本文選題：肺腫瘤　切入點：支持性照護需求　出處：《安徽醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：近年來,關注癌癥患者的支持性照護需求以針對性地為患者提供支持性照護逐漸成為研究的熱點之一。研究表明,采取有效的措施促進患者支持性照護需求的滿足不僅可以增加患者對疾病的認識,促進患者參與決策,減少不確定感,提高生命質(zhì)量、主觀幸福感、對護理服務的滿意水平,并且能夠建立良好的醫(yī)患關系。肺癌患者由于生存率較低、軀體癥狀及心理社會問題較多,因而支持性照護需求較為突出。而現(xiàn)有的關于癌癥患者支持性照護需求的研究,關注肺癌患者支持性照護需求及其影響因素相對較少,明確肺癌患者支持性照護需求的現(xiàn)狀、主要影響因素及作用機制,有助于針對性地為肺癌患者提供支持性照護,促進其支持性照護需求的滿足。目的(1)描述肺癌患者支持性照護需求的現(xiàn)狀;(2)探究肺癌患者支持性照護需求的預測因素及各變量間的路徑關系,闡明影響肺癌患者支持性照護需求的主要因素,為臨床針對性地給予患者有效的支持性照護提供依據(jù)。方法運用橫斷面描述性研究設計,采用便利抽樣法于2016年5月~9月選取在安徽省三所三級甲等醫(yī)院就診的370例住院肺癌患者作為研究對象。采用一般資料調(diào)查表、癌癥患者護理專業(yè)性社會支持需求量表(Nursing Professional Social Support Needs Scale,NPSSNS)、領悟社會支持量表(Perceived Social Support Scale,PSSS)、心理困擾溫度計(Distress Thermometer,DT)、中文版安德森癥狀評估表(Chinese Version of the M.D.Anderson Symptom Inventory,MDASI-C)、D型人格量表(Type D Personality Scale,DS-14)、肺癌患者病恥感量表(Cataldo Lung Cancer Stigma Scale,CLCSS)、醫(yī)學應對方式問卷(Medical Coping Modes Questionnaire,MCMQ)、事件影響量表(The Impact of Events Scale-Revised,IES-R)、臨床結局簡版問卷(the 36-item Medical Outcomes Study Short Form,SF-36)、紐卡斯爾病人對護理服務滿意度量表(The Newcastle Satisfaction with Nursing Scales,NSNS)、疾病進展恐懼簡化量表(the Fear of Progression Questionnaire,Fo P-Q-SF)對肺癌患者進行調(diào)查。采用Epi Data3.1軟件進行資料的錄入,SPSS23.0軟件對資料進行描述性分析,AMOS21.0軟件對結構方程模型進行構建和驗證。結果肺癌患者支持性照護需求的共性模塊得分為3.06(1.16),特異型模塊得分為2.60(1.50),各維度的得分以技術需求維度得分最高,其次是信息需求維度,情感/心理需求維度得分最低;排在前10位的需求以技術需求維度所占比例最高,無情感/心理需求;一般人口學及疾病資料中女性、具有D型人格、年齡較輕、經(jīng)濟水平較低、患病時間較長、疾病轉移、分期為Ⅳ期的肺癌患者支持性照護需求水平較高;心理困擾、癥狀困擾、社會支持、疾病進展恐懼、侵擾性思想、病恥感、護理服務滿意度及面對應對均與患者的支持性照護需求呈正相關;生理功能與患者的支持性照護需求水平呈負相關;結構方程模型中對支持性照護需求具有直接顯著性預測作用的變量為癥狀困擾、護理服務滿意度、疾病進展恐懼、社會支持及面對應對;具有間接顯著性預測作用的變量為D型人格、病恥感及屈服應對。其中,疾病進展恐懼對支持性照護需求具有正向預測作用,路徑系數(shù)β=0.403(t=6.180,P0.001),進一步分解其對支持性照護需求的標準化效應后發(fā)現(xiàn),疾病進展恐懼對支持性照護需求的總效應為0.427,其中直接效應為0.403,通過護理服務滿意度及面對應對的間接效應為0.024;癥狀困擾對支持性照護需求具有正向的預測作用,路徑系數(shù)β=0.158(t=2.607,P0.01),總效應為0.302,直接效應為0.158,通過疾病進展恐懼的間接效應為0.144;護理服務滿意度對支持性照護需求具有正向預測作用,路徑系數(shù)β=0.135(t=2.553,P0.05),總效應為0.159,直接效應為0.135,通過面對應對的間接效應為0.024;社會支持對支持性照護需求具有正向的預測作用,路徑系數(shù)β=0.177(t=2.909,P0.01),對支持性照護需求的總效應為0.247,其中直接效應為0.177,通過面對應對的間接效應為0.070;面對應對對支持性照護需求具有正向預測作用,路徑系數(shù)β=0.215(t=3.858,P0.001);D型人格對支持性照護需求不具有直接預測效應,但可通過疾病進展恐懼及社會支持對支持性照護需求產(chǎn)生正向的間接效應,間接效應為0.047;病恥感對支持性照護需求不具有直接預測效應,但可通過疾病進展恐懼及護理服務滿意度對支持性照護需求產(chǎn)生正向的間接效應,間接效應為0.073;屈服應對對支持性照護需求不具有直接效應,但可通過面對應對對支持性照護需求產(chǎn)生負向的間接效應,間接效應為-0.034。上述預測因素共解釋支持性照護需求33.0%的變異。結論肺癌患者存在信息、技術、情感/心理、照護協(xié)調(diào)與溝通、肺癌特異性方面的支持性照護需求,并且主要為技術需求方面的需求。疾病進展恐懼、癥狀困擾、社會支持、護理服務滿意度及面對應對對支持性照護需求具有直接正向預測作用,并且疾病進展恐懼可通過護理服務滿意度及面對應對對支持性照護需求產(chǎn)生間接作用;癥狀困擾可通過疾病進展恐懼對支持性照護需求產(chǎn)生間接作用;護理服務滿意度及社會支持可通過面對應對對支持性照護需求產(chǎn)生間接作用;D型人格可通過疾病進展恐懼及社會支持對支持性照護需求產(chǎn)生正向的間接效應;病恥感可通過疾病進展恐懼及護理服務滿意度對支持性照護需求產(chǎn)生正向的間接效應;屈服應對可通過面對應對對支持性照護需求產(chǎn)生負向的間接效應。明確肺癌患者支持性照護需求的預測因素及各因素之間的路徑關系,可為進一步制定支持性照護干預方案以滿足肺癌患者的需求、改善其生命質(zhì)量提供參考依據(jù)。
[Abstract]:In recent years, attention and support of cancer patient care needs in order to provide patients with supportive care has gradually become one of the hotspots in the research. The study shows that to take effective measures to promote patients with supportive care needs not only can increase the understanding of disease, promote the patients to participate in decision-making, reduce uncertainty and improve the life the quality, subjective well-being, satisfaction of nursing service, and to establish a good doctor-patient relationship. The lung cancer patients because of lower survival rate, more somatic symptoms and psychosocial problems, and supportive care needs more prominent. But the existing research on the demand for care of cancer patients, attention to supportive care in patients with lung cancer demand and its influencing factors is relatively small, clear lung cancer patients care needs to support the status quo, the main influence factors and mechanism, helps to Provide supportive care for patients with lung cancer, promote the supportive care needs. (1) to describe the status quo of care needs of patients with lung cancer support; (2) to explore prognostic factors in patients with lung cancer supportive care needs and the path of the relationship among variables, clarify the main factors affecting the demand for care of patients with lung cancer. For clinical targeted support of patients with effective care provided. Methods a cross-sectional descriptive study design, using convenience sampling method in May 2016 ~9 month in Anhui province were selected three from three hospitals in 370 cases of lung cancer patients as the research object. The general information questionnaire, social support demand for nursing professional cancer (Nursing Professional Social Support Needs table Scale, NPSSNS), perceived social support scale (Perceived Social Support Scale, PSSS), psychological distress temperature Meter (Distress Thermometer, DT), Chinese version of Anderson (Chinese Version of symptom assessment scale the M.D.Anderson Symptom Inventory, MDASI-C), type D personality scale (Type D Personality Scale, DS-14), the stigma of patients with lung cancer scale (Cataldo Lung Cancer Stigma Scale, CLCSS), medical coping mode questionnaire (Medical Coping Modes Questionnaire, MCMQ), the impact of Event Scale (The Impact of Events Scale-Revised, IES-R), clinical outcome questionnaire (the 36-item Medical version Outcomes Study Short Form, SF-36), Newcastle patients for nursing service satisfaction scale (The Newcastle Satisfaction with Nursing Scales, NSNS), disease progression fear scale (the Fear simplified of Progression Questionnaire, Fo P-Q-SF) were investigated in patients with lung cancer. The data by Epi Data3.1 software SPSS23.0 software entry, a descriptive analysis of the data, AM The structural equation model is established and verified in OS21.0 software. The general module of scores of care needs support in patients with lung cancer was 3.06 (1.16), specific module score of 2.60 (1.50), the score of each dimension to the technical requirements of the highest score, followed by the demand of information dimension, emotional / psychological needs of the lowest score; the top 10 needs to technical requirements of dimensions of the highest proportion, no emotional / psychological needs; female demographic and disease data, with type D personality, younger age, low economic level, longer duration of disease, metastatic disease, stage IV lung cancer supportive care needs higher level; psychological distress, symptom distress, social support, disease progression, fear, intrusive thoughts, stigma, nursing service satisfaction and coping with and supportive care needs of patients was positively correlated with patients with physiological function; To care demand levels are negatively correlated; the structural equation model of supportive care needs has direct significant predictor variables for symptom distress, nursing service satisfaction, disease progression, fear, social support and coping with; with indirect significant predictor variables for type D personality, stigma and coping style. The progression of the disease, fear has a positive predictive effect on supportive care needs, the path coefficient =0.403 (t=6.180, P0.001), the further decomposition of supportive care needs standardized effect after the discovery, the progression of the disease fear of the total effect of supportive care needs for 0.427, the direct effect is 0.403, and the satisfaction of nursing service the indirect effect of coping with 0.024; symptom distress has a positive predictive effect on supportive care needs, the path coefficient =0.158 (t=2.607, P0.01), the total effect is 0.302, straight The effect is 0.158, indirect effect through fear of disease progression was 0.144; nursing service satisfaction has a positive predictive effect on supportive care needs, the path coefficient =0.135 (t=2.553, P0.05), the total effect is 0.159, the direct effect is 0.135, by coping with the indirect effect was 0.024; social support has a positive predictive effect the supportive care needs, the path coefficient =0.177 (t=2.909, P0.01), the total effect of supportive care needs for 0.247, the direct effect is 0.177, through the indirect effect of confrontation is 0.070; the corresponding surfaces have positive effect on supportive care needs, the path coefficient =0.215 (t=3.858, P0.001); type D personality has no direct effect on supportive care needs, but the fear of disease progression and social support has indirect positive effect on supportive care needs, the indirect effect was 0.047; disease Sense of shame has a direct effect on supportive care needs, but can produce indirect positive effect on supportive care needs through the progression of the disease and nursing service satisfaction of fear, the indirect effect was 0.073; the yield response has no direct effect on supportive care needs, but by coping with the negative effect to the indirect support for care needs, the indirect effect is -0.034. the forecast factors can explain 33% of the variation of supportive care needs in patients with lung cancer. Conclusion the existence of information, technology, emotional / psychological care, coordination and communication, supportive care needs of lung cancer specific aspects, and the main technical requirements for the needs of the progression of the disease. Fear, symptom distress, social support, nursing service satisfaction and coping with positive predictive effect on supportive care needs, and fear of disease progression through the nursing service Satisfaction and coping with the influence of supportive care needs; symptom distress through fear of disease progression have an indirect effect on the supportive care needs; nursing service satisfaction and social support by coping with the influence of supportive care needs; type D personality through fear of disease progression and social support have indirect positive effect the supportive care needs; stigma can produce indirect positive effect on supportive care needs through the progression of the disease and nursing service satisfaction of fear; coping by coping with the negative indirect effect to supportive care needs in patients with lung cancer. A clear path between the predictors of support care needs and the various factors. For the further development of supportive care intervention programs to meet the needs of patients with lung cancer, improve the quality of life. Test the basis.

【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.73

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