老年肿瘤患者用药安全行为影响因素及路径分析

doi:10.3761/j.issn.0254-1769.2025.17.002

摘要/Abstract

摘要：

目的探究老年肿瘤患者用药安全行为现状及影响因素的路径关系，为改善其用药安全行为提供参考。方法采用便利抽样法，于2024年8—12月，应用一般资料调查表、老年慢性病患者安全用药行为问卷、老年慢性病患者药物素养量表、家庭关怀度指数问卷及中文版癌症患者赋权量表对江苏省某三级甲等医院的340例老年肿瘤患者进行调查，应用多元线性回归分析进行影响因素分析，通过SmartPLS 4.0软件构建偏最小二乘法结构方程模型并进行路径分析。结果回收有效问卷307份。老年肿瘤患者用药安全行为得分为（31.89±5.38）分，居住地、药物素养、家庭关怀度、健康赋权是老年肿瘤患者用药安全行为的影响因素，共解释总变异的37.3%。路径分析结果显示，健康赋权（β=0.480）、药物素养（β=0.154）、家庭关怀度（β=0.227）正向影响老年肿瘤患者用药安全行为；健康赋权分别在家庭关怀度和用药安全行为、药物素养和用药安全行为间起部分中介作用，中介效应分别为0.125、0.332（P<0.001），占总效应的比例为35.51%、68.31%。结论老年肿瘤患者用药安全行为处于中等水平，且受多种因素共同影响。医护人员可通过健康赋权激励老年肿瘤患者安全用药管理，加强药物知识与技能宣教，同时引导患者感知家庭关怀与支持，从而改善其用药安全行为。

关键词: 肿瘤, 用药安全行为, 健康赋权, 药物素养, 家庭关怀度, 路径分析, 老年护理

Abstract:

Objective To explore the current situation of medication safety behavior of elderly cancer patients and the path relationship of various influencing factors for improving medication safety behavior. Methods A total of 340 elderly cancer patients were investigated by a demographic questionnaire，the Medication Safety Behavior Scale，the Medication Literacy Scale，the Family Care Index Questionnaire，and the Chinese version of the Empowerment Scale for Cancer Patients from August to December 2024. The multiple linear regression analysis was applied to analyze influencing factors，and data were analyzed using SmartPLS 4.0 to construct a partial least squares structural equation model with path analysis. Results A total of 307 valid questionnaires were collected. The mean medication safety behavior score was 31.89 ± 5.38. Residential area，drug literacy，family care，and health empowerment are factors that affect medication safety in elderly cancer patients，accounting for 37.3% of the total variation. The path analysis results indicated that health empowerment（β=0.480），medication literacy（β=0.154），and family care（β=0.227） positively correlate with medication safety behavior. Health empowerment played a partial mediating role between family care and medication safety behavior，as well as between medication literacy and medication safety behavior. The mediating effects are 0.125 and 0.332（P<0.001），accounting for 35.51% and 68.31% of the total effect，respectively. Conclusion Medication safety behaviors among elderly cancer patients are at a median level and influenced by multiple factors. By improving their levels of health empowerment，healthcare professionals can motivate patients to take an active role in medication safety management. Further，promoting education on medication knowledge and teaching relevant medical skills，and together with guiding patients to perceive family care and support，can collectively improve their overall medication safety behaviors.

Key words: Cancer, Medication Safety Behaviors, Health Empowerment, Medication Literacy, Family Care, Pathway Analysis, Geriatric Care

章毛毛, 张柳柳, 吴爱珍, 邹美英, 焦雨晨, 吴冰, 刘春丽, 于蓉. 老年肿瘤患者用药安全行为影响因素及路径分析[J]. 中华护理杂志, 2025, 60(17): 2056-2062.

ZHANG Maomao, ZHANG Liuliu, WU Aizhen, ZOU Meiying, JIAO Yuchen, WU Bing, LIU Chunli, YU Rong. Analysis of influencing factors and pathway of medication safety behaviors in elderly cancer patients[J]. Chinese Journal of Nursing, 2025, 60(17): 2056-2062.

图/表 4

表1 老年肿瘤患者的一般资料与用药安全行为的单因素分析（n=307）

Table 1 The general data of elderly cancer patients and the results of univariate analysis of medication safety behaviors（n=307）

表2 老年肿瘤患者用药安全行为影响因素的多元线性回归分析结果（n=307）

Table 2 Multiple linear regression analysis of medication safety behaviors in elderly cancer patients（n=307）

表3 老年肿瘤患者用药安全行为路径分析（n=307）

Table 3 Analysis of the pathway of medication safety behavior in elderly cancer patients（n=307）

图1 老年肿瘤患者用药安全行为偏最小二乘法结构方程模型

Figure 1 Partial Least Squares-Structural Equation Modeling for medication safety behavior of elderly cancer patients

参考文献 23

[1]	Han BF, Zheng RS, Zeng HM, et al. Cancer incidence and mortality in China,2022[J]. J Natl Cancer Cent, 2024, 4(1):47-53.
[2]	Fleming B, Edison P, Kenny L. Cognitive impairment after cancer treatment:mechanisms,clinical characterization,and management[J]. BMJ, 2023, 380:e071726.
[3]	Yang Y, Gao YJ, An R, et al. Barriers and facilitators to exercise adherence in community-dwelling older adults:a mixed-methods systematic review using the COM-B model and theoretical domains framework[J]. Int J Nurs Stud, 2024, 157:104808.
[4]	Du RF, Yang HS, Zhou HY, et al. The relationship between medication literacy and skin adverse reactions in non-small-cell lung cancer patients undergoing targeted EGFR-TKI therapy[J]. BMC Cancer, 2022, 22(1):491. DOI PMID
[5]	郭永攀, 苏琳琳, 吕晓辰, 等. 家庭参与老年慢性病共病患者用药安全促进与障碍因素的质性研究[J]. 中华护理杂志, 2025, 60(10):1244-1250. DOI
	Guo YP, Su LL, LÜ XC, et al. Facilitators and barriers of family participation in medication safety in elderly patients with multimorbidity:a qualitative study[J]. Chin J Nurs, 2025, 60(10):1244-1250.
[6]	Zhang Y, Gu CF, Sun L, et al. The application effect of a pulmonary rehabilitation program based on empowerment theory for patients with COPD combined with heart failure[J]. Medi-cine, 2024, 103(41):e40067.
[7]	Kim SH, Choe YH, Kim DH. Patient empowerment in cancer care:a scoping review[J]. Cancer Nurs, 2024, 47(6):471-483.
[8]	秦超. CB-SEM与PLS-SEM:结构方程模型在教育实证研究中的应用辨析[J]. 湖北社会科学, 2023(5):146-154.
	Qin C. CB-SEM and PLS-SEM:comparison of structural equa-tion models in educational empirical research[J]. Hubei Soc Sci, 2023(5):146-154.
[9]	向桂萍. 健康教育对社区老年慢性病患者安全用药知识态度行为的效果研究[D]. 长沙: 中南大学, 2012.
	Xiang GP. Effect of health education on knowledge,attitude and behavior of safe drug use among elderly patients with chronic diseases in community[D]. Changsha: Central South University, 2012.
[10]	赵雪. 老年慢性病患者药物素养量表的研制[D]. 兰州: 兰州大学, 2023.
	Zhao X. Development of Drug Literacy Scale for Elderly Patients with Chronic Diseases[D]. Lanzhou: Lanzhou University, 2023.
[11]	吕繁, 曾光, 刘松暖, 等. 家庭关怀度指数问卷测量脑血管病病人家庭功能的信度和效度研究[J]. 中国公共卫生, 1999, 15(11):987-988.
	Lü F, Zeng G, Liu SN, et al. A study on validity and reliability of the amily APGAR[J]. Chin J Pub Heal, 1999, 15(11):987-988.
[12]	尹伊君. 癌症患者赋权量表的汉化修订及其在乳腺癌幸存者中的应用研究[D]. 唐山: 华北理工大学, 2021.
	Yin YJ. Revision of Chinese version of Cancer Patient Empowerment Scale and its application in breast cancer survivors[D]. Tangshan: North China University of Science and Technology, 2021.
[13]	崔彩彩, 高欢玲, 李红梅, 等. 认知衰弱、风险感知及自我效能对空巢老人安全用药行为的影响路径分析[J]. 现代预防医学, 2024, 51(23):4315-4320.
	Cui CC, Gao HL, Li HM, et al. Path analysis of the impact of cognitive decline,risk perception,and self-efficacy on safe medication practices among empty nesters[J]. Mod Prev Med, 2024, 51(23):4315-4320.
[14]	Bujang NNA, Kong YC, Danaee M, et al. Beliefs on causes of cancer in the general population,and the association with risk perception and lifestyle in a multiethnic setting[J]. JCO Glob Oncol, 2024, 10:e2400129.
[15]	马慧艳, 赵志刚, 乔春凤, 等. 中国城镇老年慢性病患者居家安全用药现状调查与影响因素分析:一项基于全国多中心的研究[J]. 中南药学, 2024, 22(10):2696-2701.
	Ma HY, Zhao ZG, Qiao CF, et al. Survey of current status of home medication safety among elderly patients with chronic diseases in urban China:a nationwide multi-center study on influencing factors[J]. Central South Pharmacy, 2024, 22(10):2696-2701.
[16]	Wang WN, Luan WY, Zhang ZX, et al. Association between medication literacy and medication adherence and the mediating effect of self-efficacy in older people with multimorbidity[J]. BMC Geriatr, 2023, 23(1):378. DOI PMID
[17]	Gentizon J, Hirt J, Jaques C, et al. Instruments assessing medication literacy in adult recipients of care:a systematic review of measurement properties[J]. Int J Nurs Stud, 2021, 113:103785.
[18]	Li J, Kong XJ, Wang J, et al. Family functioning and patients’ depressive symptoms:comparison in perceived family function between patients who had an acute ischaemic stroke and their primary family caregivers:a cross-sectional study[J]. BMJ Open, 2023, 13(11):e068794.
[19]	Gil-Hernández E, Ballester P, Guilabert M, et al. Enhancing safe medication use in home care:insights from informal caregivers[J]. Front Med, 2024, 11:1494771.
[20]	Tobiano G, Chaboyer W, Teasdale T, et al. Older patient and family discharge medication communication:a mixed-methods study[J]. J Eval Clin Pract, 2021, 27(4):898-906.
[21]	慈莉娅, 杨长春, 郑鹏远, 等. 医养结合机构衰弱老年人多重用药安全管理中国专家共识(2022版)[J]. 中国心血管杂志, 2022, 27(5):403-410.
	Ci LY, Yang CC, Zheng PY, et al. Chinese expert consensus on safety management of polypharmacy for frail elderly people in the institutions of combination of medical and senior health care(2022 version)[J]. Chin J Cardiovasc Med, 2022, 27(5):403-410.
[22]	杨阳, 曾铁英. 健康赋权理论在老年护理中的启示[J]. 中华护理杂志, 2016, 51(6):737-741.
	Yang Y, Zeng TY. The enlightenment of health empowerment theory in elderly care[J]. Chin J Nurs, 2016, 51 (6):737-741.
[23]	Alhani F, Asghari-Jafarabadi M, Norouzadeh R, et al. The effect of family-centered empowerment model on the quality of life of adults with chronic diseases:an updated systematic review and meta-analysis[J]. J Affect Disord, 2022, 316:140-147.