基于主体-客体互倚模型分析结直肠癌患者和家庭主要照顾者的亲密关系对生活质量的影响研究

Impact of Intimate Relationship between Colorectal Cancer Patients and Their Primary Family Caregivers on Their Quality of Life:an Analysis Based on Actor-partner Interdependence Model

背景2019年数据显示,中国结直肠癌防控形势严峻。在亲密关系背景下,癌症患者与家庭主要照顾者以一个整体单元共同适应癌症。疾病自身及治疗不仅会影响患者,造成其生活质量低下,还会严重影响与其具有亲密关系的家庭主要照顾者。目的基于主体-客体互倚模型(APIM)分析结直肠癌患者和家庭主要照顾者的亲密关系对生活质量的影响,为临床干预提供理论依据。方法采取便利抽样法选取2018年11月-2019年5月收治于南方医科大学南方医院、云南省肿瘤医院、中山大学附属第六医院的结直肠癌患者及其家庭主要照顾者作为调查对象。采用关系评估量表(RAS)测量结直肠癌患者和家庭主要照顾者过去7 d对所处的亲密关系各方面的主观满意度,采用中文版简明健康SF-12量表评定结直肠癌患者和家庭主要照顾者过去7 d的生活质量。并建立结直肠癌患者和家庭主要照顾者的亲密关系与生活质量的APIM,分析患者和家庭主要照顾者的亲密关系对生活质量的影响。结果共发放296对问卷,有效问卷271对,有效回收率为91.6%。患者亲密关系得分与家庭主要照顾者的亲密关系、生理健康(PCS)及心理健康(MCS)得分均呈正相关(P<0.05),患者PCS得分与家庭主要照顾者的PCS及MCS得分呈正相关(P<0.05),患者MCS得分与家庭主要照顾者的MCS得分呈正相关(P<0.05)。APIM分析结果显示,在主体效应方面,家庭主要照顾者的亲密关系与自身MCS呈正相关(P<0.001);在客体效应方面,患者的亲密关系和家庭主要照顾者PCS呈正相关(P<0.001),家庭主要照顾者的亲密关系和患者PCS呈正相关(P<0.001)。结论结直肠癌患者的亲密关系可以正向预测家庭主要照顾者的生活质量,家庭主要照顾者的亲密关系可以正向预测自身以及患者的生活质量。

Background The data showed that the situation for colorectal cancer prevention and control is severe in China in 2019.As cancer patients and their primary family caregivers are closely associated,they adapt to the influence of cancer together.So cancer and related treatment can impair the quality of life in the patients as well as that of their intimate primary family caregivers.Objective To analyze the changes in quality of life of colorectal cancer patients and their primary family caregivers influenced by intimate patient-caregiver relationship based on actor-partner interdependence model(APIM),to provide a theoretical basis for delivering clinical interventions.Methods By use of convenience sampling,colorectal cancer patients treated in Nanfang Hospital,Yunnan Cancer Hospital,the Sixth Affiliated Hospital,Sun Yat-sen University and their primary family caregivers were enrolled during November 2018 to May 2019.Patients and their caregivers received a self-administered survey separately with the Relationship Assessment Scale(RAS)and the Chinese version of 12-item Short-Form Health Survey(SF-12-C)for collecting their subjective satisfaction with the patient-caregiver relationship,and their self-rated quality of life in the past 7 days.An APIM was established based on the survey results and was used to analyze the changes of quality of life in both groups influenced by intergroup intimate relationship.Results A total of 296 patient-caregiver dyads participated in the survey,and 271 of them gave responsive questionnaires,achieving a response rate of 91.6%.According to the survey,the RAS score of the patients was positively correlated with the caregivers'scores of RAS,Physical Component Summary(PCS)and Mental Component Summary(MCS)(P<0.05).The PCS score of the patients was positively correlated with the caregivers'scores of PCS and MCS(P<0.05).The MCS score of the patients was positively correlated with the caregivers'MCS score(P<0.05).APIM-based analysis showed that,in terms of actor-effect,the RAS score of caregivers was positively correlated with their MCS score(P<0.001).In terms of partner-effect,the RAS score of the patients was positively correlated with the PCS score of caregivers(P<0.001).And the RAS score of caregivers was positively correlated with the PCS score of patients(P<0.001).Conclusion The RAS score of the colorectal cancer patients may positively associated with the quality of life of their primary family caregivers,while the RAS score of the caregivers may positively associated with the quality of life of themselves as well as that of the patients.