早期结直肠癌患者疾病获益感现状及其影响因素分析

背景　在生理-心理-社会医学模式下，心理因素在癌症康复中的作用受到了医生、患者的广泛关注。作为积极心理学重要领域之一，疾病获益感（BF）在癌症类型上多以乳腺癌及多癌种混合研究为主，而结直肠癌相关研究较少。目的　评估我国早期结直肠癌患者BF现状并分析其影响因素。方法　本研究为横断面研究。采取便利抽样方法，选取2014年3月-2016年6月在江阴市人民医院和南通市肿瘤医院进行住院治疗的326例早期结直肠癌患者参与问卷调查。调查方法为问卷调查，问卷内容包括：一般资料调查问卷、中文版疾病获益感量表（评估BF情况）、与医生沟通和交流问卷（评估与医生沟通和交流情况）、医院焦虑抑郁量表（评估焦虑和抑郁情绪）、生活定向测验修订版（评估乐观程度）和医学应对方式问卷（评定对疾病的应对特点，包括面对、回避和屈服）。应用多因素Logistic回归分析探讨BF的影响因素。结果　根据中文版疾病获益感量表评分将早期结直肠癌患者分为BF低水平组31例（9.5%，评分<66分），中/高水平组295例（90.5%，评分≥66分）。BF低水平组接受手术+化疗治疗方案比例及与医生沟通和交流问卷评分、乐观程度、医学应对方式中面对得分低于BF中/高水平组，BF低水平组发生并发症比例及医院焦虑抑郁量表评分、医学应对方式中屈服得分高于BF中/高水平组，两组运动锻炼频次比较，差异均有统计学意义（P<0.05）。Logistic回归分析结果表明，接受手术+化疗治疗方案〔OR=3.294，95%CI（1.239，8.759）〕、无并发症〔OR=5.867，95%CI（1.868，19.041）〕、乐观〔OR=1.569，95%CI（1.169，2.106）〕、医疗应对方式-面对〔OR=1.477，95%CI（1.267，1.721）〕是早期结直肠癌患者BF水平的影响因素（P<0.05）。结论　南通市和江阴市地区早期结直肠癌患者BF处于中/高水平。医疗应对方式中面对、乐观、接受手术+化疗治疗方案、无并发症是早期结直肠癌患者BF的重要影响因素，临床医护工作者可结合相关因素跨学科、多平台的制定及实施干预方案，切实提高早期结直肠癌患者BF水平。

Benefit Finding and Influencing Factors in Patients with Early-stage Colorectal Cancer

Background　With the development of biopsychosocial approach used in medicine，the role of psychological factors in cancer rehabilitation has been widely concerned.Benefit finding（BF） is a key research area in positive psychology，mostly focusing on patients with breast cancer or multiple cancers，rarely involving those with colorectal cancer.Objective　To assess BF and associated factors in early-stage colorectal cancer patients in China.Methods　This study is a cross-sectional study.By convenient sampling method，326 early-stage colorectal cancer inpatients were recruited from two hospitals（Jiangyin People's Hospital and Nantong Tumor Hospital） in Jiangsu to attend a questionnaire survey.Measurement instruments include General Information Questionnaire，Chinese version of Benefit Finding Scale（evaluating benefit finding），Chinese version of Communication with Doctors Questionnaire（evaluating communication with doctors），Hospital Anxiety and Depression Scale（evaluating anxiety and depression），Revised Life Orientation Test（evaluating optimism） and Medical Coping Modes Questionnaire（evaluating the response characteristics of the disease，including facing，avoiding and yielding）.Logistic regression analysis was employed to identify the independent influencing factors of BF.Results　According to the Chinese version of disease benefit scale，patients with early colorectal cancer were divided into low BF level group 31 cases（9.5%，score <66 points），and 295 cases （90.5%，score≥66 points） in medium / high level group.Compared with moderate/high BF group，low BF group had lower prevalence of receiving surgery plus chemotherapy，and lower mean scores of Chinese version of Communication with Doctors Questionnaire and confrontation subscale of Medical Coping Modes Questionnaire as well as lower mean level of optimism（P<0.05）.Moreover，low BF group showed higher mean scores of Hospital Anxiety and Depression Scale and avoidance subscale of Medical Coping Modes Questionnaire and higher incidence of complications（P<0.05）.There were also significant differences in exercise frequency between the two groups（P<0.05）.Logistic regression analysis showed that surgery plus chemotherapy〔OR=3.294，95%CI（1.239，8.759）〕，no complications〔OR=5.867，95%CI（1.868，19.041）〕，optimism〔OR=1.569，95%CI（1.169，2.106）〕，confrontation coping 〔OR=1.477，95%CI（1.267，1.721）〕 were independently associated with BF（P<0.05）.Conclusion　Early-stage colorectal cancer patients in Nantong and Jiangyin had moderate/high BF on the whole.BF was significantly affected by confrontation coping，optimism，surgery plus chemotherapy and no complications.To improve the BF of these patients，frontline physicians and nurses may formulate and implement multidisciplinary and multi-platform intervention programs based on these associated factors of BF.