基于行为转变理论的护理模式对直肠癌造口患者心理情绪障碍和生活质量的影响

目的探讨基于行为转变理论的护理模式对直肠癌造口患者心理情绪障碍和生活质量的影响。方法选取2017年1月至2018年6月间陕西中医药大学附属医院收治的94例直肠癌造口患者作为研究对象,采用随机数表法分为对照组和观察组,每组47例。对照组患者采用常规护理模式,观察组患者给予基于行为转变理论的护理模式。观察两组患者入组时、出院时、出院3个月和出院6个月时抑郁自评量表(SDS)、焦虑自评量表(SAS)、生活质量核心评定量表(QLQ-C30)和心理弹性量表(CD-RISC)评分,观察两组患者入组时和出院6个月时的健康行为优良率。结果两组患者入组时的SAS评分比较,差异无统计学意义(P> 0. 05),观察组患者出院时、出院3个月和出院6个月时的SAS评分均低于同期对照组患者,差异均有统计学意义(均P <0. 05)。两组患者入组时SDS评分比较,差异无统计学意义(P> 0. 05),观察组患者出院时、出院3个月和出院6个月时的SDS评分均低于同期对照组患者,差异均有统计学意义(均P <0. 05)。两组患者入组时CD-RISC评分比较,差异无统计学意义(P> 0. 05),观察组患者出院时、出院3个月和出院6个月时CD-RISC评分均高于同期对照组患者,差异均有统计学意义(均P <0. 05)。两组患者入组时QLQ-C30评分比较,差异无统计学意义(P> 0. 05),观察组患者出院时、出院3个月和出院6个月时QLQ-C30均高于同期对照组患者,差异均有统计学意义(均P <0. 05)。两组患者入组时健康行为优良率比较,差异无统计学意义(P> 0. 05);观察组患者出院6个月健康行为优良率高于入组时,也高于同期对照组,差异均有统计学意义(均P <0. 05)。结论基于行为转变理论的护理模式用于直肠癌术后造口患者可改善其负性心理,增加健康行为,提高患者的心理弹性,从而提高生活质量,值得临床推广应用。     

围术期正念干预对大肠癌患者术后负面情绪及自我效能感和自我护理能力的影响

目的探讨围术期正念干预对大肠癌患者术后负面情绪、自我效能感及自我护理能力的影响。方法选取2016年1月至2019年1月间榆林市第二医院收治的80例行根治性手术的大肠癌患者,采用随机数表法分为研究组和对照组,每组40例。对照组患者采用常规干预,研究组患者在常规护理干预基础上加入正念干预,比较两组患者出院当日和出院后6个月的汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、一般自我效能感量表(GSES)、自我护理能力量表(ESCA)和肿瘤患者生活质量(QOL)评分差异。结果出院当日和出院后6个月,研究组HAMA和HAMD评分均低于对照组,自我效能感评分均高于对照组,自我护理能力总分及各维度评分均高于对照组,生活质量评分均高于对照组,两组比较,差异均有统计学意义(均P <0. 05)。结论围术期正念干预可减轻大肠癌患者的术后负面情绪,提升自我效能感及自我护理能力,是一种较理想的护理干预方式。     

自我效能干预对老年宫颈癌术后放疗患者生存质量的影响

目的探讨自我效能干预对老年宫颈癌手术后放疗患者生存质量的影响。方法选取2017年1月至2019年1月间咸阳市中心医院收治的行宫颈癌根治术后放疗的60例老年宫颈癌患者,采用随机数字表法分为观察组和对照组,每组30例。两组患者均采用宫颈癌术后放疗临床路径实施治疗后照护干预,观察组患者加用自我效能干预,比较两组患者干预前后自我效能评分(GSES)、心理社会适应能力、医学应对能力及生活质量。结果干预前,两组患者GSES评分、心理社会适应能力各维度评分、医学应对问卷各维度评分和生活质量评分比较,差异均无统计学意义(P> 0. 05)。干预后,对照组患者GSES评分较干预前无明显变化,观察组患者上升,差异有统计学意义(P <0. 05)。干预后,对照组患者心理社会适应能力各维度评分无明显变化,观察组患者各维度评分均上升,差异均有统计学意义(均P <0. 05)。干预后,两组患者医学应对问卷各维度评分均上升,且观察组患者各维度评分均大于对照组,差异均有统计学意义(均P <0. 05)。干预后,对照组患者生活质量评分较干预前下降(P <0. 05),观察组患者较干预前无明显变化(P> 0. 05)。结论自我效能干预可有效提升老年宫颈癌手术患者术后放疗应对积极性,提高心理社会适应能力,缓解放疗不利刺激,提高生存质量。     

老年肺癌患者心理弹性特点分析及进取豁达心理治疗的效果评价

目的 探讨老年肺癌患者的心理弹性特点及进取豁达心理治疗的效果.方法 将86例老年肺癌患者按随机数字表法分为干预组和对照组各43例,干预组在常规抗肿瘤治疗的基础上进行豁达干预,对照组仅进行常规抗肿瘤治疗,分析干预治疗前后的心理弹性量表(CD-RISC)、进取豁达问卷(EMQ)、癌症应对自评量表(CCMQ)、焦虑量表(HADS-A)、抑郁量表(HADS-D)评分.结果 出院前,干预组患者CD-RISC、EMQ、CCMQ、HADS-A及HADS-D评分均优于对照组,差异均有统计学意义(P﹤0.05).结论 肺癌患者心理弹性水平较低,且受到多种因素的影响.豁达治疗能提高肺癌患者的进取豁达心理水平,还能改善患者焦虑抑郁情绪,对老年肺癌患者的心理健康有着积极作用.     

结构式家庭护理指导对乳腺癌根治术患者术后生活质量的影响

目的探讨结构式家庭护理指导对乳腺癌根治术患者术后心理弹性、社会功能及生活质量的影响。方法选取2011年1月至2015年6月间四川广元市中心医院收治的70例乳腺癌根治术患者,按住院顺序编号,单号分为对照组,双号分为观察组,每组35例。对照组患者给予常规护理及出院指导,观察组患者给予结构式家庭护理指导,采用心理弹性量表(CD-RICS)与乳腺癌生活质量量表(FACT-B)测定干预前和干预6个月后,两组患者心理弹性及生活质量的变化,采用自我护理能力测定表(ESCA)测定患者健康行为及自我效能的变化,采用社会功能评定表(SFRS)测定干预前和干预6个月两组患者社会功能的改善情况。结果干预前,两组患者FACTB量表各维度评分对比,差异无统计学意义(P>0.05);干预后,两组患者各维度评分均上升,且观察组患者上升幅度均高于对照组,差异均有统计学意义(均P<0.05)。干预前,两组患者CD-RICS量表各维度评分对比,差异无统计学意义(P>0.05);干预后,两组患者CD-RICS量表各维度评分均上升,且观察组评分上升幅度高于对照组,差异均有统计学意义(均P<0.05)。干预前,两组患者ESCA量表各维度评分对比,差异无统计学意义(P>0.05);干预后,两组患者自我效能量表各维度评分均明显上升,且观察组上升幅度高于对照组,差异均有统计学意义(均P<0.05)。干预前,两组患者SFRS量表各维度评分对比,差异无统计学意义(P>0.05);干预后,两组患者量表各维度评分均显著降低,且观察组患者降低幅度高于对照组,差异均有统计学意义(均P<0.05)。结论结构式家庭护理指导可改善乳腺癌患者根治术后生活质量,提升其心理弹性与自护能力,改善其社会功能。     

心理干预对非小细胞肺癌化疗患者负性心理及生活质量的影响

目的探讨心理干预措施对非小细胞肺癌化疗患者负性心理反应的作用及其对生活质量的影响。方法选择2012年10月至2014年12月间收治的98例肺癌患者,采用随机数字表法随机分为研究组(51例)和对照组(47例)。研究组患者在常规化疗方案的基础上进行心理干预,对照组患者行常规化疗方案。采用抑郁自评量表(SAS)、焦虑自评量表(SDS)和中国癌症化疗患者生活质量调查问卷(QLQ-CCC)评价并比较两组患者的干预效果。结果护理干预前后,两组患者症状自评量表(SCL-90)各因子评分比较显示,干预前两组间各因子的差异均无统计学意义(P>0.05),干预后研究组患者各因子评分均明显降低(P<0.05),对照组患者无明显变化(P>0.05),且研究组患者的各因子评分均低于对照组(P<0.05)。两组患者首次测评SAS及SDS评分的差异无统计学意义(P>0.05)。干预第8周时,研究组患者评分显著低于首次测评(P<0.05),对照组无明显变化(P>0.05),且研究组患者显著低于对照组(P<0.05)。两组患者化疗前,在生理功能、心理功能和社会功能障碍、日常活动影响以及对治疗的满意态度等评分的差异均无统计学意义(P>0.05)。护理干预第8和16周时,研究组患者各方面评分均低于对照组(P<0.05)。结论心理干预可以明显改善非小细胞肺癌患者的心理障碍,提高患者的生活质量。     

同质健康教育模式对结直肠癌造口术后患者自我护理能力、自我效能及心理弹性的影响

目的探讨同质健康教育模式对结直肠癌造口术患者自我护理能力、自我效能及心理弹性的影响。方法采用随机数字表法将行造口术治疗的100例结直肠癌患者分为改进组(给予同质健康教育模式干预)和对照组(给予常规健康指导),各50例。比较两组患者干预前及干预4周后的自我护理能力、自我效能感及心理弹性。结果干预4周后,改进组患者自我护理测定量表中自护概念的认知、自护责任、自护技能、相关知识了解维度的评分及总分均高于对照组患者,差异均有统计学意义(P﹤0.05)。干预4周后,改进组患者的自我效能感评分明显高于对照组患者,差异有统计学意义(P﹤0.01)。干预4周后,改进组患者由Connor和Davidson编制的心理弹性量表(CD-RISC)中坚韧、自强、乐观维度的评分及总分均高于对照组,差异均有统计学意义(P﹤0.05)。结论同质健康教育模式对结直肠癌造口术患者的自我护理能力、自我效能感及心理弹性具有明显的改善作用。     

同感心心理沟通对肝癌介入治疗疼痛者的临床价值

目的探讨同感心心理沟通在肝癌介入治疗疼痛患者中的应用效果。方法选取2017年12月至2018年12月间陕西省榆林市第二医院收治的86例实施介入治疗的肝癌患者,根据护理模式不同分为研究组和对照组,其中,采用常规护理和同感心心理沟通的45例患者纳入研究组,采用常规护理的41例患者纳入对照组。比较两组患者焦虑和抑郁状况及疼痛评分。结果护理前,两组患者的焦虑自评量表(SAS)和抑郁自评量表(SDS)评分比较,差异无统计学意义(P>0. 05);护理后,研究组患者SAS和SDS评分,均低于对照组,差异均有统计学意义(均P <0. 05)。研究组患者疼痛评分为(3. 68±0. 35)分低于对照组患者的(4. 12±1. 25)分,差异有统计学意义(P <0. 05)。结论同感心心理沟通作为一种非药物干预措施,可有效缓解肝癌介入治疗患者的疼痛状况,改善患者的焦虑和抑郁状态。     

聚焦解决模式对卵巢癌术后化疗患者心理弹性及自我效能感的影响

目的探讨聚焦解决模式对卵巢癌术后化疗患者心理弹性及自我效能感的影响。方法依据随机数字表法将94例卵巢癌术后化疗患者分为对照组和观察组,每组47例,对照组患者给予常规干预,观察组患者在对照组的基础上按照聚焦解决模式进行干预。比较干预前和干预3个月后两组患者的心理弹性量表(CDRISC)评分和中文版癌症自我管理效能感量表(C-SUPPH)评分。结果干预前,两组患者的CDRISC评分比较,差异无统计学意义(P﹥0.05);干预3个月后,观察组患者的CDRISC评分明显高于对照组,差异有统计学意义(P﹤0.01)。干预前,两组患者C-SUPPH各维度评分比较,差异均无统计学意义(P﹥0.05);干预3个月后,观察组患者C-SUPPH各维度评分均高于对照组,差异均有统计学意义(P﹤0.05)。结论聚焦解决模式对提高卵巢癌术后化疗患者的心理弹性水平和自我效能感具有重要意义。     

自我效能干预对胃癌患者自我效能、疼痛程度、睡眠质量及生活质量的影响

目的 探讨自我效能干预对胃癌患者自我效能、疼痛程度、睡眠质量及生活质量的影响.方法 采用随机数字表法将150例胃癌患者分为研究组和对照组,每组75例.对照组患者接受常规护理干预,研究组患者接受自我效能干预.干预前和干预3个月后,比较两组患者的一般自我效能感量表(GSES)评分、视觉模拟评分法(VAS)评分、匹兹堡睡眠质量指数(PSQI)量表评分、简明健康状况调查问卷(SF-36)评分和护理满意度.结果 干预前,两组患者的GSES评分、VAS评分、PSQI量表各维度评分、SF-36量表各维度评分及总分比较,差异均无统计学意义(P﹥0.05).干预3个月后,研究组患者的GSES评分、SF-36量表各维度评分及总分、护理满意度均高于对照组患者,VAS评分和PSQI量表各维度评分均低于对照组患者,差异均有统计学意义(P﹤0.05).结论 自我效能干预能够提高胃癌患者的自我效能、睡眠质量、生活质量和护理满意度,减轻患者的疼痛程度.     

Comorbid mental disorders in laryngectomees

OBJECTIVES: This study attempted to determine the prevalence of mental disorders among laryngectomees and to assess the current status of the supplied psychooncological care. PATIENTS AND METHODS: Patients who were laryngectomized between 1970 and 2001 were recruited at 6 different otolaryngology clinics in the region of Central Germany. 189 interviews were conducted. Structured clinical interviews (SCID) and standardized questionnaires (HADS, KFA) were used to assess patients' mental health. The past and the current status of received psychotherapeutic care was evaluated. RESULTS: 23% of the patients were diagnosed with mental disorders. The most frequently occurring disorder was alcohol dependency with 8%, followed by affective disorders (7% major depression, 5% minor depression). Only one patient was currently receiving psychotherapeutic or psychiatric treatment. CONCLUSION: Only a small fraction of the laryngectomy patients suffering from mental illness were receiving appropriate treatment.     

Shared mental models of cancer survivorship care

Quality cancer survivorship care relies on care continuity within the healthcare team. The purpose of this study was to explore the perspectives of healthcare team members regarding cancer survivorship care using the framework of shared mental models. Semi‐structured interviews of cancer survivors, primary support individuals, oncology providers, primary care providers and registered nurses were completed. Data were extrapolated to seven primary themes with associated secondary themes. Primary themes included survivor definition and identity, care setting, team member roles, care gaps, survivor needs, barriers to care and facilitators of care. Through these themes, participants emphasised the individuality of the survivorship experience, acknowledged care gaps and described ongoing needs of cancer survivors. Information provision and communication were noted as care facilitators. Through clarification of team member roles, healthcare providers will be equipped to promote cancer survivor transition by focusing on care continuity, communication and collaboration.     

癌症相关基因与精神疾病的关联

Stathmin,RIN1和DRD2基因被发现是癌症相关基因,这些基因在乳腺癌,宫颈癌,肝癌等癌细胞中高表达.研究发现Stathmin在情感相关脑区海马及杏仁核高度表达,是参与恐惧记忆调节的基因;RIN1高表达于端脑抑制恐惧记忆的获得;DRD2基因调控多巴胺D2受体表达,该基因失调会导致多巴胺功能紊乱,引起酒精依赖.从而证明这些基因与创伤后应激反应(post traumatic stress disorder,PTSD),精神分裂,抑郁症等精神疾病存在着紧密联系.本文从Stathmin,RIN1,DRD2基因入手,重点阐述这些癌症相关基因在精神疾病中的表现,从基因角度为寻求癌症与精神性疾病之间的关联提供证据.     

Family communication and mental health after breast cancer

In the context of a traumatic event, such as a breast cancer diagnosis, talking with others about the event can facilitate emotional adjustment and meaning-finding. Among women with a history of breast cancer, open communication is likely to be of particular importance in the family setting, as the family is frequently a primary source of support. The goal of this cross-sectional survey study was to determine the association between open family communication about cancer and breast cancer survivors' mental health. Responses from 230 women at various stages post-treatment suggest that the majority of women are able to talk openly with their family about breast cancer. Multivariate regression analysis further indicates that open family communication is independently associated with better mental health outcomes. Given that many women live long after a breast cancer diagnosis, maintaining mental health functioning is an important long-term goal. Efforts to enhance productive communication between patients and their family members may help women cope with and overcome the challenges of breast cancer survivorship.     

Using mental imagery and visualisation with cancer patients

Mental imagery and visualisation are techniques that can help cancer patients manage their responses to the illness and help them mobilise inner psychological resources.     

Psychosocial variables associated with mental adjustment to cancer

To investigate the role of psychosocial variables and psychological vulnerability on adjustment to cancer, a study was undertaken on 157 cancer patients. Assessment of adjustment to cancer (Mental Adjustment to Cancer-MAC-scale), social support (Social Support Index), external locus of control (ELC scale), psychiatric history and present mental status (DSM-III- R) was carried out. The results indicated that the MAC dimension Fighting Spirit (FS) was related to low ELC and high social support, while an opposite association was shown for Helplessness (H) and Fatalism (F). According to MAC cut-off scores, ‘cases’ reported higher ELC and lower social support than ‘non-cases’. Patients with a lifetime history of emotional disorders, as well as a present DSM-III-R diagnosis, showed a style of mental maladjustment to cancer (low FS, high H, F and Anxious Preoccupation). The findings seem to confirm the utility of using the MAC in oncologic settings and the importance of prior psychological problems, present emotional disorders, external locus of control and inadequate interpersonal support in favouring less effective strategies of adjustment to cancer.     

Oesophageal cancer: caregiver mental health and strain

Objective: To investigate strain and mental health among family caregivers of oesophageal cancer patients and possible factors associated with caregiver mental health and strain. Methods: Patients with oesophageal adenocarcinoma in Ireland were recruited into the FINBAR study (the main aim of which was to investigate factors influencing the Barrett's adenocarcinoma relationship). Carers completed the 13‐item Caregiver Strain Index and the General Health Questionnaire‐30 (GHQ) in the context of a brief interview with trained research staff that was undertaken separately from the interview with each cancer patient. Results: Two hundred and twenty‐seven patients participated in the FINBAR study. A total of 39 patients did not have a family carer or the carer could not be identified. Fifty percent (94/188) of carers completed the questionnaires. Mean (SD) scores for strain (6.65, SD=3.63) and mental health status (10.21, SD=7.30) were high and 71% of carers scored >5 on the GHQ indicating psychological distress. There was a statistically significant positive relationship between level of strain experienced by caregivers and the severity of their mental health status and whether or not carers scored >5 on the GHQ. Relatives were 1.70 (95% CI 1.34–2.15) times more likely to be defined as high scorers with each unit increase in the CSI score. Conclusions: A significant proportion of caregivers experienced high levels of strain and psychological distress. There is a need to provide appropriate support and services targeted specifically at reducing the considerable strain of caring for patients with oesophageal cancer, particularly for carers of patients from lower socioeconomic groups. Copyright © 2008 John Wiley & Sons, Ltd.     

150例癌症患者心理健康状况调查分析

目的　通过对癌症患者心理健康测查,了解癌症患者的心理健康状况,实施相应的治疗。方法　应用《心理健康测查表》对１５０ 例肿瘤患者进行调查,并与非癌症组,健康人群进行对照比较。结果　癌症患者的心理健康状况明显低于非癌症级及健康人群,这可能与其发病、康复有着密切地相关性。结论　癌症患者应具有良好心理健康状态,才有利于早日康复。