结直肠癌化疗患者不同阶段心理弹性和应对方式对生存质量的影响研究

Effects of psychological resilience and coping styles on quality of life in colorectal cancer patients with adjuvant chemotherapy at different stages

目的探讨结直肠癌化疗患者不同阶段心理弹性状态及应对方式对生存质量的影响。方法随机抽取结直肠癌化疗患者121例,运用心理弹性量表、应对方式问卷以及生存质量问卷对患者出院前、化疗开始后1个月、3个月、6个月进行调查分析。采用Pearson相关法分析其相关性,并应用logistic回归模型对可能影响生存质量因素进行多因素分析。结果结直肠癌患者出院前、化疗开始后1个月、3个月、6个月的心理弹性、生存方式及总健康状况比较,差异均有统计学意义(F分别=4.00、5.21、3.74,P均<0.05)。各维度进一步分析显示,坚韧、乐观、屈服、回避、认知功能、角色功能、社会功能、躯体功能及症状维度在不同阶段存在明显差异性(F分别=3.37、4.27、4.68、7.22、22.78、13.98、8.76、7.26、6.69,P均<0.05)。相关性分析显示,化疗后第6个月心理弹性总分、应对方式总分与总体健康状况、认知、角色、社会、躯体及情绪功能均呈正相关(r分别=0.68、0.64、0.47、0.37、0.53、0.72;0.50、0.59、0.47、0.70、0.64、0.61,P均<0.05),与症状维度呈负相关(r分别=-0.61、-0.73,P均<0.05)。logistic回归模型表示,年龄、居住环境、配偶、月入水平、肿瘤分期以及心理弹性、应对方式是影响化疗后第6个月生存质量的影响因素(OR分别=1.44、1.22、1.66、1.77、1.99、0.83、1.69,P均<0.05)。结论结直肠癌化疗患者积极的心理弹性及应对方式随着治疗进展而逐渐升高,进而提高了生存质量。可根据化疗不同阶段对患者预测因子采取不同的干预方案来从而提高生存质量水平。

Objective To explore the effects of psychological resilience and coping styles on quality of life in patients with colorectal cancer chemotherapy at different stages. Methods A total of 121 colorectal cancer patients with adjuvant chemotherapy were randomly selected.The psychological resilience scale,coping styles and quality of life questionnaire were used before discharge,1 month,3 months,and 6 months after the chemotherapy.The pearson correlation method was used to analyze the correlation between psychological resilience and quality of life,and the logistic regression model was used to analyze the risk factors of the quality of life. Results There were significant differences in psychological resilience,coping styles and quality of life at different stages of chemotherapy(F=4.00,5.21,3.74,P<0.05). The toughness,optimism,surrender,avoidance,cognition,role,society,physical and symptom dimensions were significantly different at different stages(F=3.37,4.27,4.68,7.22,22.78,13.98,8.76,7.26,6.69,P<0.05).Correlation analysis showed that the total score of psychological resilience and coping styles at the 6 months after chemotherapy were positively correlated with overall health status,cognition,role,social,physical and emotional function(r=0.68,0.64,0.47,0.37,0.53,0.72;0.50,0.59,0.47,0.70,0.64,0.61,P<0.05),and negatively correlated with symptoms(r=-0.61,-0.73,P<0.05).Logistic regression model showed that the age,living environment,spouse,income,tumor stage,and psychological resilience and coping style were independent influence factors affecting quality of life(OR=1.44,1.22,1.66,1.77,1.99,0.83,1.69,P<0.05). Conclusion The positive psychological flexibility and coping style of patients with colorectal cancer undergoing chemotherapy gradually increased with the progress of treatment,which improved the quality of life.Different interventions can be applied to improve the quality of life in patient with different stages of chemotherapy.