癌症患者心理韧性质性研究的系统评价

Resilience of cancer patients:a systematic review of qualitative studies

目的系统评价有关癌症患者心理韧性发展的真实体验,为更好地制定心理韧性干预方案提供理论依据。方法计算机检索Cochrane Library、Medline、CINAHL、Embase、PubMed、Web of Science、Psyc INFO以及中国生物医学文献数据库、中国知网、维普、万方数据库从建库至2019年6月相关的质性研究。采用澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准(2016)对文献进行评价,采用汇集性整合方法进行结果整合。结果共纳入10篇文献,提炼42个明确的结果,形成8个类别,汇总成3个整合结果。①心理韧性发展是动态循环的过程:危机负性期,调节成长期,积极转化期,循环强化期;②心理韧性的阻碍因素:个体(消极应对,错误认知,症状和体象困扰),环境(传统社会文化,医疗环境,家庭负担);③心理韧性的保护因素:个体(积极心理与应对方式,复原经历,宗教信仰,自我表露,利他主义与行为),环境(家庭因素,医疗照护,人际支持)。结论心理韧性的发展是动态循环过程,受个体和环境因素影响,医护人员应根据不同阶段的影响因素给予针对性护理措施,促进患者心理韧性的形成和发展,提高患者的生活质量。

Objective To systematically evaluate the qualitative research on resilience of cancer patients,and to provide bases for better clinical nursing interventions.Methods 7 English databases(the Cochrane Library,Medline,CINAHL,Embase,PubMed,Web of Science、Psyc INFO)and 4 Chinese databases(CBM,CNKI,VIP,WANFANG)were chosen to retrieve litetature from inception to June 2019 on resilience of cancer patients.The literature was evaluated by the JBI Critical Appraisal Tool for qualitative studies in Australia(2016).Integrated method was applied to integrate the results.Results Totally 42 findings were extracted from 10 qualified studies.The 42 findings were integrated into 8 categories and finally 3 synthesized results were summarized from the 8 categories.Integration result 1:The development of resilience is the process of dynamic circulation(with negative crisis period,regulatory growth period,positive transformation period,and cycle strengthening period).Integration result 2:The obstructive factors of resilience include individual factors(negative response,false cognition,symptoms and body image disturbance)and environmental factors(traditional sociocultural environment,medical environment,family burdens).Integration result 3:The protective factors of resilience include individual factors(positive psychology and coping style,recovery experiences,religion,self-disclosure,altruism and behavior)and environmental factors(family factors,medical care,interpersonal support).Conclusion The development of resilience is a process of dynamic cycle,influenced by the individual and environmental factors.Clinical nursing staff should give targeted nursing measures according to the influencing factors of different stages,promote the formation and development of patients'resilience and improve the quality of life of patients.