【作者】 张莹；

【导师】 于晓松；

【作者基本信息】 中国医科大学 ， 公共卫生（专业学位）， 2021， 硕士

【摘要】 目的:基于单纯使用治愈率和生存率作为指标评估癌症的治疗效果不太符合对癌症特性的判断,于是当今世界更多的采用对癌症患者生命质量进行评价作为主要评估方式。由世界卫生组织制定的三大治癌目标中就包含对生命质量提升的指标当前学界对口腔癌的临床研究中也越来越多地将生命质量评估与传统的临床表现综合评估开展研究。本研究旨在探索中国口腔癌患者生命质量的现状和分布规律;并且着重研究口腔癌患者病耻感与其生命质量的关系;在此基础上分别引入个体可利用的外部心理资源(如社会支持)和内部心理资源(如心理弹性),探讨它们是否在口腔癌患者病耻感与生命质量之间起到双重中介作用。最后根据研究结果,为提高口腔癌患者生命质量提供科学依据。研究方法:本研究采用便利抽样方法,于2018年2月到2019年7月分别在辽宁省沈阳市中国医科大学附属口腔医院和中国医科大学附属第一医院选取符合入选标准的来院进行治疗的口腔癌患者进行自填式问卷调查。此次调查共发放271份问卷,最终收回有效问卷230份,问卷有效回收率为84.87%。本研究采用头颈部肿瘤患者生活质量测定量表(Functional Assessment of Cancer Therapy-Head and Neck,FACT-H&N)测量口腔癌患者生命质量状况;采用社会影响量表(Social Impact Scale,SIS)测量口腔癌患者的病耻感程度;应用领悟社会支持量表(Perceived Social Support Scale,PSSS)测量口腔癌患者的领悟社会支持水平;应用自我韧性量表(Ego-Resiliency Scale,ER89)测量口腔癌患者的心理弹性水平;应用一般情况调查 问卷调查口腔癌患者的人口学和疾病相关因素。单因素方差分析和t检验被用于比较不同人口统计学资料的口腔癌患者的生命质量的差异;Pearson相关分析被用于评估口腔癌患者生命质量与病耻感、社会支持和心理弹性之间的相关性;多元线性分层回归分析被用于确定口腔癌患者生命质量的影响因素与其作用大小;多元线性分层回归分析还被用于初步验证社会支持和心理弹性在病耻感与生命质量之间的中介效应。最后Bootstrap法被用于验证社会支持和心理弹性的中介作用。结果:口腔癌患者生命质量平均得分为93.04±20.02。患者的性别、年龄、婚姻状况、居住地以及是否吸烟、是否切除部分下颌骨、是否伴随远处转移可能是生命质量的影响因素。在控制了混杂因素的影响之后,患者的病耻感、社会支持、心理弹性都是生命质量的重要影响因素,分别解释了生命质量38.5%、6.4%和5.2%的变异量。并且社会支持和心理弹性在口腔癌患者的病耻感对生命质量的关系之间均起到不完全的中介作用,且社会支持的相对中介效应值为10.4%,心理弹性的相对中介效应值为12.36%。结论:相较于其他癌症人群,口腔癌患者生命质量得分更低。口腔癌患者的病耻感强度,领悟社会支持的能力和心理弹性水平都是其生命质量的影响因素;病耻感程度越高的口腔癌患者生命质量水平更低;社会支持和心理弹性都是有助于改善口腔癌患者心理健康并提高生命质量的积极心理资源。并且社会支持和心理弹性都在口腔癌患者病耻感与生命质量之间起到不完全中介作用。因此,卫生健康部门应当更加注重疾病相关知识的科普工作;医护工作者在进行常规护理工作的时候,应该对于患者的心理状况给予更多的关心;患者家属在日常生活中,给予患者更多的心理安慰;更重要的是,患者本人应积极学习积极应对方式、正念培训等措施发展和提升心理弹性水平来解除心理困扰,以达到提高患者生命质量的目的。更多还原

【Abstract】 Objective:Because it’s difficult to evaluate the curative effect of cancer with cure rate and the evaluation effect of survival rate is relatively limited,quality of life(QoL)assessment in cancer field became the mainstream direction of QoL research.The World Health Organization(WHO)also has identified improving QoL as one of the three major targets of cancer treatment.In the research of oral cancer,it also has become a trend to combine QoL assessment with traditional clinical endpoints.The purpose of our study was to explore the status and distribution of QoL in oral cancer patients.The relationship between stigma and QoL was studied.On this basis,social support and resilience were introduced to explore whether social support and mental resilience played a mediating role in the relationship between stigma and QoL.Based on the results,we will provide scientific basis for improving QoL of patients with oral cancer.Methods:In this study,oral cancer patients in the Department of Stomatology,Shengjing Hospital of China Medical University and Stomatology Hospital of China Medical University in Liaoning Province,China were recruited by convenience sampling to complete self-administered questionnaires.271 questionnaires were distributed and 230 questionnaires were collected.The effective response rate was 84.87%.The Functional Assessment of Cancer Therapy-Head and Neck(FACT-H&N)was used to measure the QoL of oral cancer patients.The Social Impact Scale(SIS)was used to measure the stigma of oral cancer patients.the Multidimensional Scale of Perceived Social Support(PSSS)was used to measure the perceived social support of oral cancer patients.The Ego-Resiliency Scale(ERS)was used to measure the level of resilience among oral cancer patients.The general situation questionnaire was used to investigate demographic and clinical-related factors in oral cancer patients.One-way ANOVA and t-test were used to compare the difference of quality of life among oral cancer patients in different general characteristics;Pearson correlation analysis was used to evaluate the relationship between QoL and its related factors in oral cancer patients;hierarchical regression analysis was used to explore the effects of influencing factors of QoL,and to explore whether the social support and resilience mediates the relationship between stigma and QoL.Finally,we use the Bootstrap method to verify the mediating effect of social support and resilience.Results:The average score of QoL of oral cancer patients was 93.04±20.02.Gender,age,marital status,residence,smoking,partial mandibular resection,and distant metastasis might be the influencing factors of QoL.After controlling the covariate variables,stigma,social support and resilience were all important influencing factors of QoL,which accounted for 38.5%,6.4%,and 5.2%variance of QoL,respectively.Moreover,both social support and resilience played an incomplete mediating role in the relationship between stigma and QoL in oral cancer patients.Conclusion:Compared with other cancer populations,patients with oral cancer were suffer from lower QoL.The stigma intensity,the ability to perceive social support and the level of psychological resilience are all factors affecting their QoL;the higher the stigma of oral cancer patients,the lower QoL;social support and psychological resilience are both positive psychological resources which could improve the mental health of patients with oral cancer and improve the QoL.In addition,social support and resilience both play an incomplete mediating role between stigma and QoL among patients with oral cacner.Therefore,the health department should pay more attention to the popularization of disease-related knowledge;medical workers should pay more attention to the patient’s psychological condition when performing routine nursing work;the family members of the patient should give patients more attention in their daily lives psychological comfort;more importantly,by mastering active coping strategies,mindfulness training and other measures to develop and improve the level of psychological flexibility to alleviate the psychological distress of patients,so as to achieve the purpose of improving the quality of life of patients.更多还原