直肠癌永久性肠造口患者病耻感及影响因素分析

Analysis of stigma in patients with rectal cancer and permanent enterostomy and its influencing factors

目的：调查直肠癌永久性肠造口患者的病耻感水平并分析其影响因素。方法2013年9月—2014年10月采用便利抽样法选择我国中部地区某省6所三级甲等医院的101例直肠癌永久性肠造口患者，采用一般情况调查表及社会影响量表（SIS）调查其一般资料及病耻感水平，采用t检验、方差分析和线性多元逐步回归分析进行病耻感影响因素分析。结果101例直肠癌肠造口患者的SIS总分为（60.7±10.4）分，社会排斥、经济歧视、内在羞耻感、社会隔离维度得分分别为（21.8±4.3）、（8.0±1.9）、（12.7±2.5）、（18.2±3.6）分；各维度得分均高于普通癌症患者的常模，得分最高的5个条目依次为：我比平常更需要确定别人对我的关心、我的疾病影响我工作的稳定性、因为我的病我遇到一些令我难堪的状况、我曾因财务困难而影响到我对自己的感受、我觉得我的能力比生病前差。单因素及多因素分析结果显示，与医护人员的交流程度是直肠癌肠造口患者病耻感水平的影响因素（P＜0.05）。结论直肠癌肠造口患者的病耻感水平处于中等水平，与医护人员的交流程度是其影响因素；在患者住院期间，医护人员教会患者造口护理的技能及心理调适的方法，同时患者出院后做好延续性护理，告知患者造口专业门诊的信息，定期举办造口联谊会及造口知识讲座，与社区家庭护士做好交接，尽可能多地给予造口患者更多的支持与帮助。

Objective To investigate the stigma of patients with rectal cancer and permanent enterostomy and its influencing factors. Methods Totally 101 patients with rectal cancer and permanent enterostomy were selected from six tertiary hospitals of a province in central China from September 2013 to October 2014 by convenience sampling method. The questionnaire survey and social impact scale（ SIS） were used to investigate participants′ general information and stigma issues. T-test,analysis of variance （ANOVA）,and linear multivariate stepwise regression analysis were used to analyze the influencing factors of stigma. Results The total SIS score of 101 participants was（ 60.7±10.4）. The scores for social exclusion, economic discrimination,intrinsic stigma,and social isolation were（ 21.8±4.3）,（8.0±1.9）,（12.7±2.5） and （18.2±3.6）. The scores of all dimensions in SIS for patients with rectal cancer and enterostomy were higher than general cancer patients. The top five items were：need more concern,adverse impact on career,embarrassing conditions,economic burden,and worse health status. Single factor analysis and multiple-factor analysis indicated that the communication with doctors and nurses had an impact on patients′ stigma level（P 〈 0.05）. Conclusions The stigma of patients with rectal cancer and enterostomy was at a moderate level,and it can be influenced by the communication with medical staff. Thus,patients should be taught about the nursing skills and mental adjustment methods before their discharge. After their discharge,continuous nursing care and other supports（ e.g. providing professional information,organizing communicating and educational activities,and cooperating with community nurses） should be achieved.