience were the factors that affected patients’ benefit finding. Spouse’s education level，occupation，self-disclosure，psychological resilience and patients’ self-disclosure and psychological resilience were the influencing factors of spouse’s benefit finding. The Actor-Partner Interdependence Model analysis indicated that the self-disclosure and psychological resilience of cervical cancer patients positively predicted their own benefit finding and that of their spouses（path coefficients were 0.415，0.501，0.216，and 0.168，respectively，all P<0.05）. However，spouses’ self-disclosure and psychological resilience could only positively predict their own benefit finding（path coefficients were 0.188 and 0.254，respectively，all P<0.05）. Conclusion Benefit finding among cervical cancer patients and their spouses is moderate and influenced by various factors. Both self-disclosure and psychological resilience of cervical cancer patients and their spouses have positive subjective effects on their own benefit finding. Healthcare professionals should encourage both parties to engage in healthy interactions about the disease，take steps to increase the level of psychological resilience of both，and ultimately tap into a higher level of benefit finding.

Key words: Cervical Cancer, Spouses, Self-Disclosure, Psychological Resilience, Benefit Finding, Oncologic Nursing

张转转, 李霞, 王哲, 杨雨桐, 朱东阁, 江欣格, 刘梦瑶. 宫颈癌患者及其配偶疾病获益感的影响因素及路径分析[J]. 中华护理杂志, 2024, 59(18): 2214-2221.

ZHANG Zhuanzhuan, LI Xia, WANG Zhe, YANG Yutong, ZHU Dongge, JIANG Xinge, LIU Mengyao. Analysis of influencing factors and impact path of benefit finding in patients with cervical cancer and their spouses[J]. Chinese Journal of Nursing, 2024, 59(18): 2214-2221.

图/表 5

表1 宫颈癌患者及其配偶的一般资料与疾病获益感的单因素分析（n=225）

Table 1 The general data of patients with cervical cancer and their spouses and the results of univariate analysis of benefit finding（n=225）

表2 宫颈癌患者及其配偶自我表露、心理韧性与疾病获益感的相关性（r值，n=225）

Table 2 Correlation of self-disclosure， psychological resilience and benefit finding in patients with cervical cancer and their spouses（r，n=225）

表3 宫颈癌患者疾病获益感影响因素的多元线性回归分析（n=225）

Table 3 Multivariable linear regression of predictors of benefit finding in patients with cervical cancer（n=225）

表4 配偶疾病获益感影响因素的多元线性回归分析（n=225）

Table 4 Multivariable linear regression of predictors of benefit finding in spouses（n=225）

图1 宫颈癌患者及其配偶自我表露、心理韧性与疾病获益感的主客体互倚模型

Figure 1 The actor-partner independence model of self-disclosure， psychological resilience and benefit finding in patients with cervical cancer and spouses 1）P<0.001；2）P<0.05。

参考文献 29

[1]	王临红, 赵更立. 子宫颈癌综合防控指南[M]. 2版. 北京: 人民卫生出版社, 2023.
	Wang LH, Zhao GL. Guidelines for comprehensive prevention and control of cervical cancer[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2023.
[2]	Li XC, Liu L, He JH, et al. Analysis of the effectiveness of the application of pelvic floor rehabilitation exercise and the factors influencing its self-efficacy in postoperative patients with cervical cancer[J]. Front Oncol, 2023,13:1118794.
[3]	刘谆谆, 张兰凤, Lisa Gudenkauf. 癌症患者疾病获益感量表的跨文化调适[J]. 中华护理杂志, 2015, 50(5):561-566.
	Liu ZZ, Zhang LF, Lisa Gudenkauf. Cross-cultural adaptation of the Benefit Finding Scale(BFS) in Chinese cancer patients[J]. Chin J Nurs, 2015, 50(5):561-566.
[4]	Rottmann N, Hansen DG, Larsen PV, et al. Dyadic coping within couples dealing with breast cancer:a longitudinal,population-based study[J]. Health Psychol, 2015, 34(5):486-495. DOI PMID
[5]	Zhou LH, Hong JF, Qin RM, et al. Post-traumatic growth and its influencing factors among Chinese women diagnosed with gynecological cancer:a cross-sectional study[J]. Eur J Oncol Nurs, 2021,51:101903.
[6]	Norbury A, Seeley SH, Perez-Rodriguez MM, et al. Functional neuroimaging of resilience to trauma:convergent evidence and challenges for future research[J]. Psychol Med, 2023, 53(8):3293-3305. DOI PMID
[7]	Manne S, Badr H. Intimacy and relationship processes in couples’ psychosocial adaptation to cancer[J]. Cancer, 2008, 112(Suppl 11):2541-2555.
[8]	Cook WL, Kenny DA. The actor-partner interdependence model:a model of bidirectional effects in developmental studies[J]. Int J Behav Dev, 2005, 29(2):101-109.
[9]	王建华. 实用医学科研方法[M]. 北京: 人民卫生出版社,2003:56-57.
	Wang JH. Practical medical research methods[M]. Beijing: People’s Medical Publishing House,2003:56-57.
[10]	吴明隆. 结构方程模型:AMOS的操作与应用[M]. 重庆: 重庆大学出版社, 2009.
	Wu ML. Structural equation modeling:operation and application with AMOS[M]. Chongqing: Chongqing University Press, 2009.
[11]	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
[12]	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.
[13]	Connor KM, Davidson JRT. Development of a new resilience scale:the Connor-Davidson Resilience Scale(CD-RISC)[J]. Depress Anxiety, 2003, 18(2):76-82.
[14]	Yu XN, Zhang JX. Factor analysis and psychometric evaluation of the Connor-Davidson Resilience Scale(CD-RISC) with Chinese people[J]. Soc Behav Pers, 2007, 35(1):19-30.
[15]	Kahn JH, Hessling RM. Measuring the tendency to conceal versus disclose psychological distress[J]. J Soc Clin Psychol, 2001, 20(1):41-65.
[16]	李新民. 大学生成人依恋、自我表露与抑郁状态的关系研究[D]. 石家庄: 河北师范大学, 2009.
	Li XM. Research on the relationship between adult attachment,self-disclosure and depression of college students[D]. Shijiazhuang: Hebei Normal University, 2009.
[17]	刘畅, 伍新春. 主客体互倚性的成对模式及其检验[J]. 心理发展与教育, 2017, 33(1):105-112.
	Liu C, Wu XC. Dyadic patterns in the actor-partner interde-pendence model and its testing[J]. Psychol Dev Educ, 2017, 33(1):105-112.
[18]	Lin Y, Luo XJ, Li JY, et al. The dyadic relationship of benefit finding and its impact on quality of life in colorectal cancer survivor and spousal caregiver couples[J]. Support Care Cancer, 2021, 29(3):1477-1486.
[19]	Zhu PT, Chen C, Liu XY, et al. Factors associated with benefit finding and mental health of patients with cancer:a systematic review[J]. Support Care Cancer, 2022, 30(8):6483-6496.
[20]	Li LP, Rao DF, Chen XX, et al. The impact of hospital-family integrated continuation nursing based on information technology on patients unhealthy mood,family function and sexual function after cervical cancer surgery[J]. Medicine, 2023, 102(16):e33504.
[21]	何昕, 刘燕, 王双, 等. 肺癌患者家庭照顾者疾病获益感现状及影响因素分析[J]. 中华现代护理杂志, 2022, 28(14):1918-1921.
	He X, Liu Y, Wang S, et al. Current situation and influencing factors of disease benefit of family caregivers of patients with lung cancer[J]. Chin J Mod Nurs, 2022, 28(14):1918-1921.
[22]	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):1330-1338. DOI URL
	Ma L, Shi CQ, Chen XR. Latent profile analysis and nursing countermeasures of benefit finding in family caregivers of lung cancer patients[J]. Chin J Nurs, 2023, 58(11):1330-1338. DOI URL
[23]	温晓萌, 蔡萍, 褚江辉, 等. 萨提亚模式干预在食管癌病人家庭照顾者中的应用[J]. 护理研究, 2022, 36(9):1671-1675.
	Wen XM, Cai P, Chu JH, et al. Application of Satir model intervention in family caregivers of patients with esophageal cancer[J]. Chin Nurs Res, 2022, 36(9):1671-1675.
[24]	Song YY, Liu H, Wang S, et al. Dyadic effects of rumination and self-disclosure on posttraumatic growth in newly diagnosed gynecological cancer couples:an actor-partner interdependence modeling approach[J]. Support Care Cancer, 2022, 30(6):5167-5174.
[25]	Bu LX, Chen XS, Zheng SY, et al. Construction of the structural equation model of stigma,self-disclosure,social support,and quality of life of breast cancer patients after surgery-a multicenter study[J]. Front Oncol, 2023,13:1142728.
[26]	张贤贤, 张利霞, 贾智慧, 等. 夫妻自我表露在青年乳腺癌患者癌症复发恐惧干预中的应用研究[J]. 中华护理杂志, 2019, 54(11):1610-1614. DOI URL
	Zhang XX, Zhang LX, Jia ZH, et al. Application and effect evaluation of marital self-disclosure intervention on the fear of cancer recurrence in young breast cancer patients[J]. Chin J Nurs, 2019, 54(11):1610-1614. DOI URL
[27]	陈园园. 乳腺癌患者配偶益处发现现状及其影响因素研究[D]. 扬州: 扬州大学, 2021.
	Chen YY. Study on the current situation of benefit finding and its influencing factors among spouses of women with breast cancer[D]. Yangzhou: Yangzhou University, 2021.
[28]	刘志薇, 张振香, 梅永霞, 等. 癌症患者夫妻疾病沟通干预的研究进展[J]. 中华护理杂志, 2023, 58(18):2288-2293. DOI URL
	Liu ZW, Zhang ZX, Mei YX, et al. Research progress of disease communication intervention for spouses with cancer[J]. Chin J Nurs, 2023, 58(18):2288-2293. DOI URL
[29]	Wang ZM, Chen X, Zhou JR, et al. Feasibility and preliminary effect of a couple-based posttraumatic growth intervention for colorectal cancer couples:a randomized controlled pilot study[J]. Clin Psychol Psychother, 2023, 30(6):1433-1445.