积极视角下晚期癌症患者心理弹性变化过程及影响因素的描述性现象学研究

Descriptive phenomenological study of influencing factors and changes of psychological resilience in patients with advanced cancer:from a positive perspective view

目的探讨积极视角下晚期癌症患者心理弹性的动态变化过程及各阶段影响因素,为晚期癌症患者的心理弹性干预方案提供实践依据。方法采用描述性现象学研究的方法,2021年4月至7月通过目的抽样法选取山东省济南市某三级甲等综合医院肿瘤中心放疗科11例晚期癌症患者进行半结构式深入访谈,并采用主题分析法对访谈资料进行整理分析。结果晚期癌症患者心理弹性动态变化过程包括三个阶段,分别为弹性紊乱期—初步应对危机、弹性调节期—加强资源整合、弹性重组期—与疾病和谐共存。包括14个亚主题,分别为5个内部保护因素(科学认知方式、重构生活经历、发挥个人能力、构建生命希望、关注积极收获)、6个外部保护因素(家庭支持、朋友支持、专业支持、政策支持、同伴支持、丰富生活)、3个危险因素(产生负性情绪、经历身心痛苦、角色适应不良)。结论医务人员可针对晚期癌症患者心理弹性动态变化过程的特征采取对策提升其心理弹性,使其能以更好的身心状态应对癌症。

Objective To explore the changes and influencing factors of psychological resilience in patients with advanced cancer,from a positive perspective,so as to provide theoretical and practical basis for the intervention of psychological resilience.Methods A qualitative research of descriptive phenomenology was conducted in this study.Between April and July,2021,11 patients with advanced cancer were selected by purpose sampling method for semi-structured in-depth interviews,from the radiotherapy department of the tumour centre of a tertiary hospital in Jinan,Shandong Province.The acquired data from the interviews were analysed by thematic analysis.Results The changes of psychological resilience in the patients were identified and divided into three stages:(i)from the resilience disorder to initial response to crisis,(ii)from the resilience adjustment to strengthening resource integration and(iii)from the resilience reorganisation to harmonious coexistence with the disease.Fourteen sub-factors in 3 dimensions were also observed:(a)5 internal protection factors including methods for scientific cognition,reconstruction of life experiences,exertion of personal ability,building hopes for life,and attention to positive gains,(b)6 external protection factors including family support,friend support,professional support,policy support,peer support and a good life,and(c)3 risk factors including negative emotions,physical and mental pain,and role maladjustment.Conclusions Medical staff should take actions to improve the psychological resilience of patients with advanced cancer by identifying the characteristics of the changing resilience,therefore to make the patients are able to cope with cancer in a better physical and mental state.