肝细胞癌患者心理困扰现状及其影响因素分析

Prevalence and Related Factors of Psychological Distress among Patients with Hepatocellular Carcinoma

目的分析肝细胞癌(hepatocellular carcinoma,HCC)患者心理困扰现状及其影响因素,为后续制定针对性护理干预措施提供理论依据。方法便利抽样选择2016年6月1日至2017年1月31日入住东方肝胆外科医院肝外三科、胆道一科初次诊断并预行根治切除术的HCC患者151例患者,应用美国综合癌症网络推荐并经汉化的心理困扰筛查工具中的困扰温度计(distress thermometer,DT)及问题列表,对其进行心理困扰现况调查,用自编一般情况调查表收集HCC患者的人口学特征。结果本组患者中有83例(55.0%)患者存在心理困扰,其中,女性、未婚、年轻、文化程度低、人均收入低、新农合作医疗及自费的HCC患者心理困扰检出率高于男性、已婚、年长、文化程度高、人均收入高以及城镇(城市)医保的患者,差异均具有统计学意义(均P<0.05)。心理困扰问题列表各维度平均得分以实际问题最高(0.37±0.33)分,其次是情绪问题(0.34±0.31)分,有心理困扰HCC患者问题列表各维度平均得分均要高于无心理困扰HCC患者,差别均具有统计学意义(均P<0.05);问题列表34个条目中,回答"是"表示"经历了相应问题"的前5位条目分别是:担心、就医不方便、记忆力及注意力降低、低落、疲乏。结论 HCC患者心理困扰现象较为普遍,且女性、未婚、年轻、文化程度低、人均收入低、新农村合作医疗及自费的HCC患者更容易发生,及早发现并及时给予针对性护理干预非常重要。

Objective To investigate prevalence and related factors of psychological distress in patients with hepatocellular carcinoma(HCC)and provide a theoretical evidence for development of specific nursing interventions.Methods Psychological distresses of 151 HCC patients who received surgical dissection at Department of Hepatobiliary Medicine I and Liver Surgical Medicine III,Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between Jun 2016 and Jan 2017 were regularly screened by nursing staff using the distress thermometer(DT)and Chinese problem list(PL).The prevalence of psychological distress was assessed and related factors of psychological distress were analyzed by the self-designed questionnaires.Results There were 83(55.0%)cases recognized as having psychological distress.Female,unmarried,younger in age,lower income,less education,living in countryside or small towns,new rural insurance,and own expense were significantly related to high prevalence of psychological distress(all P<0.05).Practical problems had highest scores(0.37±0.33)among sub-dimensions of PL,followed by emotional problems(0.34±0.31).The average score of each PL dimension for HCC patients with psychological distress was higher than those HCC patients without psychological distress(all P<0.05).Among 34 items included in the statistical analysis,the top 5 items were worry,inconvenient of medical treatment,decreasing of memory or concentration,depression and fatigue.Conclusion Psychological distress of HCC patient was very common.HCC patients who are female,younger in age,unmarried,with lower income and education level,having new rural insurance or without medical insurance,and live in countryside or small towns are more likely to have it.Early detection of psychological distress and prompt psychiatric consultation and management are very important for them.