白血病患儿父母疾病进展恐惧发展轨迹及影响因素分析

Development trajectory of fear of progression and its influencing factors in parents of children with leukemia

目的探究白血病患儿父母疾病进展恐惧发展轨迹及影响因素,为实施干预提供借鉴。方法采用前瞻性纵向研究设计,2022年10月—2023年7月采取便利抽样法选取符合抽样标准的187名白血病患儿父母作为研究对象,分别在确诊后1个月末,确诊后3个月末和确诊后6个月末调查其疾病进展恐惧水平。使用潜变量增长混合模型识别轨迹类别,使用CART算法建立白血病患儿父母疾病进展恐惧影响因素的决策树分类模型。结果白血病患儿父母疾病进展恐惧轨迹可以分为低水平恐惧上升组(10.0%)、中水平恐惧下降组(31.3%)和高水平恐惧下降组(58.7%)。结果显示,婚姻状况、病情危重程度、自悯和认知融合影响白血病患儿父母疾病进展恐惧发展轨迹类别(均P<0.05)。决策树分类模型分析显示认知融合是根节点,内部节点为患儿病情危重程度、婚姻状况和自悯。结论白血病患儿父母疾病进展恐惧存在3条不同的发展轨迹,决策树显示认知融合是最重要的影响因素,其次为患儿疾病严重程度、婚姻状况和自悯,需尽早针对可能的影响因素实施疾病进展恐惧干预。

Objective To explore the development trajectory and influencing factors of fear of progression in parents of children with leukemia,and to provide reference for targeted intervention.Methods A prospective longitudinal study was adopted.From October 2022 to July 2023,187 parents(who met sampling criteria)of children with leukemia were gathered by convenience sampling.Parents were surveyed at the end of one month,three and six months after diagnosis respectively.Latent growth mixture modeling was used to identify trajectory categories of fear of progression.CART algorithm was used to establish a decision tree classification model for the influencing factors.Results Parents’fear of progression development trajectory was divided into and named as low-level fear rising group(10.0%),medium-level fear declining group(31.3%),and high-level fear declining group(58.7%).Marital status,degree of distress,self-compassion,and cognitive fusion influenced the category of fear of progression trajectory(all P<0.05).Decision tree classification model analysis showed that cognitive fusion was the root node,while the internal nodes were disease severity,marital status,and self-compassion.Conclusion There are three trajectories of fear of progression in parents of children with leukemia.The decision tree model shows that cognitive fusion is the key influencing factor,followed by disease severity,marital status and self-compassion.Early intervention for fear of progression should be implemented based on possible influencing factors.