基于云平台的延续护理对乳腺癌患者阈下抑郁影响的研究

doi:10.3761/j.issn.0254-1769.2024.02.002

摘要/Abstract

摘要：

目的探讨基于云平台的延续护理对乳腺癌患者阈下抑郁的影响。方法采用便利抽样法，选取2021年7月—2022年8月在广西壮族自治区某三级甲等医院乳腺科化疗的74例乳腺癌阈下抑郁患者作为研究对象。按照入院时间先后顺序，将2022年2月—8月入院的患者作为试验组，2021年7月—2022年1月入院的患者作为对照组，各37例。试验组在常规护理基础上实施基于云平台的延续护理，对照组采用常规护理，21 d为1周期，共干预4个周期。于干预前、干预后采用阈下抑郁初筛量表-流调中心抑郁量表（Centre for Epidemiological Studies Depression Scale，CES-D）、汉密尔顿抑郁量表-17（Hamilton Rating Scale for Depression，HAMD-17）、基本心理需求量表（Basic Psychological Needs Scale，BPNS）和乳腺癌患者生命质量测定量表（Functional Assessment of Cancer Therapy-Breast，FACT-B）评价干预效果。结果试验组34例、对照组36例完成研究。干预后，两组的CES-D评分、HAMD-17评分均较干预前降低（P<0.05），试验组的CES-D评分、HAMD-17评分均低于对照组，差异有统计学意义（t=7.748，P<0.001；t=8.150，P<0.001）；两组的BPNS评分均较干预前提高，试验组的BPNS评分明显高于对照组（t=-6.534，P<0.001）；两组的FACT-B评分均较干预前提高，试验组的FACT-B评分明显高于对照组（t=-4.579，P<0.001）。结论基于云平台的延续护理可改善乳腺癌患者的阈下抑郁状况，提升其自我决定感和生活质量。

关键词: 乳腺肿瘤, 自我决定理论, 阈下抑郁, 移动健康, 生活质量, 护理

Abstract:

Objective To explore the effect of a mobile health intervention model based on self-determination theory on subthreshold depression in breast cancer patients. Methods By convenience sampling method，74 patients with breast cancer subthreshold depression who received chemotherapy in the breast department of a tertiary hospital in Guangxi from July 2021 to August 2022 were selected as the research subjects. According to the order of admission time，the patients admitted from February 2022 to August 2022 were taken as an experimental group，and the patients admitted from July 2021 to January 2022 were taken as a control group，with 37 cases in each group. On the basis of routine nursing，the experimental group implemented a mobile health intervention model based on self-determination theory. The control group received routine nursing，with every 21 days for 1 cycle and a total of 4 cycles of intervention. Before and after the intervention，the Centre for Epidemiological Studies Depression Scale（CES-D），Hamilton Rating Scale for Depression（HAMD-17），Basic Psychological Needs Satisfaction Scale（BPNS） and Functional Assessment of Cancer Therapy-Breast（FACT-B） were used to evaluate the intervention effect. Results 34 patients in the experimental group and 36 patients in the control group completed the study. After intervention，the CES-D score and HAMD-17 score of the 2 groups were lower than those before intervention（P<0.05）；the CES-D score and HAMD-17 score of the experimental group were lower than those of the control group，and the difference was statistically significant（t=7.748，P<0.001；t=8.150，P<0.001）. The BPNS scores of the 2 groups were higher than those before the intervention，and the BPNS score of the experimental group was significantly higher than that of the control group（t=-6.534，P<0.001）. The scores of FACT-B in the 2 groups were higher than those before the intervention，and the scores of FACT-B in the experimental group were significantly higher than those in the control group（t=-4.579，P<0.001）. Conclusion The mobile health intervention model based on self-determination theory can improve the subthreshold depression，self-determination and quality of life of breast cancer patients.

Key words: Breast Neoplasms, Self-Determination Theory, Subliminal Depression, Mobile Health, Quality of Life, Nursing Care

吴国凤, 李芯睿, 钟美容, 杨琳, 程树锦, 陈岩, 钟静静, 孙瑞. 基于云平台的延续护理对乳腺癌患者阈下抑郁影响的研究[J]. 中华护理杂志, 2024, 59(2): 142-148.

WU Guofeng, LI Xinrui, ZHONG Meirong, YANG Lin, CHENG Shujin, CHEN Yan, ZHONG Jingjing, SUN Rui. The effect of a mobile health intervention model based on self-determination theory on subthreshold depression in breast cancer patients[J]. Chinese Journal of Nursing, 2024, 59(2): 142-148.

图/表 4

表1 两组一般资料的比较

Table 1 General data of patients in 2 groups

表2 干预前后两组阈下抑郁初筛量表-流调中心抑郁量表、汉密尔顿抑郁量表-17评分的比较（分，$\bar{x}±s$）

Table 2 Comparison of CES-D and HAMD-17 scores between the 2 groups before and after intervention（score，$\bar{x}±s$）

表3 干预前后两组基本心理需求量表评分的比较（分，$\bar{x}±s$）

Table 3 Comparison of BPNS scores between the 2 groups before and after intervention（score，$\bar{x}±s$）

表4 干预前后两组乳腺癌患者生命质量测定量表评分的比较（分，$\bar{x}±s$）

Table 4 Comparison of FACT-B scores between the 2 groups before and after intervention（score，$\bar{x}±s$）

参考文献 21

[1]	Hajj A, Hachem R, Khoury R, et al. Clinical and genetic factors associated with anxiety and depression in breast cancer patients:a cross-sectional study[J]. BMC Cancer, 2021, 21(1):872. DOI
[2]	Guo YQ, Ju QM, You M, et al. Depression,anxiety and stress among metastatic breast cancer patients on chemotherapy in China[J]. BMC Nurs, 2023, 22(1):33. DOI
[3]	Volz HP, Stirnweiss J, Kasper S, et al. Subthreshold depression-concept,operationalisation and epidemiological data. A scoping review[J]. Int J Psychiatry Clin Pract, 2023, 27(1):92-106. DOI URL
[4]	陈健健, 王虹, 丁娟, 等. 初诊乳腺癌患者阈下抑郁状况与社会关系质量的关系[J]. 中国医药导报, 2019, 16(2):37-40.
	Chen JJ, Wang H, Ding J, et al. Relationship between subliminal depression and social relationship quality in newly diagnosed breast cancer patients[J]. China Med Her, 2019, 16(2):37-40.
[5]	吕利明, 张晓华, 王雪霞, 等. 中青年乳腺癌术后患者阈下抑郁及社会参与状况研究[J]. 护理学杂志, 2017, 32(6):84-87.
	Lü LM, Zhang XH, Wang XX, et al. A study on subthreshold depression and social participation among young and middle-aged patients after breast cancer surgery[J]. J Nurs Sci, 2017, 32(6):84-87.
[6]	Sheldon KM, Prentice M. Self-determination theory as a foundation for personality researchers[J]. J Pers, 2019, 87(1):5-14. DOI PMID
[7]	张莹, 张桂芳, 张月兰, 等. 自我决定理论的康复干预对脑卒中患者自理能力及主观幸福感的影响[J]. 中国健康心理学杂志, 2022, 30(6):872-876.
	Zhang Y, Zhang GF, Zhang YL, et al. Effect of rehabilitation intervention based on self-determination theory on self-care ability and subjective well-being of stroke patients[J]. China J Health Psychol, 2022, 30(6):872-876.
[8]	张明园. 精神科评定量表手册[M]. 2版. 长沙: 湖南科学技术出版社, 1998:121-126.
	Zhang MY. Psychiatric rating scale manual[M]. 2nd ed. Changsha: Hunan Science and Technology Press, 1998:121-126.
[9]	苏铃钰. 基于自我决定理论的护理干预对原发性肝癌患者心理弹性和负性情绪的影响[D]. 郑州: 郑州大学, 2022.
	Su LY. Effect of nursing intervention based on self-determination theory on psychological resilience and negative emotions in patients with primary liver cancer[D]. Zhengzhou: Zhengzhou University, 2022.
[10]	蒋璐璐, 王喜益, 徐洁慧, 等. 智能交互式护理信息支持系统的构建及在乳腺癌患者中的应用研究[J]. 中华护理杂志, 2023, 58(6):654-661. DOI
	Jiang LL, Wang XY, Xu JH, et al. Construction of an intelligent interactive nursing information support system and its application in young breast cancer survivors[J]. Chin J Nurs, 2023, 58(6):654-661. DOI
[11]	Ghanbari E, Yektatalab S, Mehrabi M. Effects of psychoeducational interventions using mobile apps and mobile-based online group discussions on anxiety and self-esteem in women with breast cancer:randomized controlled trial[J]. JMIR Mhealth Uhealth, 2021, 9(5):e19262. DOI URL
[12]	白铁娟, 秦璐, 董建秀, 等. 基于微信直播的正念训练对经皮冠状动脉介入治疗术后患者阈下抑郁症状的影响[J]. 中华护理杂志, 2022, 57(11):1304-1309. DOI
	Bai TJ, Qin L, Dong JX, et al. Effects of mindfulness training based on WeChat live broadcast on subthreshold depressive symptoms after PCI[J]. Chin J Nurs, 2022, 57(11):1304-1309. DOI
[13]	章婕, 吴振云, 方格, 等. 流调中心抑郁量表全国城市常模的建立[J]. 中国心理卫生杂志, 2010, 24(2):139-143.
	Zhang J, Wu ZY, Fang G, et al. Development of the Chinese age norms of CES-D in urban area[J]. Chin Ment Health J, 2010, 24(2):139-143.
[14]	刘俊升, 林丽玲, 吕媛, 等. 基本心理需求量表中文版的信、效度初步检验[J]. 中国心理卫生杂志, 2013, 27(10):791-795.
	Liu JS, Lin LL, Lü Y, et al. Reliability and validity of the Chinese version of the Basic Psychological Needs Scale[J]. Chin Ment Health J, 2013, 27(10):791-795.
[15]	万崇华, 张冬梅, 汤学良, 等. 乳腺癌患者生命质量测定量表(FACT-B)中文版的修订[J]. 中国心理卫生杂志, 2003, 17(5):298-300.
	Wan CH, Zhang DM, Tang XL, et al. Revision of the Chinese Version of the FACT-B for patients with breast cancer[J]. Chin Ment Health J, 2003, 17(5):298-300.
[16]	Akkol-Solakoglu S, Hevey D. Internet-delivered cognitive behavioural therapy for depression and anxiety in breast cancer survivors:results from a randomised controlled trial[J]. Psychooncology, 2023, 32(3):446-456. DOI URL
[17]	常淑莹, 周圆, 陈若娟, 等. 乳腺癌术后患者网络结构式团体心理干预的实施[J]. 护理学杂志, 2021, 36(23):71-74.
	Chang SY, Zhou Y, Chen RJ, et al. Online structured group psychological intervention for patients after breast cancer surgery[J]. J Nurs Sci, 2021, 36(23):71-74.
[18]	Šakan D, Žuljević D, Rokvić N. The role of basic psychological needs in well-being during the COVID-19 outbreak:a self-determination theory perspective[J]. Front Public Health, 2020, 8:583181. DOI URL
[19]	Pietrek A, Kangas M, Kliegl R, et al. Basic psychological need satisfaction and frustration in major depressive disorder[J]. Front Psychiatry, 2022, 13:962501. DOI URL
[20]	Baek SY, Lee SB, Lee Y, et al. Effects of mobile healthcare applications on the lifestyle of patients with breast cancer:a protocol for a randomized clinical trial[J]. J Breast Cancer, 2022, 25(5):425-435. DOI URL
[21]	Park J, Rodriguez JL, O’Brien KM, et al. Health-related quality of life outcomes among breast cancer survivors[J]. Cancer, 2021, 127(7):1114-1125. DOI PMID