临床心灵关怀服务在肿瘤常规治疗中的作用及探讨

探讨临床心灵关怀对癌症患者负性情绪、睡眠、希望水平和应对方式的影响.纳入湖南省肿瘤医院的住院患者150例,通过5次心灵关怀干预,测量干预前后患者的焦虑、抑郁、睡眠、希望水平和应对方式情况,运用重复测量分析,结果发现心灵关怀可改善患者睡眠,降低患者焦虑抑郁水平,提高患者的希望水平,提高患者采用面对、回避应对方式的可能性.     

治疗性沟通方案对骨肿瘤手术患者希望水平和应对方式的影响

目的探讨治疗性沟通方案对骨肿瘤手术患者希望水平和应对方式的影响。方法选取2009年6月至2012年1月间收治的40例骨肿瘤患者作为对照组,采用传统常规的护理模式;2012年2月至2014年5月间收治的40例骨肿瘤患者作为观察组,采用治疗性沟通方案干预的护理模式。对比两组患者的希望水平和应对方式。结果与对照组比较,观察组患者在出院时的Herth希望评分显著提高,差异有统计学意义(P<0.05)。与对照组比较,观察组患者在出院时的消极应对评分显著降低,积极应对评分显著提高,差异有统计学意义(P<0.05)。结论治疗性沟通方案能够有效地提高骨肿瘤手术患者的希望水平,改善患者的应对方式。     

乳腺癌术后患者自我效能感与应对方式对癌症复发恐惧的影响研究

目的：调查乳腺癌术后患者癌症复发恐惧现状,并探讨其与自我效能感、应对方式的关系。方法：采用一般资料问卷、恐惧疾病进展简化量表（Fear of Progression Questionnaire-Short Form,FoP-Q-SF）、癌症自我管理效能感量表（Strategies Used by People to Promote Health,SUPHH）和医学应对方式问卷（Medical Coping Modes Questionnaire,MCMQ）对335例乳腺癌术后患者进行调查。结果：本研究发放335份调查表,最终回收有效问卷317份。317例乳腺癌术后患者FoP-Q-SF总分（32.89±8.22）分,SUPHH总分（91.63±21.51）分,MCMQ总分（46.04±4.77）分。乳腺癌术后患者复发恐惧与自我效能感的正性态度、自我解压和自我决策3个维度均呈负相关（r值分别为-0.213,-0.308,-0.241;P <0.05）;与医学应对方式的面对策略和回避策略呈负相关,与屈服策略呈正相关（r值分别为-0.315,-0.120,0.363;P <0.05...     

社会支持对结肠癌患者应对方式的影响

目的 探讨结肠癌患者应对方式的影响因素.方法 纳入2019年9月至2020年9月于郑州大学第一附属医院就诊的196例结肠癌患者,对人口统计学变量及临床资料进行收集,压力应对方式采用压力应对量表(SWCS)进行评估,社会支持采用领悟社会支持量表(MSPSS)进行评估.人口学变量、社会支持与应对方式间的关系采用Pearso...     

认知干预对卵巢癌患者情绪及应对方式的影响

目的：探讨认知干预对卵巢癌患者情绪及应对方式的影响。方法：：将60例卵巢癌患者随机分为干预组和对照组,每组30名。所有患者均在干预前进行基线测评,包括汉密尔顿焦虑量表（HAMA）、抑郁量表（HRSD）、简易应对方式问卷。两组患者均接受手术、6个-8个疗程的化疗和常规护理,干预组患者从手术后第一疗程化疗开始前接受认知干预,干预行为持续三个月。干预后第一个月测定两组患者情绪和应对方式。结果：干预后,干预组与对照组相比焦虑和抑郁得分减少（P〈0．05）,积极应对得分增加,消极应对得分减少（P〈0．05）。结论：认知干预能明显改善卵巢癌患者的焦虑和抑郁情绪,显著增加卵巢癌患者的积极应对方式,减少其消极应对方式。     

认知干预对卵巢癌患者情绪及应对方式的影响

目的:探讨认知干预对卵巢癌患者情绪及应对方式的影响。方法::将60例卵巢癌患者随机分为干预组和对照组,每组30名。所有患者均在干预前进行基线测评,包括汉密尔顿焦虑量表(HAMA)、抑郁量表(HRSD)、简易应对方式问卷。两组患者均接受手术、6个～8个疗程的化疗和常规护理,干预组患者从手术后第一疗程化疗开始前接受认知干预,干预行为持续三个月。干预后第一个月测定两组患者情绪和应对方式。结果:干预后,干预组与对照组相比焦虑和抑郁得分减少(P<0.05),积极应对得分增加,消极应对得分减少(P<0.05)。结论:认知干预能明显改善卵巢癌患者的焦虑和抑郁情绪,显著增加卵巢癌患者的积极应对方式,减少其消极应对方式。     

恶性骨肿瘤患者的心理健康与应对方式的相关性及其对临床效果的影响

目的：了解骨肿瘤患者的心理健康状态及其与患者使用的应对方式的相关性,并探讨其对临床效果的影响。方法采用方便抽样的方法选取恶性骨肿瘤的患者102例,对所有患者的心理状况、应对方式进行问卷调查,并于治疗间歇期进行跟踪随访,调查其生存状态,采用独立样本t检验进行组间差异比较,组间的相关性采用Pearson相关分析。结果 SCL-90总分及各项因子在骨科恶性肿瘤患者得分显著高于常模组,差异具有统计学意义（ P＜0．05）。面对应对与SCL-90评分的相关性分析中,除躯体化、敌对、恐怖外,总分及其他各因子均与面对应对方式呈负相关（ P＜0．05）;回避应对方式与除躯体化、强迫、抑郁外的总分及其他各项因子均呈一定的负相关（P＜0．05）;屈服应对方式与除偏执、精神病性外的其他各因素均呈一定的正相关（ P＜0．05）。评分PIHS＜45分的患者的SCL-90总分及大部分因子（除了躯体化因子）明显低于PIHS＞45分的患者（P＜0．05）。与PIHS＞45分的患者相比,PIHS＜45分的患者面对、回避应对得分明显更高,屈服应对评分明显更低（ P＜0．05）。结论骨科恶性肿瘤患者的心理健康水平明显低于正常人,且与采用消极应对存在明显的相关性。负面情绪及消极应对共同作用,导致患者出现严重的心理障碍,进而导致患者的病情发展和影响治疗效果,不利于病情恢复。     

大肠癌患者心理状况及应对方式对生存质量的影响

目的：探讨大肠癌患者不同的应对方式、心理状况对生存质量的影响,为采取相应的措施而提供科学依据。方法：于2014年11－2015年11月对某两所医院确诊住院的248例大肠癌患者应用癌症患者生存质量量表、医院焦虑抑郁量表评价及简单应对方式问卷进行调查评价。结果：大肠癌患者的生存质量各维度均处于中等偏下的水平;男性、居住于城市及经商的患者生存质量高于女性、居住于农村及其他职业的患者;无配偶只在躯体维度评分低于有配偶的,差异有统计学意义（P＜0．05）;采取积极应对方式的大肠癌患者的生存质量高于消极应对方式的患者,差异有统计学意义（P＜0．05）;消极应对方式和焦虑、抑郁是大肠癌患者生存质量的影响因素,差异有统计学意义（P＜0．05）。消极应对方式、焦虑、抑郁与QOL－LC总分呈负相关;积极应对方式与QOL－LC总分呈正相关。结论：医护人员应该关注患者的心理状态,鼓励其积极面对疾病,从而提高患者的生存质量。     

肿瘤患者康复中的气功锻炼与音乐治疗

肿瘤患者康复的最终目标应是癌症的完全根治,心理、生理和体能完全恢复,能胜任各项工作。然而由于肿瘤的特殊性,完全达到这个目标具有一定的难度。因此,实际上肿瘤康复主要是针对癌症所导致的原发性或继发性残疾,通过医学、社会、心理、体能、教育、职业等综合性手段,使患者尽可能改善或恢复,提高生活和生存质量。     

Spiritual coping,perceived growth,and the moderating role of spiritual mindfulness in cancer survivors

ABSTRACT

Purpose: This study examined the moderating role of spiritual mindfulness on the association between spiritual coping and perceived growth in individuals with and without current treatment for cancer. Design/Sample: Adults with a cancer history (N = 534) from the Midlife in the United States study completed a telephone interview and self-administered questionnaires. Methods/Findings: Moderated regression analyses, controlled for age and educational attainment, showed that mindfulness moderated the effect of spiritual coping on personal growth and on positive reinterpretation. High mindfulness amplified the effect of spiritual coping on both personal growth and positive reinterpretation. Further, this moderating effect was significantly different for adults with versus without current treatment for cancer for positive reinterpretation but not for personal growth. Conclusions/Implications: These findings highlight the potential amplifying effect of spiritual mindfulness on the effect of spiritual coping on perceived growth in cancer survivors.     

The role of positive and negative religious/spiritual coping in women’s adjustment to breast cancer: A longitudinal study

Abstract

Purpose: Investigate change in women’s use of religious/spiritual coping (R/S) in relation to breast cancer.

Design: Longitudinal, prospective.

Sample: Fifty-six breast cancer and 82 benign diagnosis.

Methods: R/S coping and depressed mood were assessed at pre-diagnosis, 3, 6, and 12?months post-diagnosis.

Findings: Breast cancer patients increased their use of benevolent reappraisal coping from 3 to 6?months post-diagnosis while women with a benign diagnosis evidenced stability in this coping strategy. Negative R/S coping and depressed mood were associated concurrently and longitudinally for both diagnostic groups.

Conclusions: Depressed mood and negative R/S coping are intertwined across time suggesting that women from both diagnostic groups may experience emotional and spiritual struggle in their adjustment to the threat of breast cancer.

Implications for Psychosocial Providers: Clinicians need to identify and intervene early to help women address negative R/S coping as it may influence women’s adjustment within the first year post-diagnosis.     

Support of cancer patients' spiritual needs and associations with medical care costs at the end of life

BACKGROUND:

Although spiritual care is associated with less aggressive medical care at the end of life (EOL), it remains infrequent. It is unclear if the omission of spiritual care impacts EOL costs.

METHODS:

A prospective, multisite study of 339 advanced cancer patients accrued subjects from September 2002 to August 2007 from an outpatient setting and followed them until death. Spiritual care was measured by patients' reports that the health care team supported their religious/spiritual needs. EOL costs in the last week were compared among patients reporting that their spiritual needs were inadequately supported versus those who reported that their needs were well supported. Analyses were adjusted for confounders (eg, EOL discussions).

RESULTS:

Patients reporting that their religious/spiritual needs were inadequately supported by clinic staff were less likely to receive a week or more of hospice (54% vs 72.8%; P = .01) and more likely to die in an intensive care unit (ICU) (5.1% vs 1.0%, P = .03). Among minorities and high religious coping patients, those reporting poorly supported religious/spiritual needs received more ICU care (11.3% vs 1.2%, P = .03 and 13.1% vs 1.6%, P = .02, respectively), received less hospice (43.% vs 75.3% ≥1 week of hospice, P = .01 and 45.3% vs 73.1%, P = .007, respectively), and had increased ICU deaths (11.2% vs 1.2%, P = .03 and 7.7% vs 0.6%, P = .009, respectively). EOL costs were higher when patients reported that their spiritual needs were inadequately supported ($4947 vs $2833, P = .03), particularly among minorities ($6533 vs $2276, P = .02) and high religious copers ($6344 vs $2431, P = .005).

CONCLUSIONS:

Cancer patients reporting that their spiritual needs are not well supported by the health care team have higher EOL costs, particularly among minorities and high religious coping patients. Cancer 2011;. © 2011 American Cancer Society.     

音乐疗法治疗癌痛应用进展概述

音乐疗法具有方便、价廉、无不良反应等优点,作为一种非药物性的辅助治疗措施备受临床工作者和癌症患者的青睐。音乐疗法的主要目的是通过减轻癌症患者生理、心理、社会和精神上的困扰来缓解患者的癌性疼痛,进而改善患者生存质量。     

Stress,coping, and hope

Hope is discussed in many literatures and from many perspectives. In this essay hope is discussed from the vantage of psychology and stress and coping theory. Hope and psychological stress share a number of formal properties: both are contextual, meaning‐based, and dynamic, and both affect well‐being in difficult circumstances. Two assumptions underlie this essay: (1) hope is essential for people who are coping with serious and prolonged psychological stress; and (2) hope is not a perpetually self‐renewing resource; it has peaks and valleys and is at times absent altogether. The relationship between hope and coping is dynamic and reciprocal; each in turn supports and is supported by the other. This relationship is illustrated with two adaptive tasks common across situations that threaten physical or psychological well‐being—managing uncertainty and coping with a changing reality. The essay describes ways in which coping fosters hope when it is at low ebb as well as ways in which hope fosters and sustains coping over the long term. Copyright © 2010 John Wiley & Sons, Ltd.     

Religious coping and behavioral disengagement: opposing influences on advance care planning and receipt of intensive care near death

Objective: This study examines the relationships between methods of coping with advanced cancer, completion of advance care directives, and receipt of intensive, life‐prolonging care near death. Methods: The analysis is based on a sample of 345 patients interviewed between January 1, 2003, and August 31, 2007, and followed until death as part of the Coping with Cancer Study, an NCI/NIMH‐funded, multi‐site, prospective, longitudinal, cohort study of patients with advanced cancer. The Brief COPE was used to assess active coping, use of emotional‐support, and behavioral disengagement. The Brief RCOPE was used to assess positive and negative religious coping. The main outcome was intensive, life‐prolonging care near death, defined as receipt of ventilation or resuscitation in the last week of life. Results: Positive religious coping was associated with lower rates of having a living will (AOR = 0.39, p = 0.003) and predicted higher rates of intensive, life‐prolonging care near death (AOR, 5.43; p<0.001), adjusting for other coping methods and potential socio‐demographic and health status confounds. Behavioral disengagement was associated with higher rates of DNR order completion (AOR, 2.78; p = 0.003) and predicted lower rates of intensive life‐prolonging care near death (AOR, 0.20; p = 0.036). Not having a living will partially mediate the influence of positive religious coping on receipt of intensive, life‐prolonging care near death. Conclusion: Positive religious coping and behavioral disengagement are important determinants of completion of advance care directives and receipt of intensive, life‐prolonging care near death. Copyright © 2011 John Wiley & Sons, Ltd.     

A non-randomized [corrected] controlled trial of the active music engagement (AME) intervention on children with cancer

Background: Coping theorists argue that environmental factors affect how children perceive and respond to stressful events such as cancer. However, few studies have investigated how particular interventions can change coping behaviors. The active music engagement (AME) intervention was designed to counter stressful qualities of the in‐patient hospital environment by introducing three forms of environmental support. Method: The purpose of this multi‐site randomized controlled trial was to determine the efficacy of the AME intervention on three coping‐related behaviors (i.e. positive facial affect, active engagement, and initiation). Eighty‐three participants, ages 4–7, were randomly assigned to one of three conditions: AME (n = 27), music listening (ML; n = 28), or audio storybooks (ASB; n = 28). Conditions were videotaped to facilitate behavioral data collection using time‐sampling procedures. Results: After adjusting for baseline differences, repeated measure analyses indicated that AME participants had a significantly higher frequency of coping‐related behaviors compared with ML or ASB. Positive facial affect and active engagement were significantly higher during AME compared with ML and ASB (p<0.0001). Initiation was significantly higher during AME than ASB (p<0.05). Conclusion: This study supports the use of the AME intervention to encourage coping‐related behaviors in hospitalized children aged 4–7 receiving cancer treatment. Copyright © 2007 John Wiley & Sons, Ltd.     

Evaluation of intrapsychic factors,coping styles,and spirituality of patients affected by tumors

Background: In this study, we consider spirituality in terms of interpersonal, transpersonal, and intrapsychic processes. The goal of this study is to establish whether a spiritual perspective is correlated with more effective coping skills and intrapsychic processes. Methodology: Patients: Lung (n = 88, n. (age 62.8±10.1)) and large bowel cancer (n = 56; age (age 60.1±11.4)) (all stages). Tests: SASB Questionnaire by L.S. Benjamin—intrapsychic processes; Scale of Coping Styles by A. Jalowiech; Brief Measure of Spirituality (BMMS); Spiritual Well Being Index by T. Daaleman and B. Bruce. Results: There is a significant correlation among inner spirituality (IS) (Cronbach's α = 0.692), spiritual coping (SC) (Cronbach's α = 0.935) (described total variability—BMMS) and Spiritual Well Being (SWB) (Cronbach's α = 0.759). (Significant correlation among the three scales, Cronbach's α = 0.676.) The patients with high spirituality are more prone to develop their potentialities and capacities. They (with IS and SC) have more effective coping mechanisms with stressful situations (SASB Cl 3: Self‐supporting and appreciate and IS = p<0.002; and SC = p<0.001. They care for themselves by developing their own capacities and potentialities—SASB Cl 5: Self‐control and IS p = 0.033; and SC p = 0.037. The profile of patients with lower intrinsic spirituality and SC scores suggest ineffective coping with high risk of depression, self‐neglect both in the physical and emotional dimensions, and of self‐abuse (SASB Cl 8: Self‐criticism and IS p = 0.033; SC p = 0.044). Conclusion: The presence of a spiritual dimension may be a marker of patients with a good adaptation to cancer treatment. Copyright © 2010 John Wiley & Sons, Ltd.     

Assessing spiritual growth and spiritual decline following a diagnosis of cancer: reliability and validity of the spiritual transformation scale

This study assessed the factor structure, reliability, and validity of an instrument designed to assess spiritual transformations following a diagnosis of cancer-the Spiritual Transformation Scale (STS). The instrument was administering to 253 people diagnosed with cancer within the previous 2 years. Two underlying factors emerged (spiritual growth (SG) and spiritual decline (SD)) with adequate internal reliability (alpha = 0.98 and 0.86, respectively) and test-retest reliability (r = 0.85 and 0.73, respectively). Validity was supported by correlations between SG and the Positive and Negative Affect Scale (PANAS) Positive Affect Subscale (r = 0.23, p < 0.001), the Daily Spiritual Experiences Scale (r = 0.57, p < 0.001), and the Post-traumatic Growth Inventory (r = 0.68, p < 0.001). SD was associated with higher scores on the Center for Epidemiological Studies Depression scale (r = 0.38, p < 0.001) and PANAS-Negative Affect Subscale (r = 0.40, p < 0.001), and lower scores on the PANAS-Positive Affect Subscale (r = -0.23, p < 0.001), and the Daily Spiritual Experiences Scale (r = -0.30, p < 0.001). Hierarchical regression analyses indicated that the subscales uniquely predicted adjustment beyond related constructs (intrinsic religiousness, spiritual coping, and general post-traumatic growth). The results indicate that the STS is psychometrically sound, with SG predicting better, and SD predicting poorer, mental and spiritual well-being following a diagnosis of cancer.