恶性肿瘤患者知情程度与治疗依从性的关系：心理状态和家庭社会支持的中介作用分析-现代医学

恶性肿瘤患者知情程度与治疗依从性的关系：心理状态和家庭社会支持的中介作用分析

单位：新疆维吾尔自治区人民医院肿瘤科, 新疆乌鲁木齐 830000

分类号：R473.73

出版年·卷·期（页码）：2023·51·第三期（328-333）

摘要：

目的：探讨恶性肿瘤患者知情程度与治疗依从性的关系，分析患者的心理状态、家庭韧性及社会支持在知情程度和治疗依从性之间的中介效应。方法：以2019年6月至2021年8月在我院肿瘤科住院的350例患者为研究对象，采用一般资料调查、服药依从性量表(MMAS)、焦虑抑郁量表(HADS)、家庭坚韧力量表(FHI)、MOS社会支持量表(MOS-SSS)及医院自制的知情程度量表对患者进行问卷调查。采用Pearson相关模型分析患者治疗依从性与心理状态和家庭社会支持度之间的关系，采用结构方程模型分析患者的心理状态与家庭韧性及社会支持在知情程度和依从性间的中介效应。结果：350份问卷中剔除30份无效问卷，最终320份问卷纳入本研究。患者知情度评估显示，150例患者知情，100例患者部分知情，70例患者不知情，据此分组后对比临床资料显示，3组患者MMAS评分、HADS评分、FHI评分及MOS-SSS评分比较差异有统计学意义(P<0.001)；Pearson相关性分析显示，恶性肿瘤患者治疗依从性MMAS评分与HADS评分呈负相关，与FHI评分、MOS-SSS评分呈正相关(P<0.05)；HADS评分与FIH、MOS-SSS评分呈负相关(P<0.05)；结构方程模型显示，心理状态和家庭及社会支持对依从性有直接正向效应(β值分别为0.44、1.08，均P<0.05)；知情程度对依从性有直接负向效应(β=-0.17，P<0.05)。结论：患者的治疗依从性与其知情程度呈现高度相关性；家庭韧性和社会支持度与患者心理状态也存在中介效应，社会支持度高的患者其心理状态、治疗依从性也较好。

Objective： To explore the relationship between the degree of awareness and treatment compliance in patients with malignant tumors, and to analyze the mediating effects of the patients' psychological state, family resilience and social support on the degree of awareness and treatment compliance. Methods： From June 2019 to August 2021, 350 patients who were hospitalized in the oncology department of our hospital were selected as the research objects. Morisky Medication Adherence Scale (MMAS), Hospital Anxiety and Depression Scale (HADS), Family Hardiness Index (FHI), MOS Social Support Scale (MOS-SSS) and the hospital-made informedness scale were used to conduct a questionnaire survey on the patients. Pearson correlation model was used to analyze the relationship between patients' awareness and treatment compliance, psychological state and family social support, and structural equation model was used to analyze the mediating effect of patients' psychological state, family resilience and social support between patients' awareness and treatment compliance. Results： There were 350 questionnaires distributed, 30 invalid questionnaires excluded, and 320 valid questionnaires were finally recovered. The survey of the degree of knowledge scale showed that 150 patients were informed, 100 patients were partially informed, and 70 patients were not aware. There were statistically significant differences in MMAS score, HADS score, FHI score and MOS-SSS score between the three groups(P<0.001). Pearson correlation analysis showed that patients' MMAS score was negatively correlated with HADS score, there was a positive correlation between MMAS score and FHI score, MOS-SSS score (P<0.001); HADS score was negatively correlated with FIH and MOS-SSS scores (P<0.001). Structural equation model showed that psychological status and family and social support had a directly positive effect on compliance(β=0.44, 1.08, all P<0.05); the degree of awareness had a directly negative effect on compliance (β=-0.17, P<0.05). Conclusion： There is a significant correlation between cancer patients' awareness of their own diseases and patients' treatment compliance. Family resilience and social support also have mediating effects on patients' psychological status. Giving patients higher social and family support is essential for improving patients' psychological status and psychological status, and also can improve their treatment compliance.

参考文献：

[1] 饶井芬,肇爽,刘承一,等.循证心理关怀对老年恶性肿瘤患者治疗依从性、负面情绪及并发症发生的影响[J].现代中西医结合杂志,2018,27(27):3068-3070.
[2] 王龙,张雪,韩晶,等.中国癌症患者病情知情程度与生活质量焦虑抑郁情绪及尊严感的相关性研究[J].河北医学,2019,25(12):1945-1950.
[3] TURAN G B,AKSOY M,ÇIFTÇIB.Effect of social support on the treatment adherence of hypertension patients[J].J VascNurs,2019,37(1):46-51.
[4] ENRIQUEZ M,MERCIER D A,CHENG A L,et al.Perceived social support among adults struggling with adherence to HIV care and treatment[J].J Assoc Nurses AIDS Care,2019,30(3):362-371.
[5] BEEN S K,SCHADÉ A,BASSANT N,et al.Anxiety,depression and treatment adherence among HIV-infected migrants[J].AIDS Care,2019,31(8):979-987.
[6] 翁艳君,赵豫梅,刘伟军,等.中文版8条目Morisky服药依从性量表在2型糖尿病患者中的信效度评价及应用研究[J].中华临床医师杂志(电子版),2018,12(8):445-450.
[7] ZIGMOND A S,SNAITH R P.The hospital anxiety and depression scale[J].Acta Psychiatr Scand，1983，67(6):361-370.
[8] MCCUBBIN H I,THOMPSON A L,MCCUBBIN M A. Family assessment:resiliency,coping,and adaptation-inventories for research and practice[M].Madison：University of Wisconsin System,1996:130-189.
[9] 何文奇,杨晓,乔晓丽,等.中文版医疗社会支持量表应用于妇科癌症病人的信效度评价[J].护理研究,2017,31(14):1709-1713.
[10] 陈翠萍,马桂芬,杨春琴,等.医疗社会支持量表中文版应用于脑卒中病人的信效度测量[J].护理研究,2015,1(32):3994-3996.
[11] ANDERSON K,BIELLO K,ROSENBERGER J G,et al.The impact of social support and partner relationship dynamics on engagement in HIV care and antiretroviral treatment adherence among MSM in Latin America[J].AIDS Care,2018,30(11):1406-1412.
[12] JIMU C,GOVENDER K,KANYEMBA R,et al.Experiences of intimate relationships,stigma,social support and treatment adherence among HIV-positive adolescents in Chiredzi district,Zimbabwe[J].Afr J AIDS Res,2021,20(3):214-223.
[13] KING E J,YAKOVLEVA A,LISECKI S R,et al.Social support and postpartum adherence to HIV treatment:a community-based participatory research study in Russia[J].Eur J Public Health,2021,31(1):63-67.
[14] 胡小春,王叶,姜月,等.家庭坚韧力在多发性骨髓瘤患者社会支持与恐惧疾病进展间的中介效应[J].护理学报,2020,27(14):30-34.
[15] CHARYEVA Z,CURTIS S,MULLEN S,et al.What works best for ensuring treatment adherence.Lessons from a social support program for people treated for tuberculosis in Ukraine[J].PLoS One,2019,14(8):e0221688.
[16] 陈娟娟,李惠萍,杨娅娟,等.家庭韧性对癌症患者心理韧性的影响:领悟社会支持和生命意义感的链式中介作用[J].中国临床心理学杂志,2019,27(6):1205-1209.
[17] SOUSA H,RIBEIRO O,PAÚL C,et al.Social support and treatment adherence in patients with end-stage renal disease:a systematic review[J].Semin Dial,2019,32(6):562-574.
[18] PAALIMÄKI-PAAKKI K,VIRTANEN M,HENNER A,et al.Effectiveness of digital counseling environments on anxiety,depression,and adherence to treatment among patients who are chronically ill:systematic review[J].J Med Internet Res,2022,24(1):e30077.
[19] BERGLUND E,LYTSY P,WESTERLING R.Living environment,social support,and informal caregiving are associated with healthcare seeking behaviour and adherence to medication treatment:a cross-sectional population study[J].Health Soc Care Community,2019,27(5):1260-1270.
[20] 吴丽霞,王姚姚,王婧淼,等.精准医疗及其在胰腺癌诊治中的应用[J].东南大学学报(医学版),2022,41(5):751-755.
[21] SEIXAS A A,TRINH-SHEVRIN C,RAVENELL J,et al.Culturally tailored,peer-based sleep health education and social support to increase obstructive sleep apnea assessment and treatment adherence among a community sample of blacks:study protocol for a randomized controlled trial[J].Trials,2018,19(1):519.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录