Abstract:

Objective To explore distinct trajectories of psychological distress on breast cancer patients from diagnosis to early survivorship,and to investigate whether sociodemographic factors,disease related factors,and personality characteristics can predict trajectories of psychological distress. Methods A prospective study was conducted. Breast cancer patients,who met inclusion and exclusion criteria,were followed up at 6 different timepoints,namely before surgery（T1）,before chemotherapy（T2）,after first chemotherapy（T3）,middle of chemotherapy（T4）,end of chemotherapy（T5）,and 2 months after chemotherapy（T6）. General information,personality,and psychological distress of patients were evaluated. Growth mixture modeling was used to identify trajectory patterns of psychological distress. Logistic regression was used to identify predictors of psychological distress trajectories. Results 3 distinct trajectories were identified and named as “high-stable distress group”“decreasing distress group” and “low-stable distress group”,accounting for 5.3%,57.2%,37.5%,respectively. Occupation（χ²=6.508,P=0.089）,income（χ²=5.237,P=0.073）,and personality（χ²=40.382,P<0.001） have effects on distress trajectories. But only personality was identified in Logistic regression as an independent predictor of psychological distress trajectories. Conclusion Breast cancer patients showed various psychological distress trajectories patterns from diagnosis to early survivorship. Most patients experienced low distress and had good adjustment following cancer diagnosis. Patients who belonged to depressive temperament were more likely to experience high-stable distress and should be given more attention.

Key words: Breast Neoplasms, Psychological Distress, Personality, Longitudinal Research, PSYCHOLOGICAL NURSING

摘要：

目的 探讨乳腺癌患者从诊断期到过渡期心理痛苦的变化轨迹,分析气质类型等因素对轨迹类别的预测作用。 方法 采用前瞻性研究设计,于2018年11月—2019年12月收集符合标准的乳腺癌患者一般资料和人格特征,并分别在手术前（T1）、化疗前（T2）、首次化疗后（T3）、化疗中期（T4）、化疗结束（T5）及化疗结束后2个月（T6）调查患者的心理痛苦水平。使用增长混合模型识别轨迹类别,采用Logistic回归分析识别轨迹类别的预测因素。 结果 本研究识别出3条不同特点的心理痛苦轨迹,命名为“持续高心理痛苦组”（5.3%）、“心理痛苦下降组”（57.2%）和“无心理痛苦组”（37.5%）。单因素分析显示,职业状态（χ²=6.508,P=0.089）、家庭人均月收入（χ²=5.237,P=0.073）和气质类型（χ²=40.382,P<0.001）与心理痛苦轨迹类别有关;Logistic回归分析显示,仅气质类型是心理痛苦轨迹的独立预测因子,抑郁质的患者更可能存在心理痛苦,多血质的患者更可能无心理痛苦。 结论 乳腺癌患者从诊断期到过渡期心理痛苦呈现不同的变化轨迹,大部分患者能够达到良好的适应状态。气质类型能够预测患者的心理痛苦轨迹,医护人员可根据患者的不同气质特点提供更具针对性的干预措施。

关键词: 乳腺肿瘤, 心理痛苦, 气质, 纵向研究, 心理护理