分化型甲状腺癌患者^(131)I治疗后症状体验及心理感受的描述性现象学研究

Symptom experience and psychological feelings of patients with differentiated thyroid cancer after radioactive ^(131)I therapy: a descriptive phenomenological study

目的探讨分化型甲状腺癌(differentiated thyroid cancer,DTC)患者^(131)I治疗后的症状体验及心理感受,为制订针对性照护方案提供参考依据。方法采用质性研究中的描述性现象学研究方法,通过目的抽样法选取山西省某三级甲等综合医院核医学科门诊复查的DTC^(131)I治疗后的12例患者进行半结构式访谈,并采用Colaizzi 7步分析法对访谈资料进行分析、归纳和主题提炼。结果提炼出5个主题,14个亚主题:躯体症状显著(疲乏无力感、头颈部不适、消化道反应、口干及味觉改变)、负性情绪体验较重(为颈部外观及功能改变感到困扰、隔离期间孤独恐惧感、为疾病不受重视感到失落、对未来的担忧与不确定感)、社会适应力降低(对生活与工作做出的转变、社交活动受限)、疾病及治疗相关信息需求较高(信息获取及鉴别能力不足、疾病及治疗知识了解不足)、疾病相关的益处发现(积极的应对方式、感受到自身变化)。结论DTC患者^(131)I治疗后面临多方面的问题,医护人员应对患者的身心状况进行及时有效的评估,关注患者的健康需求,制订有针对性的院内及院外照护方案,改善患者的治疗体验和生活质量。

Objective To explore the symptom experience and psychological feelings of patients with differentiated thyroid cancer(DTC)after^(131)I therapy so as to provide a reference for formulating targeted care programs.Methods A descriptive phenomenological research was conducted by interview of 12 patients with DTC after radioactive^(131)I therapy at the outpatient clinic of Department of Nuclear Medicine in a tertiary hospital in Shanxi Province.The patients were selected by purpose sampling method for re-examination.The acquired data were analysed,summarised and extracted by Colaizzi 7-step analysis.Results In total,14 items in 5 themes were extracted,e.g.,significant physical symptoms including fatigue,head and neck discomfort,reactions of digestive tract,xerostomia and change in taste,severe negative emotional experience including disturbance by changes in the appearance and function of neck,fear and loneliness during isolation,a sense of frustration that the disease is not being taken seriously,fear and uncertainty about the future,reduced social adaptability including changes in life and work and limited social activities,high demand for disease and treatment-related information including insufficient ability in acquiring and identifying information,insufficient understanding in knowledge of disease and treatment,and finally,disease-related benefit discovery including positive coping styles and perception of the changes in themselves.Conclusions DTC patients after radioactive^(131)I therapy may confront with many issues.Medical and nursing staff should evaluate the physical and mental conditions of patients timely and effectively,pay attention to their health requirements.Propose targeted in-hospital and out-of-hospital care programs will improve the treatment experience and quality of life of the patients.