肺癌患者住院期间支持性照顾需求现况调查及影响因素分析

Investigation on the status of supportive care needs of patients with lung cancer during hospitalization and analysis of influencing factors

目的调查肺癌患者住院期间支持性照顾需求现状。方法于2017年7月-2018年3月采用便利抽样法选择上海三家医院的肿瘤科病房和胸外科病的178名肺癌患者,应用癌症患者支持治疗需求量表(supportive care needs survey,SCNS-SF34)、医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)、安德森症状评估量表(M.D.Anderson symptom inventory,MDASI)和自制一般人口学疾病相关医学资料调查178名肺癌患者。结果本组肺癌患者都报告了中高度的支持性照顾需求,未满足需求以健康系统信息维度、心理维度为主;肺癌患者症状与支持性照顾需求5个维度正相关,焦虑、抑郁与支持性照顾需求呈现正相关。症状是5个维度的共同影响因素,心理维度有癌分期、病程月、家庭月收入3个影响因素;生理和日常生活维度有焦虑总分、治疗方式、年龄3个因素;健康系统信息维度有治疗方式、文化程度2个因素,患者照顾和支持维度有治疗方式、家庭月收入、病程、癌分期4个因素,在性维度有抑郁总分、年龄2个因素。结论躯体症状以及焦虑、抑郁是影响肺癌患者支持性照顾需求最重要的影响因素,未来需做好症状和心理状态评估,给予症状管理和心理社会支持来满足肺癌患者的支持性照顾需求,提高生存质量。

Objective To investigate the current status of supportive care needs for lung cancer patients during hospitalization.Methods From July 2017 to March 2018,178 lung cancer patients in the oncology wards and thoracic surgical diseases at three hospitals in Shanghai were selected by convenient sampling method.A total of 178 lung cancer patients were investigated with Supportive Care Needs Survey(SCNS-SF34),Hospital Anxiety and Depression Scale(HADS),MD Anderson Symptom Inventory(MDASI)and self-made general demographic disease-related medical data.Results The lung cancer patients all reported moderate to high level supportive care needs.The unmet needs were based on the health system information dimension and psychological dimension.The symptom scores of lung cancer patients were positively correlated with 5 dimensions of supportive care needs.Anxiety,depression and supportive care needs were positively correlated.Symptom scores were the common influencing factors of the five dimensions.Cancer stage,disease month,and family monthly income entered into the regression model of psychological dimension.Anxiety score,treatment method,and age entered the regression model of physiological and daily life dimensions.Treatment method and education level entered into the regression model of health system information dimension.Treatment method,family monthly income,disease course and cancer stage entered into the regression model of patient care and support dimension.Total score of depression,and age were included in the regression model of the sexual dimension.Conclusion Somatic symptoms,anxiety and depression were factors that affecting the lung cancer patients’needs.In the future,it is necessary to make a good assessment of symptoms and psychological state,to provide symptom management and psychosocial support to meet the supportive care needs of lung cancer patients and to improve their quality of life.