Status and influencing factors of demoralisation syndrome in patients with pancreatic cancer
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摘要:
目的 了解胰腺癌患者失志综合征现状及影响因素，为制定干预措施提供理论依据。 方法 采用便利抽样法选取2019年1月—2021年6月温州医科大学附属第二医院收治的162例胰腺癌患者为研究对象。采用一般资料调查问卷、失志量表、领悟社会支持量表、自我感受负担量表进行问卷调查。 结果 胰腺癌患者失志量表得分为(35.45±11.93)分，领悟社会支持量表得分为(55.64±7.04)分，自我感受负担量表得分为(34.09±8.53)分；不同年龄、性别、学历、婚姻状况、家庭人均月收入、疾病分期、治疗方式的胰腺癌患者失志得分差异有统计学意义(均P＜0.05)；Pearson相关分析结果显示，胰腺癌患者领悟社会支持总分及各维度得分均与失志得分呈负相关关系(均P＜0.01)，自我感受负担总分及各维度得分均与失志得分呈正相关关系(均P＜0.01)；多元线性回归分析结果显示，学历、疾病分期、自我感受负担、领悟社会支持是胰腺癌患者失志综合征的主要影响因素(均P＜0.05)，可解释总变异的42.1%。 结论 胰腺癌患者失志综合征程度较高，应根据患者的学历、疾病分期、自我感受负担、领悟社会支持情况采取针对性的干预措施，缓解患者的失志综合征，提高胰腺癌患者的生活质量。 Abstract:Objective To understand the current situation and influencing factors of demoralisation syndrome in pancreatic cancer patients, and to provide theoretical basis for the formulation of intervention measures. Methods A total of 162 patients with pancreatic cancer admitted to the Second Affiliated Hospital of Wenzhou Medical University from January 2019 to June 2021 were selected as the research objects by convenience sampling method. The general information questionnaire, Demoralization Scale, Perceived Social Support Scale and Self-Perceived Burden Scale were used to conduct the questionnaire survey. Results Patients with pancreatic cancer scored (35.45±11.93) points on the demoralization scale, (55.64±7.04) points on the perceived social support scale and (34.09±8.53) points on the self-perceived burden scale. There were significant differences in the demoralisation scores amongst pancreatic cancer patients with different age, gender, educational background, marital status, per capita monthly family income, disease stage and treatment methods (all P < 0.05). The results of Pearson correlation analysis showed that the total score of perceptive social support and the scores of all dimensions were negatively correlated with the scores of demoralisation syndrome (all P < 0.01), and the total score of self-perceived burden and the scores of all dimensions were positively correlated with the scores of demoralisation syndrome (all P < 0.01). The results of multiple linear regression analysis showed that education background, disease stage, self-perceived burden and perceived social support were the main influencing factors of demoralisation syndrome (all P < 0.05), which could explain 42.1% of the total variation. Conclusion Patients with pancreatic cancer have a high level of demoralisation syndrome, and targeted intervention measures should be taken according to patients' educational background, disease stage, self-perceived burden and understanding of social support, so as to alleviate the demoralisation syndrome and improve the quality of life of patients with pancreatic cancer. -
表 1 胰腺癌患者失志、领悟社会支持、自我感受负担量表得分情况(x±s，分)
Table 1. Depression, perception of social support, and self-perceived burden scale scores in pancreatic cancer patients (x±s, score)
项目 条目数 均分 条目均分 失志总分 24 35.45±11.93 1.48±0.51 失败感 5 8.69±2.94 1.74±0.59 沮丧感 5 8.55±3.07 1.71±0.61 无助感 4 5.86±2.19 1.47±0.55 情绪不安感 5 6.96±2.13 1.39±0.43 无意义感 5 5.39±2.25 1.08±0.45 领悟社会支持总分 12 55.64±7.04 4.64±0.59 家庭支持 4 19.41±3.62 4.85±0.91 朋友支持 4 18.54±3.35 4.64±0.84 其他支持 4 17.69±3.27 4.42±0.82 自我感受负担总分 10 34.09±8.53 3.41±0.85 情感负担 5 21.52±5.47 4.30±1.09 经济负担 2 5.92±1.03 2.96±0.52 身体负担 3 6.65±2.12 2.22±0.71 
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表 2 不同特征胰腺癌患者失志得分比较
Table 2. Comparison of amnesia scores in patients with pancreatic cancer with different characteristics
项目 例数(%) 失志得分(x±s，分) 统计量 P值 年龄(岁) 4.210a 0.017 ＜50 31(19.14) 33.39±10.74 50~60 74(45.68) 33.53±11.98 ＞60 57(35.19) 39.07±11.82 性别 2.779b 0.006 男性 98(60.49) 33.39±11.58 女性 64(39.51) 38.61±11.86 学历 8.822a ＜0.001 初中及以下 69(42.59) 39.51±9.70 高中或中专 58(35.80) 33.86±10.55 大专及以上 35(21.60) 30.09±15.24 婚姻状况 3.190b 0.002 有配偶 123(75.93) 33.81±11.26 无配偶 39(24.07) 40.62±12.64 家庭人均月收入(元/月) 3.519a 0.032 ＜5 000 82(50.62) 37.05±12.43 5 000~8 000 53(32.72) 35.68±11.06 ＞8 000 27(16.67) 30.15±10.88 医疗费用支付方式 0.165a 0.848 城镇医保 70(43.21) 34.90±12.44 新农合 53(32.72) 35.58±10.47 自费 39(24.07) 36.26±13.06 肿瘤部位 0.197a 0.821 胰头 84(51.85) 35.99±12.20 胰体或胰尾 49(30.25) 34.65±11.60 全胰腺 29(17.90) 35.24±12.04 疾病分期 3.859b ＜0.001 Ⅰ期/Ⅱ期 59(36.42) 30.86±11.47 Ⅲ期/Ⅳ期 103(63.58) 38.08±11.43 治疗方式 2.422b 0.017 手术 118(72.84) 34.08±11.52 非手术 44(27.16) 39.11±12.38 注：a为F值，b为t值。
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表 3 胰腺癌患者领悟社会支持、自我感受负担与失志得分的相关性分析(r值)
Table 3. Correlation analysis of perceived social support, self-perceived burden and disability scores in patients with pancreatic cancer (r value)
项目 无意义感 情绪不安感 沮丧感 无助感 失败感 失志总分 家庭支持 -0.232 -0.348 -0.346 -0.327 -0.271 -0.404 朋友支持 -0.372 -0.369 -0.348 -0.266 -0.376 -0.436 其他支持 -0.350 -0.335 0.373 0.378 0.356 0.393 领悟社会支持总分 -0.374 -0.423 -0.380 -0.426 -0.387 -0.438 身体负担 0.340 0.385 0.403 0.389 0.406 0.432 情感负担 0.360 0.280 0.348 0.330 0.363 0.414 经济负担 0.337 0.413 0.385 0.359 0.315 0.418 自我感受负担总分 0.426 0.439 0.425 0.443 0.428 0.451 注：均P＜0.01。
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表 4 胰腺癌患者失志综合征影响因素变量赋值
Table 4. Variable assignment of influencing factors of amnesia syndrome in patients with pancreatic cancer
变量 赋值方法 年龄 ＜50岁=1，50~60岁=2，＞60岁=3 性别 男=1，女=2 学历 初中及以下=1，高中或中专=2，大专及以上=3 婚姻状况 有配偶=1，无配偶=2 家庭人均月收入 ＜5 000元/月=1，5 000~8 000元/月=2，＞8 000元/月=3 疾病分期 Ⅰ期/Ⅱ期=1，Ⅲ期/Ⅳ期=2 治疗方式 手术=1，非手术=2 领悟社会支持得分 以实际值赋值 自我感受负担得分 以实际值赋值
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表 5 胰腺癌患者癌症失志综合征影响因素的多元线性回归分析
Table 5. Multiple linear regression analysis of influencing factors of cancer disorder syndrome in patients with pancreatic cancer
变量 B SE β t值 P值 学历 -6.804 1.084 -0.442 -6.275 ＜0.001 疾病分期 10.154 1.999 0.411 5.080 ＜0.001 自我感受负担 0.257 0.062 0.260 4.129 ＜0.001 领悟社会支持 -0.120 0.040 -0.197 -3.023 0.003
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[1] DOSE A M, HUBBARD J M, MANSFIELD A S, et al. Feasibility and acceptability of a dignity therapy/life plan intervention for patients with advanced cancer[J]. Oncol Nurs Forum, 2017, 44(5): E194-E202. doi: 10.1188/17.ONF.E194-E202 [2] 李玉琪, 周汎澔, 王秀红. 失志的概念分析[J]. 护理学杂志, 2015, 62(3): 83-88.LI Y Q, ZHOU P H, WANG X H. Demoralization concept analysis[J]. Journal of Nursing Science, 2015, 62(3): 83-88. [3] GRASSI L, COSTANTINI A, KISSANE D, et al. The factor structure and use of the Demoralization Scale (DS-IT) in Italian cancer patients[J]. Psychooncology, 2017, 26(11): 1965-1971. doi: 10.1002/pon.4413 [4] JULIÃO M, NUNES B, BARBOSA A. Prevalence and factors associated with demoralization syndrome in patients with advanced disease: Results from a cross-sectional Portuguese study[J]. Palliat Support Care, 2016, 14(5): 468-473. doi: 10.1017/S1478951515001364 [5] VEHLING S, KISSANE D W, LO C, et al. The association of demoralization with mental disorders and suicidal ideation in patients with cancer[J]. Cancer, 2017, 123(17): 3394-3401. doi: 10.1002/cncr.30749 [6] 杨培金, 张弘娟. 肝癌介入术后患者失志综合征与其焦虑、抑郁及希望水平的关系[J]. 国际精神病学杂志, 2020, 47(6): 1231-1233. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202006042.htmYANG P J, ZHANG H J. The level of syndrome of loss mind in liver cancer patients undergoing interventional therapy and Its relationship with anxiety, depression and hope[J]. Journal Of International Psychiatry, 2020, 47(6): 1231-1233. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202006042.htm [7] 沈艺南, 白雪莉, 梁廷波. 2017美国国立综合癌症网络胰腺癌诊断与治疗指南(V1版)更新解读[J]. 中华消化外科杂志, 2017, 16(4): 327-329. doi: 10.3760/cma.j.issn.1673-9752.2017.04.002SHEN Y N, BAI X L, LIANG T B. Updated understanding on the National Comprehensive Cancer Network guidelines (version 1. 2017) for diagnosis and treatment of pancreatic adenocarcinoma[J]. Chinese Journal of Digestive Surgery, 2017, 16(4): 327-329. doi: 10.3760/cma.j.issn.1673-9752.2017.04.002 [8] 洪晓琪, 陈虹文, 张义芳, 等. 癌症病人失志量表中文版之信效度检测[J]. 内科学志, 2010, 21(6): 427-435.HONG X Q, CHEN H W, ZHANG Y F, et al. Reliability and validity of the Chinese version of the Cancer Patient Disengagement Scale[J]. Journal of Internal Medicine of Taiwan, 2010, 21(6): 427-435. [9] 姜乾金. 领悟社会支持量表[J]. 中国行为医学科学, 2001, 10(10): 41-43. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201813017.htmJIANG Q J. Perceived social support scale[J]. Chinese Journal of Behavioral Medical Science, 2001, 10(10): 41-43. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201813017.htm [10] 武燕燕, 姜亚芳. 癌症患者自我感受负担的调查与分析[J]. 护理管理杂志, 2010, 10(6): 405-407. doi: 10.3969/j.issn.1671-315X.2010.06.011WU Y Y, JIANG Y F. Investigation and analysis of the self-perceived burden among cancer patients[J]. Journal of Nursing Administration, 2010, 10(6): 405-407. doi: 10.3969/j.issn.1671-315X.2010.06.011 [11] 梁寅寅, 甘秀妮, 王玉琼. 癌症患者失志状况及影响因素研究[J]. 重庆医科大学学报, 2017, 42(9): 1178-1182. https://www.cnki.com.cn/Article/CJFDTOTAL-ZQYK201709024.htmLING Y Y, GAN X N, WANG Y Q. Research on demoralization and related factors in cancer patients[J]. Journal of Chongqing Medical University, 2017, 42(9): 1178-1182. https://www.cnki.com.cn/Article/CJFDTOTAL-ZQYK201709024.htm [12] 张利霞, 张贤贤, 贾智慧, 等. 中青年妇科癌症患者失志水平及影响因素研究[J]. 现代预防医学, 2020, 47(7): 1215-1218. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202007018.htmZHANG L X, ZHANG X X, JIA Z H, et al. Demoralization and its influencing factors of young and middle-aged gynecological cancer patients[J]. Modern Preventive Medicine, 2020, 47(7): 1215-1218. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202007018.htm [13] 李丹. 结直肠癌术后患者失志综合征的高危因素分析[J]. 护理实践与研究, 2020, 17(8): 18-20. doi: 10.3969/j.issn.1672-9676.2020.08.006LI D. Analysis of high-risk factors of demoralization syndrome of patients after colorectal cancer surgery[J]. Nursing Practice and Research, 2020, 17(8): 18-20. doi: 10.3969/j.issn.1672-9676.2020.08.006 [14] 安冬, 魏清风, 欧阳敏, 等. 结直肠癌术后患者失志症候群及影响因素分析[J]. 护理学杂志, 2019, 34(15): 74-77. doi: 10.3870/j.issn.1001-4152.2019.15.074AN D, WEI Q F, OUYANG M, et al. Status of demoralization among post-operative colorectal cancer patients: the influencing factors[J]. Journal of Nursing Science, 2019, 34(15): 74-77. doi: 10.3870/j.issn.1001-4152.2019.15.074 [15] 李艳, 黄永霞, 陆晴, 等. 肺癌患者住院期间支持性照顾需求现况调查及影响因素分析[J]. 中华全科医学, 2019, 17(12): 2115-2118. doi: 10.16766/j.cnki.issn.1674-4152.001141LI Y, HUANG Y X, LU Q, et al. Investigation on the status of supportive care needs of patients with lung cancer during hospitalization and analysis of influencing factors[J]. Chinese Journal of General Practice, 2019, 17(12): 2115-2118. doi: 10.16766/j.cnki.issn.1674-4152.001141 [16] 闫寒, 李兵. 生命回顾干预对胰腺癌患者自我感受负担与幸福感的影响[J]. 中国实用护理杂志, 2018, 34(10): 737-742. doi: 10.3760/cma.j.issn.1672-7088.2018.10.004YAN H B, LI B. Effect of life retrospective intervention on self perceived burden and well-being of patients with pancreatic cancer[J]. Chinese Journal of Practical Nursing, 2018, 34(10): 737-742. doi: 10.3760/cma.j.issn.1672-7088.2018.10.004 [17] TANG S T, HSIEH C H, CHIANG M C, et al. Impact of high self-perceived burden to others with preferences for end-of-life care and its determinants for terminally ill cancer patients: A prospective cohort study[J]. Psychooncology, 2017, 26(1): 102-108. doi: 10.1002/pon.4107 [18] 海展, 海川. 卵巢癌术后患者复发恐惧情况与领悟社会支持的相关性分析[J]. 临床护理杂志, 2021, 20(1): 36-39. doi: 10.3969/j.issn.1671-8933.2021.01.012HAI Z, HAI C. Correlation analysis of recurrent fear and perceived social support in postoperative ovarian cancer patients[J]. Journal of Clinical Nursing, 2021, 20(1): 36-39. doi: 10.3969/j.issn.1671-8933.2021.01.012 -
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