吴冰 马周理 缪沈琴

摘 要 目的：了解社區初诊癌症患者心理痛苦现状及影响因素，为制定针对性干预措施提供依据。方法：采用包含心理痛苦温度计（DT）和心理痛苦相关问题列表（PL）两个部分的心理痛苦管理筛查工具（DMSM）对社区85例初诊癌症患者进行心理痛苦状况调查。其中男性患者34例，女性患者51例，平均年龄（50.25±11.40）岁。初次诊断结果分别为肺癌37例，乳腺癌有30例，肠癌11例，胃癌7例。结果：患者DT平均得分为（4.65±2.45）分；DT≥4分的有54例，占63.52%。不同部位癌症患者DT得分差异有统计学意义（P<0.05）；心理痛苦相关因素排序前3位的是身体问题中的癌因性疲乏、情绪问题中的担忧、和实际问题中的经济问题，所占比例分别为87.05%、78.82%、74.11%。结论：社区初诊癌症患者心理痛苦处于较高水平；影响因素较多，并相互交织。提示护理人员需了解不同患者的心理痛苦因素，在社区肿瘤随访过程中应制定个性化干预计划与措施，减轻患者心理痛苦程度，提高生命质量。

关键词 癌症；心理痛苦；社区；初诊

中图分类号：R749 文献标志码：A 文章编号：1006-1533（2018）20-0039-04

The state of psychological distress and influencing factors in newly diagnosed cancer patients in the community

WU Bing， MA Zhouli， MIAO Shenqin

（Soothing Ward of Chengjiaqiao Community Health Service Center of Changning District， Shanghai 201103， China）

ABSTRACT Objective： To understand the current situation and influencing factors of psychological distress in patients with newly diagnosed cancer in the community to provide evidence for the development of targeted interventions. Methods： Psychological distress management screening measure（DMSM） consisting of distress thermometer（DT） and psychological distress related problem list（PL） was used to investigate the psychological distress status of 85 community cancer patients. Among them， 34 were male and 51 were female， with an average age of 50.25 ± 11.40 years old. The initial diagnosis results were 37 cases of lung cancer， 30 cases of breast cancer， 11 cases of intestinal cancer and 7 cases of gastric cancer. Results： The average score of patients with DT was （4.65±2.45） points； there were 54 cases with DT≥4 points， accounting for 63.52%. The difference in DT scores of patients with different diseases was statistically significant（P<0.05）. The top three psychological distress related factors were cancer-related fatigue， anxiety in emotional problems and economic problems in practical problems， accounting for 87.05%， 78.82% and 74.11%， respectively. Conclusion： The psychological distress of patients with newly diagnosed cancer in the community is at a high level； there are many influencing factors and they are intertwined. It is suggested that nursing staff need to understand the psychological distress factors of different patients， in the community tumor follow-up process， individualized intervention plans and measures should be developed to reduce the psychological distress of patients and improve the quality of life.

KEY WORDS cancer； psychological distress； community； first diagnosis

《2015上海市恶性肿瘤报告》显示，2013年全市共诊断新发恶性肿瘤病例66 545例，比2012年增加4 776例；肿瘤是继心脑血管疾病之后的第二位死亡原因[1]。癌症的高死亡率以及治疗过程中所经受的痛苦体验，均可导致患者心理问题。美国综合癌症网络将癌症患者可能发生的一系列心理问题归纳为癌症相关心理痛苦[2]。尤其是患者突然初次面临被诊断为癌症的现实，需要承受来自工作、生活、经济、创伤性治疗及其副反应等多方面的心理应激。如果未能及时发现并进行适当的干预，心理痛苦极有可能演变成为焦虑、抑郁症，导致机体抵抗力下降，严重影响患者的治疗和康复，进一步促进肿瘤的复发、恶化、转移等[3]。有研究表明，通过各种方式消除患者身体及心理的不适，让患者保持无痛苦的状态，可以明显提高癌症患者的生活质量[4]。本文旨在探讨社区初诊癌症患者的心理痛苦状况及其影响因素，为社区制定心理干预措施，促进患者心理康复提供依据。……