恶性肿瘤终末期患者生命质量、负性情绪以及对死亡的态度研究

Quality of Life,Negative Emotions and Death Attitudes in End-Stage Patients with Malignant Tumors

目的:分析恶性肿瘤终末期患者生命质量、癌症症状、负性情绪以及对死亡的态度,为开展恶性肿瘤终末期患者的死亡认知教育提供相关参考.方法:本研究设计为横断面研究,采用便利抽样的方式选取2017年1月1日至2019年5月31日在我院介入和综合内科住院治疗的恶性肿瘤终末期患者145例,采用世界卫生组织生命质量测定量表(WHOQOL-100)、安德森症状评估量表(MDASI)、医院焦虑抑郁量表(HAD)和死亡态度描绘量表(DAP-R)分别对患者的生命质量、癌症症状、负性情绪以及对死亡的态度进行测评.结果:恶性肿瘤终末期患者的总体健康状况和生命质量评分以及生理领域、心理领域、独立性领域、社会关系领域、环境领域和精神/宗教信仰领域评分均明显低于常模组,差异有统计学意义(均P<0.05).症状发生率最高(>90%)的前4位症状依次为:疼痛(99.21%)、食欲减退(98.20%)、疲劳(94.15%)和睡眠不安(91.11%);而症状强度最显著(>5分)的前5位症状依次为:疲劳、疼痛、苦恼、健忘和睡眠不安.焦虑检出率为69.66%(101/145),其中,轻度焦虑31例、中度焦虑55例、重度焦虑15例;抑郁检出率为72.41%(105/145),其中,轻度抑郁29例、中度抑郁62例、重度抑郁14例.患者的焦虑和抑郁平均得分均处于中度水平.患者的死亡恐惧维度均分最高(4.52分),其次为死亡逃避(3.04分),再次逃离接受(2.85分).结论:终末期恶性肿瘤患者生命质量低下,癌症症状明显,多数存在焦虑抑郁情绪,面对死亡多为恐惧、逃避和逃离的态度.

Objective: To investigate the quality of life, negative emotions and death attitude in end-stage patients with malignant tumors, and provide relevant experience for carrying out death education for target patients. Methods: In this cross-sectional study, 145 patients with terminal malignant tumors hospitalized in our hospital from January 1 st, 2017 to May 31 th, 2019 were selected using convenient sampling. WHOQOL-100, M. D. Anderson Symptom Inventory(MDASI), Hospital Anxiety and Depression(HAD) Scale and Death Attitude Profile-Revised(DAP-R) were used to assess the quality of life, symptoms, negative emotions of patients and their attitudes towards death. Results: Scores in the Overall Quality of Life and General Health facet and its 6 domains(the Physical domain, the Psychological domain, the Level of Independence domain, the Social Relationships domain, the Environment domain and the Spirituality/Religion/Personal Beliefs domain) in patients with terminal malignant tumors were significantly lower than those in the norm group(all P < 0.05). The top four symptoms were pain(99.21%), loss of appetite(98.20%), fatigue(94.15%) and disturbed sleep(91.11%) as indicated by WHOQOL-100. The top five symptoms were fatigue(tiredness), pain, being distressed(upset), problem with remembering things and disturbed sleep as indicated by MDASI. The detection rate of anxiety(31 mild anxiety, 55 moderate anxiety and 15 severe anxiety) was 69.66%(101/145);the detection rate of depression(29 mild depression, 62 moderate depression and 14 severe depression) was 72.41%(105/145). The mean anxiety and depression scores were at a moderate level. The mean score of the Fear of Death dimension was the highest(4.52 points), followed by that of the Death Avoidance dimension(3.04 points), and that of the Escape Acceptance dimension(2.85 points). Conclusion: The quality of life of patients with end-stage malignant tumors is low. Cancer symptoms of these patients are obvious. Most of them have anxiety and depression. They tend to fear, avoid and escape from death.