结直肠癌患者的癌症宿命论与乐观心态的关系及医患家三方的影响

Association between cancer fatalism and optimistic attitudes in colorectal cancer patients and the moderating effects

目的研究结直肠癌患者的癌症宿命论观念与乐观心态的关系,并探讨这一关系是否进一步取决于治疗决策过程中医师、患者及家属意见的影响力。方法对2021年1月-2021年12月于首都医科大学附属北京友谊医院普外科确诊结直肠癌并等待结直肠癌根治术的64例患者开展横断面调查。其中,男性38例,女性26例;年龄(61.2±13.0)岁,年龄范围30~84岁。评估患者的癌症宿命论观念、乐观心态以及在医疗决策过程中患者、家属及医师意见的影响力。其中,患者的癌症宿命论观念采用多维度健康状况心理控制源量表C表(MHLC-C)中的"命运"分量表进行测量,乐观心态采用修正版的生活取向测试中文版(CLOT-R)评估,医疗决策过程中患者、家属及医师意见的影响力采用自编单因素量表测量。正态分布的计量资料采用均数±标准差(x±s)表示,偏态分布的计量资料以M(Q_(1),Q_(3))表示。通过spearman相关性分析来检验主要结果变量(患者乐观心态)与人口统计学资料和临床资料之间的关联。采用逐步线性回归分析配合简单斜率分析来检验交互作用。结果患者的乐观心态与癌症宿命论观念呈显著负相关(r=-0.35,P<0.01);患者的乐观心态与家属意见对医疗决策的影响力呈显著负相关(r=-0.25,P<0.05)。医疗决策中患者与家属(r=0.50,P<0.01)、家属与医师(r=0.67,P<0.01)、医师与患者(r=0.38,P<0.01)意见的影响力两两之间均呈显著正相关。逐步线性回归分析结果显示,癌症宿命论与乐观心态呈负相关(β=-0.32,P=0.01),且家属意见对医疗决策的影响力(β=-0.56,P<0.01)、医师意见对治疗决策的影响力(β=-0.36,P=0.04)均对前述关系存在显著交互作用。简单斜率分析显示,当家属的意见对医疗决策有较高影响力时,可能会增强癌症宿命论观念对患者心态的消极影响;而当医师的意见对医疗决策的影响力较高时,可在一定程度上缓解癌症宿命论对患者心态的不利影响。结论:癌症宿命论对患者的乐观态度有负面影响。医师在治疗决策中的高影响力缓解了癌症宿命论对乐观态度的消极作用;家属在治疗决策中的高影响力强化了癌症宿命论对乐观态度的消极作用。在医患沟通和共同决策过程中,对于癌症宿命论观念较强的患者,应考虑适当增加医师与患者的直接信息沟通,减少家属在医疗决策中的过多干预,从而提高患者对治疗的积极性,促进乐观心态,降低癌症宿命论观念的不利影响。

Objective To investigate the association between cancer fatalism and optimistic attitudes among colorectal cancer patients,and how the above linkage is moderated by the involvement of patients′opinions,the family members′opinions and the physicians′opinions in treatment decision-making.Methods A cross-sectional survey was conducted on 64 patients diagnosed with colorectal cancer and awaiting radical colorectal cancer surgery in the Department of General Surgery of Beijing Friendship Hospital Affiliated to Capital Medical University,from January 2021 to December 2021.There were 38 males and 26 females,aged(61.2±13.0)years from 30 to 84 years.Cancer fatalism,optimism attitudes,and the involvement of patients′opinions,the family members′opinions and the physicians′opinions in treatment decision-making were assessed.The patients′cancer fatalism beliefs were measured by the"Chance"subscale of the Form C of the Multidimensional Health Locus of Control(MHLC-C),optimism attitudes were assessed by the Chinese version of the revised Life Orientation Test(CLOT-R),and the influence of patients′,family members′,and physicians′opinions in the medical decision-making process was measured by a self-designed single factor scale.Measurement data of normal distribution were expressed as mean±standard deviation(x±s).Measurement data of skewed distribution were expressed as M(Q_(1),Q_(3)).Spearman correlation analysis and Chi-square test was used to examine the association between the main outcome variable(patients′optimistic attitudes)and demographic and clinical characteristics.Interaction was examined by hierarchical linear regression analysis combined with simple slope tests.Results Cancer fatalism was negatively associated with patients′optimistic attitudes(r=-0.35,P<0.01).Optimistic attitude of patients was significantly and negatively correlated with the influence of family members′opinions on medical decision-making(r=-0.25,P<0.05).There were significant positive correlations between the influence of patients′and family members′opinions(r=0.50,P<0.01),family members′and physicians′opinions(r=0.67,P<0.01),and physicians′and patients′opinions(r=0.38,P<0.01)in medical decision making.Hierarchical linear regression analysis showed a negative association between cancer fatalism and optimism(β=-0.32,P=0.01).This association was further moderated by the involvement of family members′opinions(β=-0.56,P<0.01)and the involvement of physicians′opinions(β=-0.36,P=0.04)in medical decision-making.Simple slope tests revealed that the negative impact of fatalistic attitudes on patients′optimism attitudes may be potentiated when family members′opinions have high influence on medical decision-making,while the negative impact may be buffered to some extent when physicians′opinions have high influence on medical decision-making.Conclusions Cancer fatalism had a negative effect on patients′optimism.The high influence of physicians in treatment decision-making buffered the negative effect of cancer fatalism on optimism;the high influence of family members in treatment decision-making potentiated the negative effect of cancer fatalism on optimism.In the process of doctor-patient communication and shared decision-making,for patients with strong fatalistic attitudes,consideration should be given to appropriately increasing direct informational communication between physicians and patients and reducing excessive family intervention in medical decision-making,so as to enhance patients′autonomy for treatment,promote optimism,and reduce the negative effects of cancer fatalism.