宫颈癌患者恐惧疾病进展现状及影响因素分析

doi:10.3761/j.issn.0254-1769.2022.18.009

摘要/Abstract

摘要：

目的了解宫颈癌患者恐惧疾病进展（fear of progression,FoP）现状,通过构建基于社会认知加工理论的结构方程模型,分析影响其FoP的路径。方法采用便利抽样法,于2020年8月—10月选取在湖南省10所三级医院肿瘤科和妇科住院治疗的222对宫颈癌患者及其配偶作为调查对象。采用一般资料调查表、中文版癌症患者FoP简化量表、中文版事件影响量表修订版、社会约束量表、中文版痛苦表露指数量表对宫颈癌患者进行调查;同时采用中文版配偶FoP简化量表对其配偶进行调查。结果宫颈癌患者FoP心理功能失调发生率为43.69%。社会约束程度、负性认知加工水平、配偶FoP水平正向影响宫颈癌患者FoP,总效应值分别为0.427、0.631、0.468;夫妻亲密度、患者自我表露水平负向影响宫颈癌患者FoP,总效应值分别为-0.279、-0.454。结论宫颈癌患者FoP心理功能失调发生率较高,医护人员在临床中应重视社会约束、认知加工、自我表露、夫妻亲密度及配偶FoP水平对患者FoP的影响,采取针对性护理措施降低患者的FoP水平。

关键词: 宫颈癌, 恐惧疾病进展, 社会约束, 认知加工, 心理护理, 影响因素分析

Abstract:

Objective To learn about the current situation of fear of progression（FoP） in patients with cervical cancer,and to analyze the influence path of FoP in cervical cancer patients by establishing a structural equation model based on Social Cognitive Processing Theory. Methods From August to October 2020,the convenience sampling method was adopted to investigate 222 cervical cancer patients who were hospitalized in Oncology and Gynecology Departments of 10 tertiary hospitals in Hunan province with the general information questionnaire,Fear of Progression Questionnaire-Short Form（FoP-Q-SF）,Impact of Event Scale Revised（IES-R）,Social Constraint Scale（SCS-15）,and Distress Disclosure Index（DDI）,while their spouses were surveyed by Fear of Progression Questionnaires for Partners（FoP-Q-SF/P）. Results The incidence of FoP mental dysfunction in cervical cancer patients was 43.69%. Social constraint,negative cognitive processing and FoP of the spouses positively affected the FoP of cervical cancer patients with a total effect of 0.427,0.631,0.468,respectively. Marital intimacy and distress disclosure negatively affected the FoP of cervical cancer patients with a total effect of -0.279,-0.454,respectively. Conclusion The incidence of FoP psychological dysfunction in cervical cancer patients is high. In clinical practice,medical staff should pay attention to the impact of social constraints,cognitive processing,distress disclosure,marital intimacy and FoP of the spouses on the FoP in cervical cancer patients,and take targeted nursing measures to reduce the level of FoP in cervical cancer patients.

Key words: Cervical Cancer, Fear of Progression, Social Constraint, Cognitive Processing, Psychological Nursing, Root Cause Analysis

姚敏, 周昔红, 夏春芳, 刘赛, 谭汀娜, 汤佳俊. 宫颈癌患者恐惧疾病进展现状及影响因素分析[J]. 中华护理杂志, 2022, 57(18): 2232-2238.

YAO Min, ZHOU Xihong, XIA Chunfang, LIU Sai, TAN Tingna, TANG Jiajun. Influencing factors analysis of fear of progression in cervical cancer patients[J]. Chinese Journal of Nursing, 2022, 57(18): 2232-2238.

图/表 4

表1 宫颈癌患者一般资料及恐惧疾病进展的单因素分析（n=222）

Table 1 Univariate analysis of the general information and fear of progression in cervical cancer patients（n=222）

表2 宫颈癌患者恐惧疾病进展与其影响因素的相关性分析（r 值）

Table 2 Correlation analysis among influencing factors of fear of progression in cervical cancer patients（r value）

图1 宫颈癌患者恐惧疾病进展影响因素的结构方程模型

Figure 1 Structural equation model diagram of factors affecting fear of progression in cervical cancer patients

表3 各变量对宫颈癌患者恐惧疾病进展水平的效应值

Table 3 The effect values of each variable of the mode on the fear of progression in cervical cancer patients

参考文献 35

[1]	Dankert A, Duran G, Engst-Hastreiter U, et al. Fear of progression in patients with cancer,diabetes mellitus and chronic arthritis[J]. Rehabilitation(Stuttg), 2003, 42(3):155-163.
[2]	Lebel S, Ozakinci G, Humphris G, et al. From normal response to clinical problem:definition and clinical features of fear of cancer recurrence[J]. Support Care Cancer, 2016, 24(8):3265-3268. DOI URL
[3]	Hanprasertpong J, Geater A, Jiamset I, et al. Fear of cancer recurrence and its predictors among cervical cancer survivors[J]. J Gynecol Oncol, 2017, 28(6):e72. DOI URL
[4]	赖小玲, 黎淑仪. 治疗后宫颈癌患者复发恐惧现状及影响因素分析[J]. 护理学杂志, 2019, 34(7):69-72.
	Lai XL, Li SY. Fear of cancer recurrence and its influencing factors among patients after cervical cancer treatment[J]. J Nurs Sci, 2019, 34(7):69-72.
[5]	Lepore SJ. A social-cognitive processing model of emotional adjustment to cancer[M]// Psychosocial interventions for cancer. Washington: American Psychological Association, 2001:99-116.
[6]	Cohee AA, Adams RN, Johns SA, et al. Long-term fear of recurrence in young breast cancer survivors and partners[J]. Psycho-oncology, 2017, 26(1):22-28. DOI URL
[7]	Lepore SJ, Revenson TA. Social constraints on disclosure and adjustment to cancer[J]. Soc Pers Psychol Compass, 2007, 1(1):313-333. DOI URL
[8]	中华医学会病理学分会女性生殖系统疾病学组. 宫颈癌及癌前病变病理诊断规范[J]. 中华病理学杂志, 2019, 48(4):265-269.
	Female Reproductive System Diseases Committee Chinese Society of Pathology. Diagnostic criterion for uterine cervical carcinoma and precancerous lesions[J]. Chin J Pathol, 2019, 48 (4):265-269.
[9]	孙振球, 徐勇勇. 医学统计学[M]. 4版. 北京: 人民卫生出版社, 2014.
	Sun ZQ, Xu YY. Medical statistics[M]. 4th ed. Beijing: People’s Medical Publishing House, 2014.
[10]	Mehnert A, Herschbach P, Berg P, et al. Fear of progression in breast cancer patients:validation of the short form of the Fear of Progression Questionnaire(FoP-Q-SF)[J]. Z Psychosom Med Psychother, 2006, 52(3):274-288.
[11]	吴奇云, 叶志霞, 李丽, 等. 癌症患者恐惧疾病进展简化量表的汉化及信效度分析[J]. 中华护理杂志, 2015, 50(12):1515-1519.
	Wu QY, Ye ZX, Li L, et al. Reliability and validity of Chinese version of Fear of Progression Questionnaire-Short Form for Cancer Patients[J]. Chin J Nurs, 2015, 50(12):1515-1519.
[12]	Zimmermann T, Herschbach P, Wessarges M, et al. Fear of progression in partners of chronically ill patients[J]. Behav Med, 2011, 37(3):95-104. DOI PMID
[13]	吴奇云. 原发性肝癌患者及其配偶对疾病进展恐惧的现状调查及研究[D]. 上海: 第二军医大学, 2016.
	Wu QY. The status research and study on fear of progression of primary liver cancer patients and their spouses[D]. Shanghai: Second Military Medical University, 2016.
[14]	Weiss DS, Marmar CR. The impact of the Event Scale-Revised[M]. New York:Assessing psychological trauma and PTSD: a practitioner’s handbook, 1997:399-411.
[15]	郭素然, 辛自强, 耿柳娜. 事件影响量表修订版的信度和效度分析[J]. 中国临床心理学杂志, 2007, 15(1):15-17.
	Guo SR, Xin ZQ, Geng LN. Reliability and validity of Chinese version of the Impact of Event Scale-Revised[J]. Chin J Clin Psychol, 2007, 15(1):15-17.
[16]	Lepore SJ, Helgeson VS. Social constraints,intrusive thoughts,and mental health after prostate cancer[J]. J Soc Clin Psychol, 1998, 17(1):89-106. DOI URL
[17]	You J, Lu Q. Social constraints and quality of life among Chinese-speaking breast cancer survivors:a mediation model[J]. Qual Life Res, 2014, 23(9):2577-2584. DOI URL
[18]	Kahn JH, Hessling RM. Measuring the tendency to conceal versus disclose psychological distress[J]. J Soc Clin Psychol, 2001, 20(1):41-65. DOI URL
[19]	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.
[20]	刘明盛, 张丹, 张勇. 宫颈癌患者复发恐惧感与其生存质量及心理状态的相关性分析[J]. 重庆医学, 2019, 48(12):2118-2121.
	Liu MS, Zhang D, Zhang Y. Correlation analysis of fear of cancer recurrence,quality of life and psychological state in cervical cancer patients[J]. Chongqing Med, 2019, 48(12):2118-2121.
[21]	Götze H, Taubenheim S, Dietz A, et al. Fear of cancer recurrence across the survivorship trajectory:results from a survey of adult long-term cancer survivors[J]. Psycho-oncology, 2019, 28(10):2033-2041. DOI URL
[22]	Yang Y, Sun HW, Liu T, et al. Factors associated with fear of progression in Chinese cancer patients:sociodemographic,clinical and psychological variables[J]. J Psychosom Res, 2018, 114:18-24. DOI URL
[23]	Uner FO, Korukcu O. A qualitative exploration of fear of cancer recurrence in Turkish cancer survivors who were referred for colposcopy[J]. Health Soc Care Community, 2021, 29(3):729-737. DOI URL
[24]	石艳, 蔡均, 吴治敏, 等. 宫颈癌患者根治术后两性关系体验的质性研究[J]. 中华护理杂志, 2019, 54(12):1825-1830. DOI
	Shi Y, Cai J, Wu ZM, et al. Experience of sexual relationship of postoperative patients with cervical cancer:a qualitative study[J]. Chin J Nurs, 2019, 54(12):1825-1830.
[25]	高乔乔, 刘东玲, 朱婷婷, 等. 乳腺癌患者心理社会适应与社会限制和侵袭性思维的关系[J]. 中国心理卫生杂志, 2020, 34(9):756-760.
	Gao QQ, Liu DL, Zhu TT, et al. Relation of psychosocial adjustment to social constraints and intrusive thoughts in patients with breast cancer[J]. Chin Ment Heal J, 2020, 34(9):756-760.
[26]	Soriano EC, Otto AK, LoSavio ST, et al. Fear of cancer recurrence and inhibited disclosure:testing the social-cognitive processing model in couples coping with breast cancer[J]. Ann Behav Med, 2021, 55(3):192-202. DOI PMID
[27]	高乔乔. 基于社会认知加工模型的乳腺癌患者心理社会适应干预方案构建及初步应用[D]. 郑州: 郑州大学, 2020.
	Gao QQ. Construction and preliminary application of psychosocial adjustment intervention program for breast cancer patients based on social cognitive processing model[D]. Zhengzhou: Zhengzhou University, 2020.
[28]	Koutrouli N, Anagnostopoulos F, Griva F, et al. Exploring the relationship between posttraumatic growth,cognitive processing,psychological distress,and social constraints in a sample of breast cancer patients[J]. Women Health, 2016, 56(6):650-667. DOI PMID
[29]	李艳艳, 单岩, 杜理平, 等. 慢性肾脏病病人与其配偶恐惧疾病进展的相关性[J]. 护理研究, 2019, 33(23):4033-4037.
	Li YY, Shan Y, Du LP, et al. Correlation of fear of disease progression between patients with chronic kidney and their spouses[J]. Chin Nurs Res, 2019, 33(23):4033-4037.
[30]	Perndorfer C, Soriano EC, Siegel SD, et al. Everyday protective buffering predicts intimacy and fear of cancer recurrence in couples coping with early-stage breast cancer[J]. Psycho-oncology, 2019, 28(2):317-323. DOI PMID
[31]	张贤贤, 张利霞, 贾智慧, 等. 康复期青年乳腺癌患者复发恐惧现状及影响因素研究[J]. 护理学杂志, 2019, 34(18):80-83.
	Zhang XX, Zhang LX, Jia ZH, et al. Fear of cancer recurrence and its influencing factors in convalescent young breast cancer patients[J]. J Nurs Sci, 2019, 34(18):80-83.
[32]	罗群, 王维利, 周利华, 等. 癌症患者与配偶亲密关系的研究进展[J]. 中华护理杂志, 2016, 51(11):1352-1356.
	Luo Q, Wang WL, Zhou LH, et al. A literature review of intimacy between cancer patients and their spouses[J]. Chin J Nurs, 2016, 51(11):1352-1356.
[33]	Du XX, Wang DY, Du HY, et al. The correlation between intimate relationship,self-disclosure,and adaptability among colorectal cancer enterostomy patients[J]. Medicine, 2021, 100(19):e25904. DOI URL
[34]	杨军, 刘春燕, 和晓美, 等. 乳腺癌患者事件影响程度与自我表露对生存质量影响[J]. 社区医学杂志, 2020, 18(14):989-993.
	Yang J, Liu CY, He XM, et al. Influence of self-disclosure and impact of event on quality of life in patients with breast cancer[J]. J Community Med, 2020, 18(14):989-993.
[35]	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
	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.