血液肿瘤患者及其配偶二元应对与恐惧疾病进展的相关性分析

doi:10.3761/j.issn.0254-1769.2025.06.012

摘要/Abstract

摘要：

目的基于主客体互倚模型探究血液肿瘤患者及其配偶二元应对对恐惧疾病进展的影响，为临床干预提供参考依据。方法采用便利抽样法，于2023年10月—2024年1月选取在山东省5所三级甲等医院住院的140例血液肿瘤患者及其配偶作为调查对象，采用一般资料调查表、二元应对量表、恐惧疾病进展简化量表和配偶恐惧疾病进展简化量表进行调查，应用AMOS 24.0软件构建二元应对对恐惧疾病进展的主客体互倚模型。结果共发放280份调查问卷，回收有效问卷272份，其中患者及其配偶各136份，有效问卷回收率为97.14%。血液肿瘤患者及其配偶的二元应对得分分别为（129.50±20.58）、（132.71±15.70）分，恐惧疾病进展得分分别为（31.71±3.13）、（29.01±3.05）分。主体效应方面，患者及其配偶的二元应对水平均可预测自身的恐惧疾病进展程度，均呈负相关（β₁=-0.52，β₂=-0.41；P<0.001）；客体效应方面，患者的恐惧疾病进展程度受配偶的二元应对水平影响，呈负相关（β=-0.19，P<0.001）。结论血液肿瘤患者及其配偶的恐惧疾病进展与两者二元应对水平存在交互影响，提示医护人员应重视血液肿瘤患者及其配偶的恐惧疾病进展的评估，积极探索以二元应对为视角的干预方案，有效降低双方恐惧疾病进展的程度。

关键词: 血液肿瘤, 配偶, 二元应对, 恐惧疾病进展, 主客体互倚模型, 护理

Abstract:

Objective To explore the impact of dyadic coping on fear of progression in patients with hematological tumors and their spouses based on the Actor-Partner Interdependence Model（APIM），and to provide references for clinical intervention. Methods By the convenient sampling method，136 pairs of hematological tumor patients and their spouses were selected from October 2023 to January 2024 in 5 tertiary hospitals in Shandong Province. A general information questionnaire，Dyadic Coping Inventory，Fear of Progression Questionnaire Short Form，and Fear of Progression Questionnaire Short Form/Partner Version were used to conduct the investigation. Amos 24.0 software was used to establish the APIM for dyadic coping with fear of progression. Results A total of 280 survey questionnaires were distributed，and 272 valid questionnaires were collected，including 136 from patients and their spouses，with an effective rate of 97.14%. The dyadic coping scores of hematological tumors patients and their spouses were （129.50±20.58） and （132.71±15.70），respectively，while the fear of progression scores were（31.71±3.13） and （29.01±3.05），respectively. Regarding the actors’ effects，the level of dyadic coping strategies of patients and their spouses can both predict their own fear of progression，and are negatively correlated（β₁=-0.52，β₂=-0.41；P<0.001）. Regarding the partners’ effects，the degree of fear of progression in patients is negatively correlated with the dyadic coping level of their spouses（β=-0.19，P<0.001）. Conclusion There is an interactive effect between the fear of progression and the level of dyadic coping between hematological tumor patients and their spouses. This suggests that clinical nursing staff should pay attention to the evaluation of fear of progression in patients with hematological tumors and their spouses，and effectively reduce the level of fear of progression on both sides.

Key words: Hematological Tumors, Spouse, Dyadic Coping, Fear of Progression, Actor-Partner Interdepen-dence Model, Nursing Care

刘雪华, 王建虹, 杨丽红, 刘佳丽, 乔艳萍, 李晓燕. 血液肿瘤患者及其配偶二元应对与恐惧疾病进展的相关性分析[J]. 中华护理杂志, 2025, 60(6): 717-722.

LIU Xuehua, WANG Jianhong, YANG Lihong, LIU Jiali, QIAO Yanping, LI Xiaoyan. An analysis of correlation between dyadic coping in patients with hematological tumors and their spouses and fear of progression[J]. Chinese Journal of Nursing, 2025, 60(6): 717-722.

图/表 3

表1 血液肿瘤患者及其配偶的一般资料

Table 1 The general data of hematological tumor patients and their spouses

表2 血液肿瘤患者及其配偶二元应对及恐惧疾病进展的相关性（r值）

Table 2 Correlation between DC and FoP in patients with hematological tumors and their spouses（r value）

图1 血液肿瘤患者及配偶二元应对与恐惧疾病进展的主客体互倚模型

Figure 1 APIM of DC and FoP in patients with hematological tumors and their spouses 1）P<0.001。

参考文献 26

[1]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality world-wide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249.
[2]	卢兴国, 龚旭波, 李早荣, 等. 白血病诊断学[M]. 北京: 人民卫生出版社, 2013.
	Lu XG, Gong XB, Li ZR, et al. Leukemia diagnostics[M]. Bei-jing: People’s Medical Publishing House, 2013.
[3]	张曦. 血液肿瘤精准诊治[J]. 陆军军医大学学报, 2024, 46(4):299-310.
	Zhang X. Precision diagnosis and treatment for hematological malignancies[J]. J Army Med Univ, 2024, 46(4):299-310.
[4]	Baudry AS, Delpuech M, Charton E, et al. Association between emotional competence and risk of unmet supportive care needs in caregivers of cancer patients at the beginning of care[J]. Support Care Cancer, 2024, 32(5):302.
[5]	Bodenmann G. Stress and coping in couples[M]. Gottingen:Ho-grefe, 2020:1-5
[6]	范文海, 于明明. 慢性病患者及其照顾者二元症状评价研究进展[J]. 中华护理教育, 2023, 20(8):1014-1019.
	Fan WH, Yu MM. Research progress of dyadic symptom eva-luation in patients with chronic diseases and their caregivers[J]. Chin J Nurs Educ, 2023, 20(8):1014-1019.
[7]	Zhang L, Shi YM, Deng J, et al. The effect of health literacy,self-efficacy,social support and fear of disease progression on the health-related quality of life of patients with cancer in China:a structural equation model[J]. Health Qual Life Outcomes, 2023, 21(1):75.
[8]	Wendołowska AM, Czyżowska D, Siwek M. The dyadic coping mo-del of bipolar disorder patients[J]. Psychiatr Pol, 2021, 55(5):1009-1024. DOI PMID
[9]	Chen MZ, Gong JL, Cao Q, et al. A literature review of the relationship between dyadic coping and dyadic outcomes in cancer couples[J]. Eur J Oncol Nurs, 2021, 54:102035.
[10]	Kenny DA, Ledermann T. Detecting,measuring,and testing dya-dic patterns in the actor-partner interdependence model[J]. J Fam Psychol, 2010, 24(3):359-366.
[11]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quan-titative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[12]	逯莹, 甘红艳, 杨玉金, 等. 下肢动脉硬化闭塞症患者静态行为现状及其影响因素研究[J]. 中华护理杂志, 2023, 58(6):714-720. DOI
	Lu Y, Gan HY, Yang YJ, et al. Study on sedentary behavior and its influencing factors in patients with arteriosclerosis obliterans[J]. Chin J Nurs, 2023, 58(6):714-720. DOI
[13]	张伟, 陈静, 王艾红. 血液系统恶性肿瘤患者自悯及影响因素的研究[J]. 中华护理教育, 2023, 20(4):485-489.
	Zhang W, Chen J, Wang AH. Analysis of self-compassion status and influencing factors in hematological malignancies patients[J]. Chin J Nurs Educ, 2023, 20(4):485-489.
[14]	Bodenmann G, Hilpert P, Nussbeck FW, et al. Enhancement of couples’ communication and dyadic coping by a self-directed approach:a randomized controlled trial[J]. J Consult Clin Psy-chol, 2014, 82(4):580-591.
[15]	Xu F, Hilpert P, Randall AK, et al. Validation of the Dyadic Coping Inventory with Chinese couples:factorial structure,mea-surement invariance,and construct validity[J]. Psychol Assess, 2016, 28(8):e127-40.
[16]	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. DOI PMID
[17]	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.
[18]	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. Investigation and study on the current situation of patients with primary liver cancer and their spouses’ fear of disease progression[D]. Shanghai: Second Military Medical Uni-versity, 2016.
[19]	Zimmermann T, Herschbach P, Wessarges M, et al. Fear of pro-gression in partners of chronically ill patients[J]. Behav Med, 2011, 37(3):95-104. DOI PMID
[20]	张莉, 薛香娟, 赵景欣,. 歧视知觉、抑郁和农村留守儿童的学业成绩:纵向中介模型[J]. 心理科学, 2019, 42(3):584-590.
	Zhang L, Xue XJ, Zhao JX. Discrimination perception,depres-sion,and academic achievement in rural left-behind children:a longitudinal mediation model[J]. J Psychol Sci, 2019, 42(3):584-590.
[21]	Tang N, Jia YY, Zhao Q, et al. Influencing factors of dyadic coping among infertile women:a path analysis[J]. Front Psy-chiatry, 2022, 13:830039.
[22]	van Roij J, Raijmakers N, Kloover J, et al. Dyadic coping and its association with emotional functioning in couples confron-ted with advanced cancer:results of the multicenter observa-tional eQuiPe study[J]. Psychooncology, 2022, 31(9):1545-1554.
[23]	Hong SJ, Biesecker B, Ivanovich J, et al. Factors affecting breast cancer patients’ need for genetic risk information:from infor-mation insufficiency to information need[J]. J Genet Couns, 2019, 28(3):543-557.
[24]	安慧颖, 雷雷, 崔盼盼. 中青年淋巴瘤患者及配偶负性情绪和婚姻质量与支持性二元应对的关系[J]. 中国心理卫生杂志, 2023, 37(12):1059-1064.
	An HY, Lei L, Cui PP. Relationship among negative emotions,marital quality,and supportive duality coping in young and middle-aged patients with lymphoma and their spouses[J]. Chin Ment Health J, 2023, 37(12):1059-1064.
[25]	Thiele S, Goebel S, Kröger N, et al. Fear of disease progres-sion and relevant correlates in acute leukemia patients prior to allogeneic hematopoietic stem cell transplantation[J]. Psy-chooncology, 2020, 29(8):1248-1254.
[26]	姚芡芡, 刘丽, 罗艳芳, 等. 原发性脑肿瘤患者心理弹性潜在类别分析[J]. 中华护理杂志, 2022, 57(19):2363-2370. DOI
	Yao QQ, Liu L, Luo YF, et al. Analysis of potential categories of psychological resilience in primary brain tumor patients[J]. Chin J Nurs, 2022, 57(19):2363-2370. DOI