Abstract:

Objective To explore the change trajectory of self-acceptance of patients with permanent urostomy，in order to provide basis for self-acceptance intervention practice of patients. Methods 168 patients with abdominal wall stoma with urinary diversion from June 2021 to June 2023 in Fudan University Cancer Hospital were selected as the survey subjects by convenience sampling. We used a general information questionnaire，SAQ，PTGI，SSRS，and COST-PROM. Baseline surveys were conducted a week after surgery（T0），and follow-up surveys were conducted at 1 month（T1），3 months（T2），and 6 months（T3） after discharge. The mixed model of latent variable growth was used to analyze the change trajectory of self-acceptance of patients with permanent urinary stoma，and the core predictors of each subtype were explored through the decision tree model. Results The number of patients who participated in the 4 surveys was 168，168，165 and 163，respectively，and the final questionnaire recovery rate was 97.02%（163/168）. The self-acceptance scores of patients with permanent urostomy were（35.72 ± 8.63） （36.81 ± 9.23） （39.88 ± 8.95） and（43.17 ± 9.56） points，respectively. The 3 subgroups of self-acceptance changes were identified，including low self-acceptance slow rising group（49.08%），medium self-acceptance first falling then rising group（30.06%），and medium self-acceptance fast rising group（20.86%）（P<0.001）. The decision tree model showed that education level，age，post-traumatic growth，social support，and economic burden could all predict the change track subtype of self-acceptance of patients with permanent urostomy，and the importance of post-traumatic growth was 100%. Conclusion The self- acceptance of patients with permanent urostomy is generally on the rise，and there is a population heterogeneity development track. Posttraumatic growth is the core predictor. It is important to identify the slow increase group of low self-acceptance according to the predictive indicators，and construct an intervention program focusing on improving the post-traumatic growth of patients with permanent urinary stoma to improve their self-acceptance level.

Key words: Bladder Cancer, Permanent Stoma, Self-Acceptance, Change Trajectory, Decision Tree Model, Nursing Care

摘要：

目的 探讨永久性泌尿造口患者自我接纳的变化轨迹，旨在为开展针对性干预提供依据。 方法 采用便利抽样法，选取2021年6月—2023年6月在上海市某三级甲等肿瘤专科医院行永久性泌尿造口的168例患者作为调查对象。采用一般资料调查表、自我接纳问卷、创伤后成长评定量表等分别于术后1周和出院后1、3、6个月进行调查。以潜变量增长混合模型分析永久性泌尿造口患者自我接纳的变化轨迹，并通过决策树模型探索各亚型核心预测因素。结果 参与4次调查的患者例数分别为168、168、165、163例，最终有效问卷回收率为97.02%（163/168）；永久性泌尿造口患者4个时间点自我接纳得分分别为（35.72±8.63）（36.81±9.23）（39.88±8.95）（43.17±9.56）分。识别出低自我接纳-缓慢上升组（49.08%）、中自我接纳-先降后升组（30.06%）、中自我接纳-快速上升组（20.86%）3个自我接纳变化亚组（P<0.001）。决策树模型显示，文化程度、年龄、创伤后成长、社会支持、经济负担水平均可预测永久性泌尿造口患者自我接纳的变化轨迹亚型，其中创伤后成长位于根结点。结论 永久性泌尿造口患者自我接纳总体呈逐渐上升趋势，且存在群体异质性发展轨迹，创伤后成长是其核心预测因素。护士可构建以提高患者创伤后成长为核心的干预方案，以提高其自我接纳水平。

关键词: 膀胱癌, 永久性造口, 自我接纳, 变化轨迹, 决策树模型, 护理