叙事医学对乳腺癌根治手术病人病耻感的影响

The effect of the narrative medicine on the stigma of radical mastectomy patients

目的探寻叙事医学对乳腺癌根治术后病人病耻感的作用及影响,以期为改善病人生活质量提供理论依据和临床循证途径。方法采用分级抽样法从2016年1月至2017年12月在西安交通大学第一、二附属医院及陕西省肿瘤医院乳腺病科选取住院期间行乳腺癌根治手术病人489例,2017年1—12月收治的乳腺癌根治手术病人244例设为观察组,行叙事医学式护理干预;2016年1—12月收治的乳腺癌根治手术病人245例设为对照组,给予常规式护理干预,两组均采用社会影响量表(SIS)于出院后第1、3、6、12个月进行病耻感评定。结果两组出院时和出院后1个月的SIS得分均差异无统计学意义(P>0.05);但是,在出院第3、6、12个月时,对照组SIS得分[(62.5±10.4)、(58.2±11.2)、(55.2±11.3)分]高于观察组[(67.9±11.2)、(67.3±11.1)、(67.1±11.4)分],差异有统计学意义(P<0.05)。结论叙事医学通过科学的方法诱导乳腺癌根治术病人宣泄不良情绪,从而改善了病人的身心状况,提高了病人的生活质量。

Objective To explore the effect of narrative medicine on radical mastectomy patients,in order to provide theoretical basis for improving the quality of life of radical mastectomy patients.Methods A Total of 489 patients with radical mastectomy were convenient sampled from the First and the Second Affiliated Hospital of Xi′an Jiaotong University and Oncology Hospital in Shaanxi Province from January 2016 to December 2017.The 244 recruited patients from February to December 2017 were recognized as observation group which was treated with narrative medicine,while 245 patients recruited from January to December 2016 were recognized as control group which was given normal health education and consultation.The Social Impact Scale(SIS)was used to assess sense of stigma at the time of discharge and on the first,the third,the sixth and the twelfth month after intervention.Results There was no significant difference in SIS scores between the two groups at the time of discharge and after a month(P>0.05).On the third,the sixth and the twelfth month after discharge,the SIS score of the observation group was significantly lower than that of the control group[(62.5±10.4),(58.2±11.2),(55.2±11.3)]vs.[(67.9±11.2),(67.3±11.1),(67.1±11.4)](P<0.05).Conclusion The narrative medicine can not only reduce psychological burden for radical mastectomy patients,but also promote the recovery of disease and improve the quality of life.