【作者】 张宁；

【导师】 吴子敬；

【作者基本信息】 中国医科大学 ， 护理学（专业学位）， 2024， 硕士

【摘要】 目的:本研究旨在调查结直肠癌患者术后重返工作准备度的现状,并分析结直肠癌患者术后重返工作准备度的影响因素。方法:本研究使用会聚平行混合性研究方法。量性研究部分使用横断面研究设计,采用便利抽样方法,于2022年10月至2023年7月选取沈阳市某两所三级甲等医院的210例结直肠癌术后患者作为研究对象。使用一般资料调查表、重返工作准备度量表、凯斯勒心理困扰量表、重返工作自我效能问卷、领悟社会支持量表、癌症疲乏量表以及社会影响量表作为研究工具收集资料。使用SPSS26.0软件进行资料分析,通过Mann-Whitney U检验和Kruskal-Wallis H检验分析一般资料对患者重返工作准备度的影响,通过Spearman检验分析患者社会支持、重返工作自我效能、疲乏感、心理困扰和病耻感与重返工作准备度的相关性,通过有序多分类logistic回归和二分类logistic回归分析未返岗与已返岗患者重返工作准备度的影响因素。质性研究部分采用描述性质性研究方法,运用目的抽样法选取12位结直肠癌术后患者进行面对面半结构访谈,并借助Nvivo 11.0软件使用内容分析法对资料进行整理和分析,并探索患者重返工作过程中的促进及阻碍因素。结果:量性研究部分结果:(1)210例结直肠癌患者中,未返回工作岗位的患者有136例,术后中位时间为3个月。已经返回工作岗位的患者有74例,术后中位时间为6个月。未返岗结直肠癌患者术后重返工作准备度水平较低,以意向阶段和前意向阶段为主;已返岗结直肠癌患者术后重返工作准备度水平较高,以主动维持阶段为主。(2)单因素分析结果显示:年龄、文化程度、家庭人均月收入、疾病分期、治疗方式、合并其他慢性疾病、患病前职业类型和患病前工作性质在未返回工作岗位的结直肠癌患者术后重返工作准备度方面的差异具有统计学意义(P<0.05);年龄、疾病分期、患病前职业类型和患病前每日工作时间在已经返回工作岗位的结直肠癌患者术后重返工作准备度方面差异有统计学意义(P<0.05)。(3)相关分析结果显示:对于未返岗与已返岗结直肠癌术后患者,社会支持(r_s=0.718;r_s=0.436)、重返工作自我效能(r_s=0.591;r_s=0.437)与重返工作准备度水平呈正相关,心理困扰(r_s=-0.540;r_s=-0.296)、疲乏感(r_s=-0.582;r_s=-0.487)和病耻感(r_s=-0.613;r_s=-0.323)与重返工作准备度水平呈负相关。(4)回归分析结果显示:未返岗结直肠癌患者术后重返工作准备度的保护因素包括年龄40～50岁(OR=6.931,P=0.023)、家庭人均月收入<3000元(OR=92.481,P<0.001)、社会支持(OR=1.127,P=0.014)和重返工作自我效能(OR=3.248,P=0.049),危险因素包括体力劳动(OR=0.115,P=0.048)、心理困扰(OR=0.862,P=0.019)、疲乏感(OR=0.893,P=0.024)和病耻感(OR=0.857,P=0.005)。已返岗患者重返工作准备度的保护因素包括疾病分期II期(OR=56.666,P=0.015)、社会支持(OR=1.192,P=0.018)和重返工作自我效能(OR=15.031,P=0.017),危险因素包括患病前工作时间8小时/天(OR=0.010,P=0.032)、患病前工作时间>8小时/天(OR=0.010,P=0.001)和疲乏感(OR=0.838,P=0.023)。质性研究部分结果:通过对12名结直肠癌术后患者进行半结构访谈,影响结直肠癌术后患者重返工作过程的促进因素最终归纳为3个主题,分别是经济压力、社会支持(包括家人支持和工作场所支持2个亚主题)以及工作益处(包括工作有助于分散疾病注意力、有助于回归正常社交以及有助于实现自我价值3个亚主题)。阻碍因素归纳为3个主题,分别是疾病因素(包括造口护理不便、疾病不确定性、排便功能障碍以及身体虚弱4个亚主题)、造口羞耻以及高强度工作。结论:(1)结直肠癌患者术后一年内的重返工作率较低。未返岗结直肠癌患者术后重返工作准备度以前意向和意向阶段为主;已返岗患者术后重返工作准备度以主动维持阶段为主。(2)结直肠癌患者术后重返工作准备度水平受多种因素的影响,涵盖个人因素(年龄、重返工作自我效能、心理困扰和病耻感)、环境因素(社会支持)、疾病因素(癌症分期、身体虚弱、排便功能障碍、疾病不确定性、造口护理不便和疲乏感)、工作因素(患病前工作性质、患病前每日工作时间和工作益处)和经济因素。因此,临床医护人员应该将影响结直肠癌患者术后重返工作准备度的因素纳入到日常工作中,从而识别重返工作准备度水平较低的患者,并针对延迟复工风险较高以及工作维持度较低的患者提供全面的职业康复相关指导,帮助患者提高重返工作准备度水平。更多还原

【Abstract】 Objective:This study was aimed to investigate the current status and analyze the predictors of readiness for return to work in postoperative patients with colorectal cancer.Methods:This study used convergent parallel mixed methods design.A cross-sectional study was conducted among 210 postoperative patients with colorectal cancer at two tertiary hospitals in Shenyang between November 2022 and July 2023.The General information questionnaire,Kessler Psychological Distress Scale(K10),Perceived Social Support Scale(PSSS),Return-to-Work Self-efficacy(RTW-SE),Cancer Fatigue Scale(CFS),Social Impact Scale(SIS),and Readiness for Return-to-Work Scale(RRTW)were used to collect data.The data were analyzed using SPSS26.0.Mann-Whitney U test and Kruskal-Wallis H test were used to analyze the influence of general information on patients’readiness for return to work.Spearman test was used to analyze the correlation between patients’social support,return-to-work self-efficacy,cancer fatigue,psychological distress and stigma and their readiness for return to work.Ordinal multinomial logistic regression and binary logistic regression were used to analyze the influencing factors of readiness for return to work of patients who did not return to work and those who returned to work.A descriptive qualitative study was carried out from November 2022 to July 2023 at two tertiary hospitals in Shenyang.A total of 12 colorectal cancer patients were selected by purposive sampling for face-to-face semi-structured interviews.The data were organized and analyzed by Nvivo 11.0 software using content analysis method,in order to explore the promoting and hindering factors of patients’return for work.Results:Cross-sectional study results:(1)Among 210 patients with colorectal cancer,136patients did not return to work,and the median postoperative time was 3 months.74patients had returned to work with a median postoperative time of 6 months.The readiness for return to work of postoperative colorectal cancer patients who have not returned to work was at a low level,mainly in the contemplation stage and the pre-contemplation stage,and patients who have returned to work was at a high level,mainly in the active maintenance stage.(2)The univariate results showed that age,education,family per capita monthly income,cancer stage,treatment method,combined with other chronic diseases,work type,and work nature before diagnosis had statistically significant differences in the readiness for return to work among colorectal cancer patients who did not return to work(P<0.05).Age,cancer stage,and work time before diagnosis were statistically differences in the readiness for return to work among colorectal cancer patients who had returned to work(P<0.05).(3)The results of correlation analysis showed that for postoperative colorectal cancer patients who did not return to work and returned to work,social support(r_s=0.718;r_s=0.436)and return-to-work self-efficacy(r_s=0.591;r_s=0.437)were positively correlated with their readiness for return to work,and psychological distress(r_s=-0.540;r_s=-0.296),cancer fatigue(r_s=-0.582;r_s=-0.487)and stigma(r_s=-0.613;r_s=-0.323)were negatively correlated with their readiness for return to work.(4)Regression analysis results showed that the protective factors of readiness for return to work in patients with colorectal cancer who did not return to work included age40-50 years(OR=6.931,P=0.023),family per capita monthly income<3000 RMB(OR=92.481,P<0.001),social support(OR=1.127,P=0.014),and self-efficacy(OR=3.248,P=0.049),and the risk factors included physical labor(OR=0.115,P=0.048),psychological distress(OR=0.862,P=0.019),cancer fatigue(OR=0.893,P=0.024),and stigma(OR=0.857,P=0.005).The protective factors of readiness for return to work of patients who had returned to work included disease stage II(OR=56.666,P=0.015),social support(OR=1.192,P=0.018),and self-efficacy to return to work(OR=15.031,P=0.017),and the risk factors included work time 8 hours(OR=0.010,P=0.032)and>8 hours every day(OR=0.010,P=0.001)and cancer fatigue(OR=0.838,P=0.023).Descriptive qualitative study results:Through the semi-structured interviews of 12postoperative patients with colorectal cancer after surgery,the facilitating factors of return to work in patients with colorectal cancer included economic pressure,social support(family support and workplace support)and work benefits(work helps to distract from illness,helps to return to normal social life,and helps to realize self-worth).The hindering factors of return to work in patients with colorectal cancer included disease factors(inconvenience of stoma care,disease uncertainty,defecation dysfunction,and physical weakness),stoma shame,and high-intensity work.Conclusions:(1)A low proportion of patients with colorectal cancer returned to work within one year after diagnosis.Colorectal cancer patients who have not returned to work after surgery have a low level of readiness for return to work,mainly in the stage of pre-contemplation and contemplation.Patients who have returned to work have a high level of readiness for return to work after surgery,mainly in the active maintenance stage.(2)The readiness for return to work among postoperative patients with colorectal cancer was affected by multiple factors,including personal factors(age,return-to-work self-efficacy,psychological distress,and stigma),environmental factor(social support),disease factors(cancer stage,physical weakness,defecation dysfunction,disease uncertainty,inconvenience of stoma care,and cancer fatigue),work factors(work nature before diagnosis,daily work hours before diagnosis,and work benefits),and economic factors.Therefore,clinical medical staff should incorporate the factors affecting the readiness for return to work among colorectal cancer into their daily work,so as to identify patients with a low level of readiness for return to work,and provide comprehensive vocational rehabilitation related guidance for patients with a high risk of delayed return to work and a low level of work maintenance,so as to help patients improve their readiness for return to work.更多还原