McMaster模式家庭治疗在改善中晚期肝细胞癌患者家庭功能中应用的效果评价

Role of McMaster model of family therapy in improving family function of patients with advanced hepatoceilular carcinoma

目的探讨McMaster模式家庭治疗在改善中晚期HCC患者家庭功能中的作用。方法将东方肝胆外科医院肝胆内-科2012年10月1日至2013年6月25日初次诊断为中晚期肝细胞癌并行肝动脉栓塞或栓塞化疗的患者，随机分为观察组51例与对照组49例，对照组给予常规的家庭支持教育，观察组在常规家庭支持教育基础上，根据McMaster模式FAD评价结果，在入院第2天、第3天针对性对患者及其家属实施McMaster模式家庭治疗，采用FAD量表检测2组患者入院第1天以及第4周家庭功能状况，比较2组患者家庭功能差异。结果观察组和对照组在年龄、性别、文化程度、居住地、职业、家庭经济状况、医疗付费方式、肝肾功能、HBV感染、肝硬化以及肿瘤负荷等方面比较均差异无统计学意义。观察组和对照组患者在肝动脉栓塞或栓塞化疗治疗前，除问题解决外，在交流、角色、情感反应、情感介入、行为控制以及家庭总功能方面均存在不良，2组比较差异无统计学意义；4周后观察组除问题解决维度外，其他各维度以及家庭总功能均明显优于对照组，t值分别为-2．544，-3．767，-3．904，-2．848，-4．950及-4．953，差异有统计学意义。结论McMaster模式家庭治疗有助于提高中晚期肝细胞癌患者家庭功能。

Objective We aimed to investigate the role of MeMaster model of family therapy in im- proving family function of patients with advanced hepatocellular carcinoma （HCC）. Methods Patients who had advanced HCC and received transarterial embolization （TAE） or transarterial chemoembolization （TACE） from Department of Hepatobiliary I, Eastern Hepatobiliary Surgery Hospital between October 1, 2012 and June 25, 2013 were randomly divided into two groups：the experimental group （51 patients） and the control group （49 patients）. The control group received routine family support education. The experimental group not only executed routine family support education, but also was given McMaster model of family therapy according to evaluation results of family assessment device （FAD） on the second and third day of hospitaliza- tion. The status of family function of all patients were assessed by FAD on the first day of hospitalization and fourth week after therapy. We compared the status of family function between the two ~ups. Results In age, gender, educational level, place of residence, occupation, family economic status, medical payment, liver or kidney function, HBV infection, cirrhosis and tumor burden, no statistical differences were found between the experimental group and the control group patients before TAE or TACE. Two groups were dysfunction in com- munication, roles, affective responsiveness, affective involvement, behavior control, and general function in addition to problem solving before TAE or TACE. No statistical differences were found between two groups. Af- ter the therapy, compared with the control group, those patients in the experimental group had a lower level scoring in communication, roles, affective responsiveness, affective involvement, behavior control, and general function in addition to problem solving on the fourth week after the therapy, t value was -2.544,-3.767,-3.904, -2.848,-4.950 and -4.953, the difference had statistical significance. Conclusions McMaster model of family therapy may help to improve family function of patients with advanced HCC.