肺癌患者心理痛苦发展轨迹的调查研究

The investigation of psychological distress development trajectory in lung cancer patients

目的探讨肺癌患者从确诊至术后化疗阶段心理痛苦的发展轨迹,并分析影响因素对轨迹类别的预测作用。方法采用纵向前瞻性研究设计。2022年11月至2023年7月便利选取山东第一医科大学附属省立医院和山东第一医科大学第二附属医院2所医院的胸外科符合标准的肺癌患者250例。于术前(T0)收集肺癌患者的一般资料和人格类型,并于术前(T0)、化疗前(T1)、化疗第1个月(T2)、化疗第3个月(T3)、化疗第6个月(T4)5个时间点,评估肺癌患者心理痛苦水平。采用潜类别增长模型拟合心理痛苦轨迹类别,并使用多元Logistic回归分析轨迹影响因素。结果最终230例(92%)肺癌患者完成随访,男130例,女100例,年龄为(61.21±6.95)岁。T0、T1、T2、T3、T4肺癌患者心理痛苦得分分别为(5.29±1.20)、(5.05±1.26)、(4.63±1.24)、(4.62±1.24)、(3.87±1.41)分;其心理痛苦发展轨迹分为3个亚组,分别为无心理痛苦组(39.2%)、心理痛苦减轻组(42.6%)、持续心理痛苦组(18.2%)。单因素分析表明,性别(χ^(2)=6.12,P=0.047)、文化程度(χ^(2)=23.64,P<0.001)、家庭人均月收入(χ^(2)=18.84,P=0.004)、人格类型(χ^(2)=48.96,P<0.001)与心理痛苦轨迹类别有关;多元Logistic回归分析显示,性别(OR=0.371,95%CI 0.155~0.887)、多血质(OR=3.064,95%CI 1.305~7.195)、抑郁质(OR=0.248,95%CI 0.064~0.960)是心理痛苦轨迹的预测因素(均P<0.05)。结论肺癌患者从确诊至化疗第6个月内心理痛苦大部分得到改善,其心理痛苦轨迹存在异质性,临床医疗团队可根据心理痛苦轨迹类别的影响因素制订干预措施给予个性化护理。

Objective To explore the trajectory of psychological distress on lung cancer patients from diagnosis to the postoperative chemotherapy period,and to analyze whether influencing factors can predict trajectory category.Methods Adopting prospective study design,from November 2022 to July 2023,250 lung cancer patients who met the criteria in the Department of Thoracic Surgery of the Provincial Hospital of Shandong First Medical University and the Second Affiliated Hospital of the First Medical University of Shandong Province were selected.General information and personality types of lung cancer patients were collected before operation(T0)and psychological distress was evaluated at five time points:preoperative(T0),pre-chemotherapy(T1),1 months after chemotherapy(T2),3 months after chemotherapy(T3),and 6 months after chemotherapy(T4).A latent category growth model was used to identify psychological distress trajectories of psychological distress.Logistic regression was used to analyze the influencing factors.Results The final 230(92%)lung cancer patients completed follow-up,including 130 males and 100 females,aged(61.21±6.95)years old.Psychological distress scores of lung cancer patients at T0,T1,T2,T3 and T4 were(5.29±1.20),(5.05±1.26),(4.63±1.24),(4.62±1.24)and(3.87±1.41)points.Three trajectories of psychological distress were fitted,which were no psychological distress group(39.2%),reducing psychological distress group(42.6%),and persistent psychological distress group(18.2%).Univariate analysis showed that gender(χ^(2)=6.12,P=0.047),education level(χ^(2)=23.64,P<0.001),monthly family income(χ^(2)=18.84,P=0.004),and personality type(χ^(2)=48.96,P<0.001)were associated with psychological distress trajectories.Logistic regression analysis showed that gender(OR=0.371,95%CI 0.155-0.887),sanguine personality(OR=3.064,95%CI 1.305-7.195),and depressive personality(OR=0.248,95%CI 0.064-0.960)were predictive factors of the psychological distress trajectories(all P<0.05).Conclusions Lung cancer patients′psychological distress mostly improved from diagnosis to the 6th month of chemotherapy.There was group heterogeneity in psychological distress trajectory.The clinical team should develop interventions to provide individual care according to the influential factors of the trajectories of psychological distress.