中青年晚期癌症患者心理痛苦体验的质性研究

Qualitative study of psychological distress experience in young and middle-aged patients with advanced cancer

目的:探讨中青年晚期癌症患者心理痛苦体验,为实施全人照顾提供参考依据。方法:采用目的抽样法,抽取2017年5-7月在我院中西医结合科住院的12例中青年晚期癌症患者作为研究对象,所选患者心理痛苦评分(Distress Thermometer,DT)均≥4分,进行深度访谈,采用现象学分析访谈内容,整理提炼主题。结果:生理方面,对患者痛苦最大的前3位症状包括疲乏、疼痛、恶心呕吐;心理方面,主要存在担心、恐惧、病耻感及自我负担感;家庭社会方面,经济问题、无精力照顾孩子和老人、家属过分关心给患者带来很大心理痛苦;灵性方面,患者主要存在失去希望、绝望、自杀意图,怨天尤人,感叹不公,不放心,孤立隔绝等问题。结论:中青年晚期癌症患者存在身、心、社、灵等多方面心理痛苦,医护人员在临床工作中在重视患者症状管理的同时也要关注患者心理痛苦体验并给予针对性心理疏导,做到全人照顾,提高患者终末期生活质量。

Objective： To explore the real psychological distress experience of young and middle-aged patients with advanced cancer in order to provide reference for specific nursing for them. Methods： 12 patients whose scores of distress thermometer were higher than 4 from the department of combined Chinese and western medicine were selected in the study using purposive sampling method from May to July 2017. The phenomenological research method was adopted to analysis the interview content and different themes were extracted. Results： In the physical aspects, the first three symptoms of the disease were fatigue, pain, nausea and vomiting. The main problems were anxious, concerns, fears, stigma and self-burden in the psychological aspects; while economic problems, lack of energy to take care of children and the elderly, the excessive care of the family members; loss hope, despair, suicidal intention, complain; exclamation of injustice; worry; isolation in the spiritual aspects. Conclusion： Medical staff should pay attention to the young and middle-aged patients with advanced cancer psychological distress experience and sources, and carries on the targeted psychological counseling, to reduce the level of psychological distress and improve end-stage life quality.