年轻女性乳腺癌患者经济毒性应对困境的质性研究

A qualitative study on financial toxicity coping dilemmas in young female patients with breast cancer

目的 探索年轻女性乳腺癌患者在应对经济毒性过程中面临的困境,以期为构建该人群经济毒性的干预策略提供建议。方法 采用描述性质性研究方法,于2021年9月-2022年1月通过目的抽样法,选取上海市某三级甲等肿瘤医院乳腺外科随访门诊的29例乳腺癌患者为研究对象,对其进行半结构式访谈,运用内容分析法对访谈资料进行二次分析。结果 年轻女性乳腺癌患者经济毒性应对困境提炼为3个主题和11个亚主题:经济毒性导致的不良后果(因病负债或中断治疗、家庭关系改变或恶化、日常生活水平下降)、应对经济毒性的困境与矛盾(成本沟通困境、家庭角色困境、工作能力受损与渴望收入的矛盾、维护自尊和隐私与寻求帮助的矛盾)、缓解应对困境的措施与方法(谨慎决策经济支出、动态调整工作投入、尽量弥补或隐瞒家人、寻找癌症的积极作用)。结论 医护人员应关注年轻女性乳腺癌群体面临的困境,通过早期筛查与评估、加强医患成本沟通、主动提供社会支持资源、动员家庭共促患者重返工作等方式助力患者应对经济毒性。

Objective To explore the dilemmas of coping with financial toxicity in young female breast cancer patients,so as to provide recommendations for constructing intervention strategies of financial toxicity in this population.Methods Using a descriptive qualitative research method,from September 2021 to January 2022,29 breast cancer patients from the follow-up outpatient clinic of the breast surgery department at a tertiary cancer hospital in Shanghai were selected by purposive sampling,and semi-structed interviews were adopted to collect data,and content analysis method was applied to secondary analyze the interview data.Results The dilemmas to cope with financial toxicity for young female breast cancer patients could be distilled into 3 themes and 11 sub-themes:Adverse consequences of financial toxicity(Financial debt or treatment interruption due to illness,changes or deterioration in family relationships,and decreased daily life quality),dilemmas and contradictions in coping with financial toxicity(Cost communication dilemma,family role dilemma,contradiction between impaired work capacity and desire for income,and contradiction between maintaining dignity and privacy and seeking help),and measures and methods to alleviate coping dilemmas(Prudent decision-making on financial expenses,dynamically adjusting work input,attempting to compensate or conceal from family,and seeking positive aspects of cancer).Conclusion Healthcare providers should pay attention to the dilemmas faced by young female breast cancer survivors and assist them in coping with financial toxicity through early screening and assessment,strengthening cost communication between doctors and patients,actively providing social support resources,and mobilizing families to promote patients to return to work.