心理行为干预对癌症化疗病人生活质量、情绪及应对方式的影响

1、心理行为干预对癌症化疗病人生活质量、情绪及应对方式的影响【中文摘要】目的测评癌症化疗患者生活质量、情绪和应对方式,探讨心理行为干预对癌症化疗患者生活质量、情绪和应对方式的影响,通过临床实践以验证心理行为干预方法的效果。方法本研究在回顾大量文献的基础上,采用类实验性研究方法,对湖南省肿瘤医院87名确诊为乳腺癌或肺癌的患者进行随机分组对照,干预组43人(乳腺癌22人,肺癌21),对照组44人(乳腺癌和肺癌各22人)。干预的内容主要包括研究者对病人的个体化教育性干预两次,并给予相关内容的材料;指导其进行渐进性肌肉放松练习,并给其有关PMR的活页,要求天天练习两次,坚持1个化疗周期。在干预前和干预后对

2、两组患者的生活质量、情绪和应对方式进行评价,分析心理行为干预的效果。结果(1)采用非参数统计(non-parametric statistics)中Mann-Whitney U检验方法检验:干预前,干预组和对照组生活质量各功能量表和症状的比较无明显差异(P0.05)。干预后,干预组生活质量的改善普遍有统计学意义,对照组变化甚微。分别对两组患者的QLQ-C30得分差值(干预后一干预前)进行组间比较,结果显示经过干预后干预组较之对照组除躯体功能、呼吸困难和疲乏(P0.05)外,其他方面均有明显改善(P0.05)。(2)采用非参数统计(non-parametric statistics)中Mann-

3、WhitneyU检验方法检验:干预前,干预组和对照组情绪各维度的比较无明显差异(P0.05)。与正凡人的情绪得分进行单样本t检验,结果显示参与本研究的87名癌症化疗病人的TMD明显高于正凡人(t=-13.47,p=0.000)。干预后,干预组情绪的变化有统计学意义(P0.05),对照组的变化无统计学意义(P0.05)。分别对两组患者的POMR-SF得分差值(干预后干预前)进行组间比较,结果显示干预后与对照组相比,干预组的情绪状况发生了明显好转(P0.05)。(2)双变量相关分析显示,干预前,与患者的生活质量及情绪状况普遍相关的是患者采取屈服的应对方式,与面对和回避几乎不相关。采用非参数统计(n

4、on-parametric statistics)中Mann-Whitney U检验方法检验:干预前,干预组和对照组应对方式各方面的比较无明显差异(P0.05)。干预后,干预组仅面对的变化有统计学意义(P0.05),对照组各方面的变化均无统计学意义(P0.05)。分别对两组患者的MCMQ得分差值(干预后干预前1)进行组间比较,结果显示干预组较之对照组,面对的变化有统计学意义(P0.05)。即干预后患者更倾向采取面对的应对方式。(4)采用非参数统计(non-parametric statistics)中Mann-WhitneyU检验方法检验:干预前,初次化疗患者与多次化疗患者在躯体功能、角色功能

5、、愤怒-敌意、方面的比较有统计学意义(P0.05)。干预组干预后初次化疗与多次化疗患者在角色功能、呼吸困难、愤怒-敌意等方面的变化有统计学意义(P0.05)。(5)采用非参数统计(non-parametric statistics)中Mann-WhitneyU检验方法检验:干预前肺癌组和乳腺癌组患者各对照组和干预组在各量表的比较上无统计学意义(P0.05),干预后,其变化趋势基本相同。(6)重复丈量方差分析结果表明,面对、情绪的时间主效应和干预主效应均明显(P0.05);回避、屈服的时间主效应和干预主效应不明显(P0.05);面对和情绪的时间因素与干预因素均存在交互作用(P0.05),而回避和

6、屈服的时间因素与干预因素均不存在交互作用(P0.05)。交互轮廓图显示,在干预的期间,随着时间的变化,面对的得分明显高于对照组,而情绪、回避和屈服的得分明显低于对照组。结论(1)癌症化疗患者的各种功能状况和症状经心理行为干预后得到不同程度的改善,改善明显的功能状况是:情绪功能、整体生活质量、角色功能和认知功能,改善明显的症状是:恶心呕吐、睡眠障碍、食欲丧失、便秘。对于改善躯体功能、呼吸困难和疲乏没有明显效果。(2)癌症化疗患者的情绪紊乱比正凡人多,经过干预后的癌症化疗患者紧张焦虑、抑郁沮丧、疲乏迟钝、愤怒敌意、迷惑混乱及整体情绪得到明显缓解,精力活力得到明显进步。(3)干预后,干预组患者较多运

7、用面对的积极应对方式,较少运片J回避和屈服应对方式,对照组变化不大。(4)较之多次化疗患者,干预对于改善初次化疗患者的角色状态和呼吸困难的症状、降低初次化疗患者的愤怒敌意情绪、增加初次化疗患者的精力活力有更加明显的效果。(5)肺癌和乳腺癌患者各方面的变化趋势基本相同,乳腺癌患者在躯体功能、情绪功能、睡眠以及食欲方面的改善较肺癌患者更加明显。);【Abstract】 Objectives To measure the quality of life,emotion and coping style of cancer patients undergoing chemotherapy,to exp

8、lore the effects of psychological and behavioral intervention on the quality of life,emotion and coping style of cancer patients undergoing chemotherapy,to prove the effectiveness of psychological and behavioral intervention through clinical practice.Methods In reviewing this study,a large number of

9、 literature based on the use of quasi-experimental research methods,87 patients diagnosed as breast cancer or lung cancer in Hunan Provincial Tumor Hospital were randomized,43 in the intervention group and 44 in the control group,by the method of quasi-experimental study based on reviewing extensive

10、 literature.The content of intervention mainly includes twice individual education intervention on patients by investigators and giving related materials,guiding them in the progressive muscle relaxation requiring twice a day and continuing one cycle of chemotherapy and giving related leaflets.It ev

11、aluated the quality of life,emotion and coping style of the two groups of patients Pre-and Pro- intervention,thus analyzed the effectiveness of psychological and behavioral interventionResults(1) By Wilcoxon Mann-Whitney U test,before the intervention,the quality of life and symptoms were not signif

12、icantly different(P0.05) between the intervention group and control group. After the intervention,the improvement of quality of life was statistically significantly in the intervention group,while the changes were insignificant in the control group.Two groups of patients,respectively QLQ-C30 scoring

13、 margin(post-intervention-pre-intervention) for inter-group comparison,except for the physical function,dyspnea and fatigue(P0.05),the QLQ-C30 between two groups were significance (P0.05)(2) By Wilcoxon Mann-Whitney U test,before the intervention, every factor of emotion was not significantly differ

14、ent(P0.05) between the intervention group and control group.Normal emotional and single sample t test results showed that participation in this study 87 patients with cancer chemotherapy TMD significantly high than the normal(t=-13.47,p=0.000).After the intervention,intervention group changes in moo

15、d were statistically significant(P0.05),the control group no significant changes(P0.05).Two groups of patients,respectively POMR-SF score difference(post-intervention-pre-intervention) for inter-group comparison,the results showed that after the intervention compared with the control group,the inter

16、vention group has taken place in the emotional state of a significant turn for the better.(3) Bivariate correlation analysis showed that pre-intervention,the quality of life of patients and emotional status of patients in general is related to yield responses taken,and to face and to avoid almost ir

17、relevant; by Wilcoxon Mann-Whitney U test,intervention group and control group to deal with all aspects of the way of comparison there was no significant difference(P0.05).After the intervention,the intervention group only changes the face of statistical significance(P0.05),all aspects of the contro

18、l group had no statistically significant change(P0.05).Two groups of patients were scored MCMQ margin(post-intervention pre-intervention) for inter-group comparison,the results showed that compared with the control group,in the face of the changes were statistically significant(P0.05).That is,after

19、the intervention in patients with a tendency to take the face of the coping style.(4) By Wilcoxon Mann-Whitney U test,before the intervention, initial chemotherapy in patients with chemotherapy in patients with multiple functions in the body、role function、anger-hostility、energy -the more dynamic asp

20、ects of statistical significance(P0.05). Intervention group after the intervention of the initial chemotherapy and chemotherapy in patients with many functions in the role、difficulty in breathing、anger-hostility and effort-there are dynamic changes in statistical significance(P0.05).(5) By Wilcoxon

21、Mann-Whitney U test,before the intervention, Patients with lung cancer and breast cancer among the control group and intervention group on the scale of comparison was not significant(P0.05),After the intervention,the trend is basically the same.(6) Repeated measures analysis of variance results show

22、 that,in the face,emotional time for the main effects and main effects of intervention were significantly(P0.05);Avoided and the yield of the main effects of time and interfere with the main effect was not significant(P0.05);Face and emotion of the time factor and the existence of factors interfere

23、with the interaction(P0.05),while avoiding the time factor and yield factors do not exist interfere with the interaction(P0.05).Interactive contour map shows that during the intervention,changes over time,in the face of significantly higher scores,and emotional、to avoid points and the yield was sign

24、ificantly lower than the control group.Conclusion(1) Cancer chemotherapy patients with a variety of functional status and symptoms after the intervention by the mental act of the general improvement in varying degrees,significant improvement in functional status is:emotional function,the overall qua

25、lity of life,role function and cognitive function,significantly improving the symptoms are:nausea and vomiting,sleep disturbance,appetite loss,constipation. To improve physical function,dyspnea and fatigue no significant effect.(2) Cancer chemotherapy patients with mood disorders than normal, After the interv