诊断告知/隐瞒对早、中期肝癌患者的焦虑、抑郁及疾病感知的影响

Impact of disclosure and nondisclosure of diagnosis on anxiety,depression and illness perceptions in patients with hepatocellular carcinoma

目的探讨诊断告知或隐瞒对肝癌患者的焦虑、抑郁及疾病感知的影响。方法对住院手术的早、中期肝癌患者,按照出院前是否被告知其肝癌诊断,分为告知组和隐瞒组,以焦虑自评量表、抑郁自评量表、疾病感知问卷进行测评,测评时点为入院时、出院时、出院后1个月时。观察隐瞒组患者在出院后1个月时是否得知了诊断实情以及知情的途径。结果 285例患者纳入研究,其中150例(52. 6%)被告知了肝癌诊断。焦虑症状发生率:在出院时及出院后1个月时,隐瞒组均显著高于告知组(P=0. 045、P=0. 001);纵向比较,告知组的焦虑发生率随时间迁移而逐渐下降,而隐瞒组的焦虑发生率逐渐增加。抑郁症状发生率:在出院时告知组显著高于隐瞒组(P=0. 043),但出院后1个月时,告知组的抑郁发生率低于隐瞒组(P=0. 039),纵向比较,告知组的抑郁发生率在出院时最高,出院后1个月时显著下降,而隐瞒组的抑郁发生率在出院时及出院后1个月时均呈现逐渐升高的趋势。疾病感知方面:出院后1个月时,告知组"对疾病的知识了解"以及"自我对疾病的控制力"评分均显著高于隐瞒组(P均<0. 001),而"情绪受影响程度"评分,告知组显著低于隐瞒组(P=0. 001),多因素分析显示告知诊断与出院后1个月时的"情绪受影响程度"显著负相关(P <0. 001)。隐瞒组在出院后1个月时,84. 4%的患者已通过自己的方式得知了诊断实情,查看诊断证明书等病历资料是知情的主要途径。结论告知诊断有利于早中期肝癌患者调节情绪以及形成积极的疾病感知。建议对有明确的知情意愿的早中期癌症患者,满足患者的知情意愿。

Objective To investigate how disclosure and nondisclosure of diagnosis affect anxiety, depression and illness perceptions in Chinese patients with hepatocellular carcinoma (HCC). Methods Patients with early/intermediate stage HCC admitted for potentially curative operations in a teaching hospital were recruited. According to whether they were informed of the diagnosis before discharge, the patients were divided into disclosure group and nondisclosure group and assessed for anxiety, depression and illness perceptions at admission, at discharge and at one month after discharge. The uninformed patients were interviewed for whether and how they had known the actual diagnosis at one month after discharge. Results A total of 285 patients were recruited in this study, and 52.6% of them were informed of their cancer diagnosis before discharge (disclosure group). The incidence of anxiety declined gradually with time in the disclosure group and tented to increase in the nondisclosure group during the study period; The incidence of anxiety was significantly higher in the nondisclosure group than in the disclosure group both at discharge (P=0.045) and at one month after discharge (P=0.001). The incidence of depression was the highest at discharge and decreased significantly at one month after discharge in the disclosure group, but increased progressively over time in the nondisclosure group; The incidence of depression was significantly higher at discharge (P=0.043) but significantly lower at one month after discharge (P=0.039) in the disclosure group than in the nondisclosure group. The patients in the disclosure group had higher scores for understanding of the illness (P<0.001) and personal control (P<0.001) but had lower scores for emotional impact (P=0.001) at one month after discharge. Multivariate analysis showed that disclosure of diagnosis was negatively correlated with emotional impact (P<0.001). At 1 month after discharge, 84.4% of the patients in the nondisclosure group had been in the knowledge of their cancer diagnosis, mainly by reading the medical records. Conclusion For patients with early/intermediate stage HCC, disclosure of the diagnosis is beneficial to promote their emotional adjustment and more positive illness perceptions.