二元应对在肺癌患者配偶照顾负担与生活质量间的中介作用分析-现代医学

二元应对在肺癌患者配偶照顾负担与生活质量间的中介作用分析

单位：1. 河北中医药大学护理学院, 河北石家庄 050200;
2. 河北北方学院附属第一医院介入手术室, 河北张家口 075000

分类号：R473.73

出版年·卷·期（页码）：2024·52·第一期（108-114）

摘要：

目的：评估肺癌患者配偶二元应对、照顾负担、生活质量的现状，分析三者之间的路径作用机制。方法：采用方便抽样法，选取2022年9月至2023年4月河北省5所三级甲等医院的331例肺癌患者配偶为研究对象。采用一般资料调查表、照顾者负担量表(ZBI)、家庭照顾者生活质量量表(FAMQOL)、二元应对量表(DCI)对其进行调查，分析二元应对在肺癌患者配偶照顾负担与生活质量间的中介作用。结果：331例肺癌患者配偶照顾负担总分为(24.58±13.42)分，生活质量总分为(50.41±8.08)分，二元应对总分为(127.20±18.16)分。照顾负担与二元应对、生活质量均呈负相关(r值分别为-0.488、-0.265，均P＜0.01)，二元应对与生活质量呈正相关(r=0.419，P＜0.01)。结构方程模型结果显示，肺癌患者配偶的照顾负担可负向预测生活质量，效应值为-0.183，二元应对在照顾负担与生活质量间起部分中介效应，占总效应的40.72%。结论：医护人员应开展以影响二元应对路径为依据的干预策略，尝试构建以夫妻为中心的疾病管理干预方案，从而降低患者配偶的照顾负担，提高其生活质量。

Objective: Assess the current status of dual coping, care burden, and quality of life among spouses of lung cancer patients, and analyze the pathway mechanisms among the three. Methods: Using the convenience sampling method, 331 spouses of lung cancer patients from 5 tertiary hospitals in Hebei Province from September 2022 to April 2023 were selected as the research subjects. A survey was conducted using a general information questionnaire, caregiver burden scale(ZBI), family caregiver quality of life scale(FAMQOL), and binary coping scale(DCI) to analyze the mediating role of binary coping in the care burden and quality of life of spouses of lung cancer patients. Results: The total score of spouse care burden for 331 lung cancer patients was(24.58±13.42), the total score of quality of life was(50.41±8.08), and the total score of binary coping was(127.20±18.16). The burden of care was negatively correlated with binary coping and quality of life(r values were -0.488 and -0.265, respectively, P<0.01), while binary coping was positively correlated with quality of life(r=0.419, P<0.01).The structural equation model results show that the care burden of spouses of lung cancer patients can negatively predict their quality of life, with an effect value of -0.183. Binary coping plays a partial mediating effect on care burden and quality of life, accounting for 40.72% of the total effect. Conclusion: Dual coping is a mediating variable between the burden of care and quality of life for spouses of lung cancer patients. Medical staff should implement intervention strategies based on the influence of binary coping pathways, attempting to construct a disease management intervention plan centered on spouses, in order to reduce the care burden on patients' spouses and improve their quality of life.

参考文献：

[1] LEBRETT M B,CROSBIE E J,SMITH M J,et al.Targeting lung cancer screening to individuals at greatest risk:the role of genetic factors[J].J Med Genet,2021,58(4):217-226.
[2] BRAY F,FERLAY J,SOERJOMATARAM I,et al.Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2018,68(6):394-424.
[3] BORGES L,FRANCESCHINI J,COSTA H,et al.Family caregiver burden:the burden of caring for lung cancer patients according to the cancer stage and patient quality of life[J].J Bras Pneumol,2017,43(1):18-23.
[4] 陈丽，任小红，黄伶智，等.肺癌化疗患者主要照顾者生活质量的影响因素研究[J].护理学报，2013，20(8)：1-4.
[5] MILBURY K,LI Y,DURRANI S,et al.A mindfulness-based intervention as a supportive care strategy for patients with metastatic non-small cell lung cancer and their spouses:results of a three-arm pilot randomized controlled trial[J].Oncologist,2020,25(11):e1794-e1802.
[6] HAMANO J,MORITA T,IGARASHI N,et al.The association of family functioning and psychological distress in the bereaved families of patients with advanced cancer:a nationwide survey of bereaved family members[J].Psychooncology,2021,30(1):74-83.
[7] 陈敏，陈丽.肺癌化疗患者配偶照顾负担与社会支持的相关性研究[J].当代护士(下旬刊)，2015，29(5)：69-70.
[8] 梁津，李鸿艳.脑卒中主要照顾者身心健康研究进展[J].循证护理，2021，7(7)：906-910.
[9] BODENMANN G.A systemic-transactional conceptualization of stress and coping in couples[J].Swiss J Psychol,1995,54(1):34-49.
[10] KARIN M,FALCONIER,REBEKKA,et al.Dyadic coping in couples:aconceptual integration and a review of the empirical literature[J].Front Psychol,2019,72(6):24-31.
[11] 支修益，杨跃，王长利，等.原发性肺癌诊疗规范(2015年版):外科部分[J].中国医学前沿杂志(电子版)，2015，7(2)：28-31.
[12] 倪平，陈京立，刘娜.护理研究中量性研究的样本量估计[J].中华护理杂志，2010，45(4)：378-380.
[13] XU F,HILPERT P,RANDALL A K,et al.Validation of the dyadic coping inventory with chinese couples:factorial structure,measurement invariance,and construct validity[J].Psychol Assess,2016,28(8):e127-e140.
[14] ZARIT S H,FEMIA E E,KIM K,et al.The structure of risk factors and outcomes for family caregivers:implications for assessment and treatment[J].Aging Ment Health,2010,14(2):220-231.
[15] 王烈，杨小湜，侯哲，等.护理者负担量表中文版的应用与评价[J].中国公共卫生，2006，17(8)：970-972.
[16] NAUSER J A,BAKAS T,WELCH J L.A new instrument to measure quality of life of heart failure family caregivers[J].J Cardiovasc Nurs,2011,26(1):53-64.
[17] 钱海兰.居家慢性心力衰竭患者和家庭照顾者疾病管理及生活质量的调查[D].上海：复旦大学，2012.
[18] 段含含，徐巍，赵丽敏，等.维持性血液透析患者二元应对现状及影响因素分析[J].上海护理，2023，23(6)：31-35.
[19] 安欣，李玉琢，张丹，等.心理弹性在肺结核患者照顾者负担与生活质量间的中介效应[J].中国防痨杂志，2022，44(1)：83-90.
[20] 孟欢欢，卢海滨，吕文龙，等.老年脑卒中病人主要照顾者照顾负担与心理弹性的相关性分析[J].全科护理，2023，21(9)：1170-1173.
[21] FUJINAMI R,SUN V,ZACHARIAH F,et al.Family caregivers' distress levels related to quality of life,burden,and preparedness[J].Psychooncology,2015,24(1):54-62.
[22] JAFARI H,EBRAHIMI A,AGHAEI A,et al.The relationship between care burden and quality of life in caregivers of hemodialysis patients[J].BMC Nephrol,2018,19(1):321-330.
[23] 李秋萍，刘福珍，周闻红.重症肝炎患者配偶二元应对现状与影响因素研究[J].当代护士(下旬刊),2022，29(4)：18-21.
[24] CHEN M,GONG J,CAO Q,et al.A literature review of the relationship between dyadic coping and dyadic outcomes in cancer couples[J].Eur J Oncol Nurs,2021,21(7):92-104.
[25] LYONS K S,LEE C S.The theory of dyadic illness management[J].J Fam Nurs,2018,24(1):8-28.
[26] COYNE J C,SMITH D A.Couples coping with a myocardial infarction:a contextual perspective on wives' distress[J].J Pers Soc Psychol,1991,61(3):404-412.
[27] 徐翠荣，曹小彤，陈泳，等.同伴支持对慢性心力衰竭患者生活质量的干预效果研究[J].东南大学学报(医学版)，2022，41(4)：552-556.

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