乳腺癌患者夫妻对治疗相关身体变化体验和二元应对质性研究的Meta整合

Experience of altered body image and dyadic coping in couples with breast cancer:a meta-synthesis of qualitative studies

目的系统整合乳腺癌夫妻对治疗相关身体变化体验和二元应对的质性研究,为医护人员构建患者身体意象干预方案提供参考。方法检索中英文数据库中关于乳腺癌患者及其配偶对身体变化体验的质性研究,采用2016版澳大利亚JBI循证卫生保健中心质性研究质量评价标准进行文献质量评价,采用汇集性整合方法对结果进行归纳和整合。结果纳入20项研究,提炼出45个研究结果,归纳为8个类别,形成3个整合结果。按照时间进程,乳腺癌夫妻对于治疗相关身体变化经历了三个阶段:迷茫期—身体改变使夫妻备受打击,沟通不良;应激期—夫妻积极弥补身体缺陷,应对良好;稳定期—夫妻对身体的关注趋于平淡,夫妻关系稳固或恶化。结论乳腺癌患者夫妻经历了迷茫期、应激期和稳定期,医护人员应重视患者身体变化给夫妻带来的感受和体验,在乳腺癌诊断、治疗和康复的整个过程中以夫妻为整体进行二元干预,使他们更好地应对身体意象问题。

Objective To systematically integrate qualitative research on experience of altered body image and dyadic coping in breast cancer couples,and to provide evidence-based references for future intervention programs.Methods Qualitative studies on the experiences of body image in breast cancer patients and their spouses were searched in Chinese and English databases.The quality of the literature was evaluated using the 2016 edition of JBI Evidence-Based Health Care Center quality evaluation criteria for qualitative studies.The results were summarized and integrated by meta-aggregative approach.Results A total of 45 results were extracted from 20 studies,which were summarized into 8 categories and 3 conclusions.According to the time course,breast cancer couples experienced three stages of treatment-related physical changes:confusion period-physical changes make the couple suffer from shock and poor communication;stress period-couples actively compensate for physical defects,and cope well;stable period-the couple′s attention to the body tends to be settled,and the couple′s relationship is stable or deteriorated.Conclusion The couples with breast cancer have experienced confusion,stress and stability.Medical staff should pay attention to patient experience related to altered appearance and conduct dyadic interventions in the diagnosis,treatment and rehabilitation,to help them better cope with the body image problem.