心理行為干預(yù)對癌癥化療病人生活質(zhì)量、情緒及應(yīng)對方式的影響

1、心理行為干預(yù)對癌癥化療病人生活質(zhì)量、情緒及應(yīng)對方式的影響【中文摘要】目的測評癌癥化療患者生活質(zhì)量、情緒和應(yīng)對方式,探討心理行為干預(yù)對癌癥化療患者生活質(zhì)量、情緒和應(yīng)對方式的影響,通過臨床實踐以驗證心理行為干預(yù)方法的效果。方法本研究在回顧大量文獻(xiàn)的基礎(chǔ)上,采用類實驗性研究方法,對湖南省腫瘤醫(yī)院87名確診為乳腺癌或肺癌的患者進(jìn)行隨機(jī)分組對照,干預(yù)組43人(乳腺癌22人,肺癌21),對照組44人(乳腺癌和肺癌各22人)。干預(yù)的內(nèi)容主要包括研究者對病人的個體化教育性干預(yù)兩次,并給予相關(guān)內(nèi)容的材料;指導(dǎo)其進(jìn)行漸進(jìn)性肌肉放松練習(xí),并給其有關(guān)PMR的活頁,要求天天練習(xí)兩次,堅持1個化療周期。在干預(yù)前和干預(yù)后對

2、兩組患者的生活質(zhì)量、情緒和應(yīng)對方式進(jìn)行評價,分析心理行為干預(yù)的效果。結(jié)果(1)采用非參數(shù)統(tǒng)計(non-parametric statistics)中Mann-Whitney U檢驗方法檢驗:干預(yù)前,干預(yù)組和對照組生活質(zhì)量各功能量表和癥狀的比較無明顯差異(P0.05)。干預(yù)后,干預(yù)組生活質(zhì)量的改善普遍有統(tǒng)計學(xué)意義,對照組變化甚微。分別對兩組患者的QLQ-C30得分差值(干預(yù)后一干預(yù)前)進(jìn)行組間比較,結(jié)果顯示經(jīng)過干預(yù)后干預(yù)組較之對照組除軀體功能、呼吸困難和疲乏(P0.05)外,其他方面均有明顯改善(P0.05)。(2)采用非參數(shù)統(tǒng)計(non-parametric statistics)中Mann-

3、WhitneyU檢驗方法檢驗:干預(yù)前,干預(yù)組和對照組情緒各維度的比較無明顯差異(P0.05)。與正凡人的情緒得分進(jìn)行單樣本t檢驗,結(jié)果顯示參與本研究的87名癌癥化療病人的TMD明顯高于正凡人(t=-13.47,p=0.000)。干預(yù)后,干預(yù)組情緒的變化有統(tǒng)計學(xué)意義(P0.05),對照組的變化無統(tǒng)計學(xué)意義(P0.05)。分別對兩組患者的POMR-SF得分差值(干預(yù)后干預(yù)前)進(jìn)行組間比較,結(jié)果顯示干預(yù)后與對照組相比,干預(yù)組的情緒狀況發(fā)生了明顯好轉(zhuǎn)(P0.05)。(2)雙變量相關(guān)分析顯示,干預(yù)前,與患者的生活質(zhì)量及情緒狀況普遍相關(guān)的是患者采取屈服的應(yīng)對方式,與面對和回避幾乎不相關(guān)。采用非參數(shù)統(tǒng)計(n

4、on-parametric statistics)中Mann-Whitney U檢驗方法檢驗:干預(yù)前,干預(yù)組和對照組應(yīng)對方式各方面的比較無明顯差異(P0.05)。干預(yù)后,干預(yù)組僅面對的變化有統(tǒng)計學(xué)意義(P0.05),對照組各方面的變化均無統(tǒng)計學(xué)意義(P0.05)。分別對兩組患者的MCMQ得分差值(干預(yù)后干預(yù)前1)進(jìn)行組間比較,結(jié)果顯示干預(yù)組較之對照組,面對的變化有統(tǒng)計學(xué)意義(P0.05)。即干預(yù)后患者更傾向采取面對的應(yīng)對方式。(4)采用非參數(shù)統(tǒng)計(non-parametric statistics)中Mann-WhitneyU檢驗方法檢驗:干預(yù)前,初次化療患者與多次化療患者在軀體功能、角色功能

5、、憤怒-敵意、方面的比較有統(tǒng)計學(xué)意義(P0.05)。干預(yù)組干預(yù)后初次化療與多次化療患者在角色功能、呼吸困難、憤怒-敵意等方面的變化有統(tǒng)計學(xué)意義(P0.05)。(5)采用非參數(shù)統(tǒng)計(non-parametric statistics)中Mann-WhitneyU檢驗方法檢驗:干預(yù)前肺癌組和乳腺癌組患者各對照組和干預(yù)組在各量表的比較上無統(tǒng)計學(xué)意義(P0.05),干預(yù)后,其變化趨勢基本相同。(6)重復(fù)丈量方差分析結(jié)果表明,面對、情緒的時間主效應(yīng)和干預(yù)主效應(yīng)均明顯(P0.05);回避、屈服的時間主效應(yīng)和干預(yù)主效應(yīng)不明顯(P0.05);面對和情緒的時間因素與干預(yù)因素均存在交互作用(P0.05),而回避和

6、屈服的時間因素與干預(yù)因素均不存在交互作用(P0.05)。交互輪廓圖顯示,在干預(yù)的期間,隨著時間的變化,面對的得分明顯高于對照組,而情緒、回避和屈服的得分明顯低于對照組。結(jié)論(1)癌癥化療患者的各種功能狀況和癥狀經(jīng)心理行為干預(yù)后得到不同程度的改善,改善明顯的功能狀況是:情緒功能、整體生活質(zhì)量、角色功能和認(rèn)知功能,改善明顯的癥狀是:惡心嘔吐、睡眠障礙、食欲喪失、便秘。對于改善軀體功能、呼吸困難和疲乏沒有明顯效果。(2)癌癥化療患者的情緒紊亂比正凡人多,經(jīng)過干預(yù)后的癌癥化療患者緊張焦慮、抑郁沮喪、疲乏遲鈍、憤怒敵意、迷惑混亂及整體情緒得到明顯緩解,精力活力得到明顯進(jìn)步。(3)干預(yù)后,干預(yù)組患者較多運

7、用面對的積極應(yīng)對方式,較少運片J回避和屈服應(yīng)對方式,對照組變化不大。(4)較之多次化療患者,干預(yù)對于改善初次化療患者的角色狀態(tài)和呼吸困難的癥狀、降低初次化療患者的憤怒敵意情緒、增加初次化療患者的精力活力有更加明顯的效果。(5)肺癌和乳腺癌患者各方面的變化趨勢基本相同,乳腺癌患者在軀體功能、情緒功能、睡眠以及食欲方面的改善較肺癌患者更加明顯。);【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