【作者】 张艳；

【导师】 胡德英；

【作者基本信息】 华中科技大学 ， 护理（专业学位）， 2023， 硕士

【摘要】 目的:描述妇科恶性肿瘤患者的心理弹性现状及影响因素,探讨明确各影响因素对妇科恶性肿瘤患者心理弹性的作用路径;同时从心理弹性角度出发,深入探讨妇科恶性肿瘤患者患病过程的真实体验,剖析心理弹性的危险因素及保护因素,为今后实施妇科恶性肿瘤患者心理弹性干预措施提供借鉴和参考依据。方法:本研究采用混合方法研究中的解释性序列设计,先进行量性研究分析,接着依据量性研究结果设计质性研究,质性研究结果用于解释或扩展量性研究结果。第一部分:采用方便抽样法,于2021年12月到2022年6月选取武汉市1家三级甲等综合医院肿瘤中心满足本研究纳入排除标准的224例妇科恶性肿瘤患者作为研究对象。采用一般资料调查表、心理弹性量表(CD-RISC)、家庭关怀度指数量表(APGAR)、医学应对量表(MCMQ)、抑郁-焦虑-压力量表(DASS-21)对其开展调查,分析妇科恶性肿瘤患者心理弹性现状及影响因素。采用SPSS24.0和AMOS25.0统计软件对数据进行处理,运用描述性统计分析、单因素分析、相关性分析、多元线性回归分析和路径分析等统计学方法分析妇科恶性肿瘤患者心理弹性影响因素及各影响因素间的作用路径。第二部分:以目的抽样的方法选取量性研究中不同心理弹性水平的妇科恶性肿瘤患者进行质性访谈,采用NVivo12.0软件基于描述性质性研究方法对访谈文本资料进行分析。结果:量性研究描述性统计分析结果显示:妇科恶性肿瘤患者心理弹性平均得分为(50.88±15.17),家庭关怀度平均得分为(7.41±2.84),医学应对中面对、回避、屈服各个维度平均得分分别为(16.84±4.62)、(10.06±3.20)、(14.60±2.12),抑郁-焦虑-压力平均得分分别为(4.90±1.17)、(4.29±1.15)、(6.41±2.26)。单因素分析结果显示,不同社会人口学特征的妇科恶性肿瘤患者心理弹性比较,年龄、文化程度、户口所在地、家庭人均月收入、医疗费用承担方式差异有统计学意义(P<0.05)。相关性分析结果显示:妇科恶性肿瘤患者家庭关怀度与心理弹性呈正相关(r=0.463,P<0.05);面对与心理弹性呈正相关(r=0.418,P<0.05),回避与心理弹性呈正相关(r=0.243,P<0.05),屈服与心理弹性呈负相关(r=-0.464,P<0.05);抑郁-焦虑-压力与心理弹性呈负相关(r=-0.609,P<0.05)。多元线性回归分析结果显示:妇科恶性肿瘤患者心理弹性=3.818*文化程度+0.784*家庭关怀度-0.919*负性情绪。路径分析结果显示:家庭关怀度对妇科恶性肿瘤患者心理弹性的直接预测作用不显著,应对方式、负性情绪在患者家庭关怀度与心理弹性间起完全中介作用,并存在链式中介作用。家庭关怀度、面对、回避、屈服、负性情绪对心理弹性的总效应值分别为0.413、0.186、0.200、-0.356、-0.564。本研究中结构方程模型各变量的标准化系数效应指标显示,家庭关怀度可通过应对方式和负性情绪间接影响心理弹性,家庭关怀度对面对有直接正效应(β=0.285,P<0.05),对屈服和负性情绪有直接负向效应(β=-0.342,-0.422,P<0.05),面对对心理弹性有直接正向效应(β=0.186,P<0.05),回避对心理弹性有直接正向效应(β=0.200,P<0.05),屈服对心理弹性有直接负向效应(β=-0.139,P<0.05),负性情绪对心理弹性有直接负向效应(β=-0.564,P<0.05)。质性研究结果显示:妇科恶性肿瘤患者心理弹性的影响因素根据类别分为危险因素和保护因素两大类。其中,危险因素主要包括个人危险因素(防御性应对、消极认知)、疾病危险因素(疾病不确定性、疾病恐惧感、疾病症状困扰)、环境危险因素(医疗环境、经济环境);保护因素主要包括个人保护因素(勇敢应对、积极认知)、家庭保护因素(家庭情感支持、家庭资源支持)、社会保护因素(社会融合、医疗保健资源)。结论:妇科恶性肿瘤患者心理弹性处于较低水平,亟需引起重视;年龄、文化程度、户口所在地、家庭人均月收入、医疗费用承担方式是妇科恶性肿瘤患者心理弹性的影响因素,妇科恶性肿瘤患者心理弹性=3.818*文化程度+0.784*家庭关怀度-0.919*负性情绪;家庭关怀度对妇科恶性肿瘤患者心理弹性的直接预测作用不显著,医学应对和负性情绪在妇科恶性肿瘤患者家庭关怀度与心理弹性间起完全中介作用,并存在链式中介作用,家庭关怀度可以通过屈服和负性情绪预测心理弹性;妇科恶性肿瘤患者心理弹性影响因素由危险因素和保护因素构成,应重视妇科恶性肿瘤患者心理弹性的建设,从医护、社会、家庭、个人不同层面有针对性地实施相应干预措施以提高心理弹性水平。更多还原

【Abstract】 Objectives: To describe the status of psychological resilience of patients with gynecologic malignancies and the influencing factors,to explore the pathway to clarify the role of each influencing factor on the psychological resilience of patients with gynecologic malignancies,and to explore the real experience of patients with gynecologic malignancies during their illness from the perspective of psychological resilience,to analyze the risk factors and protective factors of psychological resilience,and to provide reference and basis for the implementation of psychological resilience interventions for patients with gynecologic malignancies in the future.Methods: This study used an explanatory sequence design in a mixed methods study.A quantitative study analysis was conducted followed by a qualitative study design based on the results of the quantitative study,and the results of the qualitative study were used to interpret or extend the results of the quantitative study.Part I: A convenience sampling method was used to select 224 patients with gynecologic malignancies who met the inclusion and exclusion criteria of this study from December 2021 to June 2022 in an oncology center of a tertiary care general hospital in Wuhan.The General Information Questionnaire,the Connor-Davidson Resilience Scale(CD-RISC),the Family APGAR Index(APGAR),the Medical Coping Modes Questionnaire(MCMQ)and the Depression Anxiety and Stress Scale(DASS-21)were used to investigate them and analyze the current psychological resilience of gynecologic malignancy patients and the influencing factors.SPSS24.0 and AMOS25.0 statistical software were used to process the data,and statistical methods such as descriptive analysis,one-way analysis,correlation analysis,multiple linear regression analysis and path analysis were applied to analyze the factors influencing psychological resilience of gynecologic malignancy patients and their mechanisms of action.Part Ⅱ: Qualitative interviews were conducted with patients with different levels of psychological resilience in gynecologic malignancies in the quantitative study selected by purposive sampling,and the interview text data were analyzed using NVivo 12.0 software based on the thematic analysis.Results: The results of the descriptive analysis of the quantitative study showed that the mean score of psychological resilience in patients with gynecologic malignancies was(50.88±15.17),the mean score of family caring was(7.41±2.84),the mean scores of each dimension of medical coping were(16.84±4.62),(10.06±3.20),(14.60±2.12),and the mean depression-anxiety-stress scores were(4.90±1.17),(4.29±1.15),and(6.41±2.26),respectively.The results of univariate analysis showed that the differences in psychological resilience of gynecologic malignancy patients with different sociodemographic characteristics were statistically significant(P < 0.05)when comparing age,education,household location,per capita monthly household income,and mode of medical cost bearing.The results of correlation analysis showed that family care degree of gynecologic malignancy patients was positively correlated with psychological resilience(r=0.463,P<0.05).Confrontation was positively correlated with psychological resilience(r=0.418,P<0.05),avoidance was positively correlated with psychological resilience(r=0.243,P<0.05),and submission was negatively correlated with psychological resilience(r=-0.464,P<0.05).Depression-anxiety-stress was negatively correlated with psychological resilience(r=-0.609,P<0.05).The results of multiple linear regression analysis showed that psychological resilience in patients with gynecologic malignancies = 3.818 * literacy +0.784 * family care-0.919 * negative emotions.The results of path analysis showed that the direct predictive effect of family caring degree on psychological resilience of patients with gynecologic malignancies was not significant,and coping style and negative emotion played a fully mediated role between patients’ family caring degree and psychological resilience,and there was a chain mediation effect.The total effect values of family care,confrontation,avoidance,submission,and negative emotion on psychological resilience were 0.413,0.186,0.200,-0.356,and-0.564,respectively.Standardized coefficient effect indicators for each variable of the structural equation model in this study showed that family care could indirectly affect psychological resilience through coping style and negative emotion,and family care had a direct positive effect on confrontation(β=0.285,P<0.05),a direct negative effect on submission and negative emotions(β=-0.342,-0.422,P<0.05),a direct positive effect of confrontation on psychological resilience(β=0.186,P<0.05),a direct positive effect of avoidance on psychological resilience(β=0.200,P<0.05),and a direct negative effect of submission on psychological resilience(β=-0.139,P<0.05),and negative emotions had a direct negative effect on psychological resilience(β=-0.564,P<0.05).The results of the qualitative study showed that the factors influencing the psychological resilience of patients with gynecologic malignancies were divided into two categories,risk factors and protective factors,according to the categories.Among them,risk factors mainly include personal risk factors(defensive coping,negative cognition),disease risk factors(disease uncertainty,disease fear,disease symptom distress),and environmental risk factors(medical environment,economic environment).Protective factors mainly include personal protective factors(brave coping,positive cognition),family protective factors(family emotional support,family resource support),and social protective factors(social integration,health care resources).Conclusions: The psychological resilience of gynecologic malignancy patients is at a low level and needs urgent attention.Age,education level,household location,per capita monthly family income,and medical cost bearing mode are the influencing factors of psychological resilience of gynecologic malignancy patients,psychological resilience of gynecologic malignancy patients = 3.818*education level + 0.784*family care degree-0.919*negative emotion.The direct predictive effect of family care degree on psychological resilience of gynecologic malignancy patients is not significant.Medical coping and negative emotion play a fully mediating role between family care degree and psychological resilience of gynecologic malignancy patients,and there is a chain mediating effect.Family care degree can predict psychological resilience through submission and negative emotion.The factors influencing psychological resilience of gynecologic malignancy patients are composed of risk factors and protective factors.Attention should be paid to the construction of psychological resilience of gynecologic malignancy patients.The construction of psychological resilience of patients should be paid attention to,and the corresponding interventions should be implemented in a targeted manner from different levels of medical care,society,family and individual to improve psychological resilience.更多还原