结直肠癌术后患者无法忍受不确定性对心理痛苦影响的作用路径分析

Effect of intolerance of uncertainty on cancer-related distress in patients with colo-rectal cancer after operation:a path analysis

目的分析结直肠癌术后患者无法忍受不确定性对心理痛苦影响的作用路径,为医护人员识别结直肠癌术后患者负性情绪,开展精准护理提供理论依据。方法以便利抽样法抽取山东省4所三级甲等医院的结直肠癌术后患者484例,应用一般资料调查表、无法忍受不确定性量表简化版、事件影响程度量表修订版、焦虑抑郁自评量表、Connor-Davidson弹性量表简化版进行调查。结果患者无法忍受不确定性总分为(31.81±7.17)分,心理痛苦总分为(33.69±11.87)分。患者无法忍受不确定性与心理痛苦、焦虑、抑郁呈正相关,心理痛苦与焦虑、抑郁呈正相关,心理弹性与无法忍受不确定性、心理痛苦呈显著负相关,焦虑、抑郁与心理弹性呈显著负相关(均P<0.05)。结构方程模型结果显示,χ^(2)/df=2.385,RMSEA=0.054,GFI=0.988,AGFI=0.956,NFI=0.992,CFI=0.996,模型适配度良好。路径结果显示,结直肠癌术后患者无法忍受不确定性可以直接预测心理痛苦,心理弹性与焦虑、抑郁在无法忍受不确定性作用于心理痛苦的路径中起链式中介作用(均P<0.05)。结论结直肠癌术后患者无法忍受不确定性及心理痛苦处于中等水平。结直肠癌术后患者的无法忍受不确定性可以正向预测心理痛苦,亦可以通过焦虑抑郁-心理弹性的链式中介作用间接预测心理痛苦。医护人员应及时关注患者负性情绪,采取干预措施调动患者内在驱动力,以降低患者负性情绪的困扰。

Objective To analyze the pathway model for the effect of intolerance of uncertainty on cancer-related distress in patients undergoing colorectal cancer surgery,so as to provide a theoretical basis for medical staff to further identify the negative emotions in patients with colorectal cancer after surgery and carry out accurate care.Methods A total of 484 postoperative patients with colo-rectal cancer were selected from 4 tertiary grade A hospitals in Shandong province using convenience sampling method.The general information questionnaire,Intolerance of Uncertainty Scale-12,Impact of Event Scale-Revised,Hospital Anxiety and Depression Scale,10-item Connor-Davidson Resilience Scale were utilized for the investigation.Results The total score of intolerance of uncertainty was(31.81±7.17),and the total score of cancer-related distress was(33.69±11.87).Patients′intolerance of uncertainty was positively correlated with cancer-related distress,anxiety and depression;cancer-related distress was positively correlated with anxiety and depression;resilience was negatively correlated with intolerance of uncertainty and cancer-related distress;anxiety and depression were negatively correlated with resilience(all P<0.05).The result of structural equation model showed that χ^(2)/df=2.385,RMSEA=0.054,GFI=0.988,AGFI=0.956,NFI=0.992,CFI=0.996,and all the indicators meet the fitting standard.The result of the path analysis showed that the intolerance of uncertainty could directly predict cancer-related distress;anxiety and depression,resilience played a chain mediating role in the pathway of intolerance of uncertainty on cancer-related distress(all P<0.05).Conclusion The level of intolerance of uncertainty and cancer-related distress in postoperative patients with colorectal cancer is moderate.The intolerance of uncertainty among postoperative patients with colorectal cancer could positively predict cancer-rela-ted distress,and it could also affect the cancer-related distress through the chain mediation of"anxiety and depression-resilience".Medical staff should pay attention to patients′negative emotions in time,and take intervention measures to mobilize patients′inner driving force to reduce the distress of patients′negative emotions.