妇科恶性肿瘤患者癌症症状求助行为特征的质性研究

Characteristics of help-seeking behavior for cancer symptoms in patients with gynecologic malignancies:a qualitative study

目的探讨妇科恶性肿瘤患者癌症症状求助行为的特征,旨在为该人群症状管理方案的制定提供参考。方法采用描述性现象学研究方法,按照目的抽样法,选择在南京市某三级甲等医院复诊治疗的妇科恶性肿瘤患者15例,对其进行半结构式深度访谈,并运用Colaizzi 7步法对访谈资料进行分析。结果提炼出5个主题:低疾病认知延迟症状求助行为(早期症状不典型导致就医曲折、症状归因合理化),社会心理因素弱化症状求助行为(家庭照顾责任拖延就诊、优先处理工作的即时需要、性生活担忧与病耻感、负性情绪与克制自我表露),感知益处促进症状求助意识(健康指导增加求助信任、多途径寻求疾病信息支持),家庭支持强化症状求助行为决策,社区卫生保健服务可及性丰富症状求助形式。结论妇科恶性肿瘤患者的癌症症状求助行为与疾病认知水平、社会心理因素、感知益处、家庭支持和社区卫生保健服务密切相关,医护人员应加强对该人群的症状管理,强化家庭及社会支持,促进癌症症状求助行为的早期发生,减少癌症症状的困扰,提高妇科恶性肿瘤患者生存期和生活质量。

Objective To explore the characteristics of help-seeking behavioral for cancer symptom in patients with gynecologic malignancies,so as to provide a reference for developing symptom management programs.Methods A descriptive phenomenological research was designed,and purposive sampling method was used to select 15 cases of gynecological malignancy patients hospitalized in a tertiary-level hospital in Nanjing City,then semi-structured in-depth interviews were conducted on them,and the Colaizzi 7-step method was applied to analyze the interview data.Results Five themes were summarized:low disease awareness delays symptomatic help-seeking behavior(early non-specific symptoms lead to delayed diagnosis,rationalization of symptom attribution),psychosocial factors weaken symptomatic help-seeking behavior(family caregiving responsibilities delaying consultation,sense of prioritization of work,sexuality concerns and stigma,negative emotions and self-expression restraint),perceived benefits promote awareness of symptomatic help-seeking(health education increases trust in help-seeking,multiple ways of seeking support for information about the disease),family support reinforces symptomatic help-seeking behavioral decision-making,and the availability of community-based health care enriches the forms of symptomatic help-seeking.Conclusion Help-seeking behavior for cancer symptom of gynecologic malignancy patients is closely related to the level of disease cognition,psychosocial factors,perceived benefits,family support,and community health care services.Healthcare professionals should strengthen symptom management in this population,reinforce family and social support,promote the early occurrence of help-seeking behaviors for cancer symptom,reduce cancer symptom distress,and improve the survival and quality of life of patients with gynecologic malignancies.