叙事医学干预对乳腺癌根治术后病耻感的影响

Effects of narrative medical intervention on stigma for breast cancer after radical mastectomy

[目的]探讨叙事医学干预对乳腺癌根治术后病耻感的影响。[方法]采用非同期对照方法,将2016年7月—2017年6月收治的乳腺癌根治手术病人250例作为观察组,进行叙事医学方面的全程干预;将2015年7月—2016年6月收治的乳腺癌根治手术病人250例作为对照组,采用传统的出院健康宣教及定时复诊方法,病人出院时及出院后1个月、3个月、6个月应用社会影响量表(SIS)对两组病人进行测评。[结果]出院后1个月、3个月、6个月,观察组SIS评分为(63.9±11.2)分、(63.5±10.6)分、(62.9±11.2)分;对照组SIS评分为(66.6±12.2)分、(68.9±11.3)分、(69.3±11.6)分,两组比较差异均有统计学意义(P<0.05);出院后1个月、3个月和6个月观察组社会排斥、内在羞耻感、社会隔离评分低于对照组,两组比较差异有统计学意义(P<0.05)。[结论]叙事医学能够减轻乳腺癌根治手术病人的病耻感,帮助其疏泄不良情绪、获取生活信心,提高生活质量。

Objective: To probe into the influence of narrative medical intervention on stigma after radical mastectomy. Methods: A total of 250 cases of breast cancer patients admitted for radical resection from July 2016 to June 2017 were selected as the observation group,and the whole-course intervention in narrative medicine was carried out by using the non-contemporaneous control method.A total of 250 patients with radical surgery for breast cancer admitted from July 2015 to June 2016 were selected as the control group.Traditional discharge health education and regular re-examination methods were adopted.The two groups of patients were evaluated by the social impact scale (SIS) at the time of discharge and 1st,3rd and 6th month after discharge. Results: 1st month,3rd month and 6th month after discharge,the SIS scores of the observation group were (63.9±11.2),(63.5±10.6) and (62.9±11.2) respectively. The SIS scores of the control group were (66.6±12.2),(68.9±11.3) and (69.3±11.6).And the differences between the two groups were statistically significant ( P <0.05).The scores of social exclusion,internal shame and social isolation were lower in the observation group than in the control group at 1st,3rd and 6th month after discharge,with statistically significant differences between the two groups ( P <0.05). Conclusion: Narrative medicine can alleviate the stigma of patients undergoing radical surgery for breast cancer,help them to release bad emotions,gain confidence in life,and improve the quality of life.