胃癌患者围手术期症状及心理痛苦感知的纵向质性研究

Longitudinal qualitative study on the perception of symptoms and psychological distress in patients with gastric cancer during the perioperative period

目的了解胃癌患者围手术期症状及心理痛苦感知变化,为临床制定针对性干预方案提供参考。方法应用纵向质性研究的方法,采用目的抽样法选取住院胃癌患者14例进行半结构式访谈,对资料进行横断面和纵向分析。结果共提炼出4个主题12个亚主题:对症状的感知(对胃肠道症状重视不足、既往症状经历的影响、对日常生活影响最大而非最严重症状),认知中的因果推理(成因多元化、无法客观评价自我效能、将症状归因于可控因素),始终存在负性情绪(对罹患胃癌需要手术治疗的恐惧、对术后恢复的担忧、对无法回归正常社会生活的沮丧),无效应对后的知识需求(采取回避行为、对术前照护知识的需求、对康复知识的需求)。结论胃癌患者围手术期症状及心理痛苦感知复杂且呈现动态变化,护理人员应关注和分析其变化过程,满足患者围手术期不同时期的照护需求。

Objective To explore the changes in symptom perception and psychological distress experienced by patients with gastric cancer during the perioperative period,and to provide references for medical staff to develop targeted interventions.Methods A purposive sampling method was used to recruit 14 hospitalized patients with gastric cancer.Semi-structured interviews were conducted,and data were analyzed using both cross-sectional and longitudinal approaches.Results Four themes and 12 subthemes were identified:perception of symptoms(insufficient attention to gastrointestinal symptoms,influence of past symptom experiences,greatest impact on daily life rather than most severe symptoms),causal reasoning in cognition(multiple attributions of causation,inability to objectively evaluate self-efficacy,attributing symptoms to controllable factors),persistent negative emotions(fear of gastric cancer and surgical treatment,concerns about postoperative recovery,frustration with inability to return to normal social life),and knowledge needs after ineffective coping(avoidance behaviors,need for preoperative care knowledge,need for rehabilitation knowledge).Conclusion The perception of symptoms and psychological distress in patients with gastric cancer during the perioperative period is complex and dynamic.Nurses should pay attention to and analyze these changes to meet the different care needs of patients throughout the perioperative period.