癌症患者心理痛苦分层管理模式的构建

Establishment of hierarchical management model of psychological distress in cancer patients

目的探索在医疗资源有限的条件下,对癌症患者住院期间心理痛苦分层评估及干预的可行性,构建癌症患者心理痛苦管理模式。方法运用心理痛苦管理筛查工具对1 000例癌症患者住院期间心理痛苦状态进行初步筛查(第1层面),≥4分患者采取抑郁自评量表(SDS)及焦虑自评量表(SAS)进一步评估(第2层面),对大于或等于4分患者医护人员干预无效者,由心理治疗师或精神专科医师介入,进行专科心理评估诊断(第3层面);与之相对应,进行心理痛苦分层干预,<4分的患者,由责任护士给予患者教育、情感支持等心理干预,对大于或等于4分的患者,由责任护士、科室心理疏导员及主管医师根据患者病情和SDS、SAS评估结果,进行针对性和个性化心理干预,当患者心理痛苦大于或等于4分,医护人员干预无效者,由心理咨询师进行专业心理干预,必要时由精神卫生专科医师给予药物干预。结果患者入院时心理痛苦程度分值平均为(2.15±1.23)分,≥4分者83例,占8.3%。出院时心理痛苦程度分值平均为(1.12±0.53)分,≥4分者31例,占3.1%。出入院时心理痛苦程度分值差异有统计学意义(P<0.05)。结论通过对癌症患者住院期间心理痛苦评估及干预,初步构建了癌症住院患者心理痛苦的筛查-诊断-干预分层管理模式,为临床提供较为高效、连续、可行的心理痛苦管理方案。

Objective To explore the feasibility of hierarchical management model of psychological distress in cancer patients,in order to establish the management model of psychological distress for them,under the condition of limited medical resources.Methods A preliminary screening（first level）of the psychological distress situations for1 000 cancer patients in the hospitals was carried out by using DMSM（Distress Management Screening Measure）.Furthermore,for the patients with ≥4scores in DMSM test,SDS and SAS were used to assess their distress status（second level）.And for the patients with ≥4scores in DMSM test and invalid intervention,specialist psychological assessment diagnosis would be carried out by psychotherapists or spirit specialists（third level）.Hierarchical psychological distress intervention was carried out,according to the scores of DMSM test.The patients with 4scores received psychological intervention such as education and feeling supports and so on from the related responsible nurses.For the patients with≥4scores,the responsible nurses,psychological counseling staffs and the doctors in charge made SDS and SAS evaluation,according to the patients′situation and other factors.For the patients with≥4scores in DMSM test and invalid intervention,they would have professional psychological intervention by apsychologist,and get drug intervention by mental health specialist,if necessary.Results The psychological distress average value of patients on admission was（2.15±1.23）scores,with 83 cases of patients≥4scores（8.3%）.And the psychological distress average value of patients when discharged from hospital was（1.12±0.53）scores,with 31 cases of patients≥4scores（3.1%）.The difference of psychological distress average values when admitted to hospital and discharged from hospital were statistically significant（P〈0.05）.Conclusion Through the psychological distress evaluation and intervention of cancer patients,the hierarchical management model of the psychological distress for cancer patients（screen-diagnosis-intervention）was primarily established,which provided an effective,continuous and feasible psychological distress management plan for clinical units.