Current situation of anticipatory sadness and its influencing factors among primary caregivers of terminal stage cancer patients
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摘要:
目的 分析肿瘤终末期患者主要照顾者预期性悲伤(AG)现状，并分析影响主要照顾者AG的因素，从而为减轻主要照顾者AG提供理论依据。 方法 以2020年2月—2023年10月绍兴市人民医院收治的188例肿瘤终末期患者的主要照顾者为研究对象。采用一般资料调查量表、预期性悲伤量表(AGS)、照顾负担量表(ZBI)、心理弹性量表(CD-RISC10)、领悟社会支持量表(PSSS)进行横断面调查，采用Pearson相关性分析研究上述量表间的相关性，采用多重线性回归分析研究主要照顾者AG的影响因素。 结果 肿瘤终末期患者主要照顾者AGS得分、ZBI得分处于中等偏上水平，CD-RISC10得分、PSSS得分处于中等偏下水平。AGS得分与ZBI得分呈正相关关系(r=0.849，P < 0.001)，与CD-RISC10得分(r=-0.863，P < 0.001)、PSSS得分(r=-0.652，P < 0.001)呈负相关关系；ZBI得分与CD-RISC10得分(r=-0.797，P < 0.001)、PSSS得分(r=-0.734，P < 0.001)呈负相关关系；CD-RISC10得分与PSSS得分呈正相关关系(r=0.725，P < 0.001)。多重线性回归分析结果显示，性别、与患者的关系、医疗费用支付方式、对疾病了解情况、接受死亡教育、工作状态、ZBI、CD-RISC10、PSSS均为影响AGS的相关因素(P < 0.05)。 结论 肿瘤终末期患者主要照顾者AG得分较高，且女性、患者的配偶、家庭经济条件一般、对疾病不了解、心理弹性和领悟社会支持较低，而照顾负担中的主要照顾者预期性悲伤更为明显。 Abstract:Objective To analyze the present situation of the expected sadness of the main caregivers of patients with terminal cancer and identify influencing factors, thereby providing a theoretical basis for alleviating the anticipatory grief (AG) of the main caregivers. Methods The main caregivers of 188 patients with terminal cancer in Shaoxing People ' s Hospital from February 2020 to October 2023 were taken as the research object. A cross-sectional survey was carried out by using the general data survey scale, AGS, Zarit caregiver burden interview (ZBI), the 10-item Connor-Davidson resilience scale (CD-RISC10), and the perceived social support scale (PSSS), and Pearson correlation was used to analyze the correlation between the above scales. Multiple linear regression was used to analyze the factors affecting AGS, the main caregiver. Results The main caregivers of terminal cancer patients demonstrated moderately high scores on the AGS and ZBI scales, but moderately low scores on the CD-RISC10 and PSSS scales. AGS scores showed a significant positive correlation with ZBI scores (r=0.849, P < 0.001), while exhibiting negative correlations with both CD-RISC10 (r=-0.863, P < 0.001) and PSSS scores (r=-0.652, P < 0.001). ZBI was negatively correlated with CD-RISC10 (r=-0.797, P < 0.001) and PSSS (r=-0.734, P < 0.001). CD-RISC10 and PSSS were positively correlated (r=0.725, P < 0.001). The results of multiple linear regression showed that gender, relationship with patients, payment method of medical expenses, knowledge of diseases, death education, working status, ZBI, CD-RISC10, and PSSS were the related factors affecting AG (P < 0.05). Conclusion The main caregivers of terminal cancer patients exhibited elevated AGS scores, particularly among females, spouses of patients, those with modest household income, limited disease knowledge, and lower psychological resilience or perceived social support. Notably, anticipatory grief was more pronounced in caregivers with heavier caregiving burdens. -
表 1 肿瘤终末期患者主要照顾者AGS、ZBI、CD-RISC10、PSSS评分的相关性分析(r值)
Table 1. Correlation analysis of AGS, ZBI, CD-RISC-10, and PSSS scores in primary caregivers of patients with terminal cancer
项目 AGS ZBI CD-RISC10 ZBI 0.849 CD-RISC10 -0.863 -0.797 PSSS -0.652 -0.734 0.725 注：均P < 0.001。 
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表 2 不同特征肿瘤终末期患者的照顾者AGS得分比较
Table 2. Comparison of AGS scores of caregivers of end-stage cancer patients with different characteristics
项目 例(%) AGS得分(x±s, 分) 统计量 P值 性别 2.746a 0.007 男性 95(55.23) 74.68±15.53 女性 77(44.77) 80.45±12.02 年龄 2.945b 0.055 18~44岁 67(38.95) 77.63±8.39 45~60岁 80(46.51) 80.28±11.21 >60岁 25(14.53) 75.36±7.14 合并疾病 0.210b 0.811 0种 73(42.44) 79.65±10.52 1种 59(34.30) 78.48±8.40 >2种 40(23.26) 79.24±12.49 文化程度 3.822a < 0.001 初中及以下 59(34.30) 85.02±6.88 初中以上 113(65.70) 79.98±10.29 家庭人均月收入 3.077a 0.002 < 5 000元 96(55.81) 81.34±10.28 ≥5 000元 76(44.19) 77.06±7.96 医疗费用支付方式 2.948a 0.004 自费或新农合 81(47.09) 80.62±10.62 医保 91(52.91) 76.51±7.08 婚姻状况 0.063b 0.939 已婚 105(61.05) 79.50±12.02 未婚 37(21.51) 78.78±10.62 其他 30(17.44) 78.99±11.04 与患者的关系 2.852a 0.005 配偶 97(56.40) 80.97±11.25 其他 75(43.60) 77.02±6.78 身体状况 6.075b 0.003 好 39(22.67) 74.36±4.87 一般 65(37.79) 77.34±5.33 不好 68(39.54) 79.64±10.25 对疾病了解情况 4.889b 0.001 了解很多 42(24.42) 75.36±5.88 了解一些 71(41.28) 78.25±8.15 不了解 59(34.30) 81.02±11.21 接受死亡教育 3.867a < 0.001 有 49(28.49) 76.21±5.21 无 123(71.51) 81.14±11.48 工作状态 2.499a 0.013 在职 75(43.60) 76.38±8.22 无业 97(56.40) 80.25±12.05 心理弹性 13.287b < 0.001 差 51(29.65) 83.15±8.25 一般 84(48.84) 77.37±5.28 良好 37(21.51) 76.91±8.02 照顾负担 6.232b 0.002 轻度负担 29(16.86) 76.39±5.28 中度负担 74(43.02) 77.38±8.92 重度负担 69(40.12) 82.03±10.36 领悟社会支持 4.579b 0.012 低支持状态 49(28.49) 82.36±8.54 中间支持状态 87(50.58) 78.35±9.36 高支持状态 36(20.93) 77.36±6.28 注：a为t值，b为F值。
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表 3 各变量赋值情况
Table 3. Variable assignment situation
变量 赋值方法 性别 男性=0，女性=1 文化程度 初中及以下=0，初中以上=1 与患者的关系 配偶=0，其他=1 家庭人均月收入 < 5 000元=0，≥5 000元=1 医疗费用支付方式 自费或新农合=0，医保=1 身体状况 好=0，一般=1，不好=2 对疾病了解情况 了解很多=0，了解一些=1，不了解=2 接受死亡教育 有=0，无=1 工作状态 在职=0，无业=1 心理弹性 差=0，一般=1，良好=2 照顾负担 轻度负担=0，中度负担=1，重度负担=2 领悟社会支持 低支持=0，中间支持=1，高支持=2
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表 4 肿瘤终末期患者照顾者AG影响因素的多元线性回归分析
Table 4. Multiple linear regression analysis of influencing factors on AGS of caregivers of patients with terminal cancer
变量 B SE β t值 P值 性别 8.737 3.627 0.263 2.409 0.018 文化程度 2.954 5.205 0.165 0.567 0.571 与患者的关系 -8.909 1.473 -0.422 -6.048 < 0.001 家庭人均月收入 -3.307 2.212 -0.098 -1.495 0.138 医疗费用支付方式 -5.473 2.683 -0.314 -2.178 0.039 身体状况 11.566 7.541 0.730 1.534 0.127 对疾病了解情况 -5.409 2.673 -0.244 -2.024 0.045 接受死亡教育 -0.970 0.053 -0.821 -18.397 < 0.001 工作状态 -19.167 7.540 -0.439 -2.542 0.012 心理弹性 36.824 15.528 1.196 2.371 0.019 照顾负担 -18.859 9.061 -0.637 -2.081 0.039 领悟社会支持 -48.035 16.037 -1.558 -2.995 0.003
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