住院癌症病人病耻感、社会支持与社交回避及苦恼的关系模型研究

Construction of the structural equation model for stigma,social support,social avoidance and distress in cancer inpatients

目的:了解住院癌症病人病耻感、社会支持与社交回避及苦恼的现状,明确3个变量相互作用机制。方法:2018年11月—2019年3月采用一般情况调查表、社会影响量表(Social Impact Scale,SIS)、社会支持评定量表(Social Support Rating Scale,SSRS)、社交回避及苦恼量表(Social Avoidance and Distress Scale,SAD)对某三级甲等医院住院治疗的294例癌症病人进行问卷调查,采用AMOS 20.0对病耻感、社会支持与社交回避及苦恼构建结构方程模型。结果:住院癌症病人病耻感、社会支持和社交回避及苦恼总分分别为(61.19±9.23)分、(38.63±6.90)分和(14.01±9.01)分,处于中等水平。进一步结构方程显示,病耻感对社交回避及苦恼有直接正向效应(β=0.259,P<0.001),对社会支持有负向效应(β=-0.239,P<0.01);社会支持在病耻感与社交回避及苦恼间有较弱中介效应(β=-0.024,P<0.01)。结论:医务人员应及时了解病人身心需求,及时纠正病人错误认知和扭转其非理性思维,为病人提供必要的支持,使其能建立正确的认知,理性对待疾病,减轻病耻感,更好融于社会。

Objective:To understand the status quo of stigma,social support,social avoidance and distress in cancer inpatients,and to clarify the interaction mechanism of the three variables.Methods:From November 2018 to March 2019,the general data questionnaire,Social Impact Scale(SIS),Social Support Rating Scale(SSRS),Social Avoidance and Distress Scale(Social Avoidance and Distress Scale(SAD))were used to conduct a questionnaire survey of 294 cancer inpatients in a class 3 level A hospital.AMOS 20.0 was used to construct a structural equation model for stigma,social support,social avoidance and distress.Results:The total scores of stigma,social support,social avoidance and distress of inpatients with cancer were(61.19±9.23),(38.63±6.90)and(14.01±9.01),respectively,which were at a moderate level.Further structural equations show that stigma had a direct positive effect on social avoidance and distress(β=0.259,P<0.001),and a negative effect on social support(β=-0.239,P<0.01).Social support had a weak mediating effect between stigma and social avoidance and distress(β=-0.024,P<0.01).Conclusions:Medical staff should understand the patient′s physical and mental needs in time,correct the patient′s erroneous cognition and reverse their irrational thinking in time,and provide the patient with the necessary support so that they can establish correct cognition,treat the disease rationally,reduce stigma,and integrated into society.