癌症化疗患者希望水平与应对方式、社会支持关系的研究
摘要
癌症已成为严重威胁人类健康的最主要疾病。希望是癌症治疗过程中的一个重要组成部分。因此通过研究确定癌症患者在化疗期间的希望水平及希望水平与应对方式和社会支持之间的关系是十分有临床意义的课题。
研究目的
本研究旨在探讨中国癌症化疗患者的希望水平，探讨不同癌症类型患者的希望水平之间是否存在差异；确定希望水平与癌症化疗患者的应对方式、社会支持状况之间的相关性。
研究方法
自2005年12月1日至2006年6月31日在哈尔滨医科大学第一临床医学院和哈尔滨医科大学第三临床医学院对首次手术治疗后正在进行化疗的300名住院癌症患者发放调查问卷，化疗次数选择在第一次至第六次期间。癌症患者的种类选择为胃癌、结肠癌、直肠癌、肺癌、乳腺癌。采用便利抽样的方法收集资料，调查问卷分为4个部分，第一部分为一般调查表，用来收集癌症患者的背景资料，第二部分为Herth希望量表，用来测定癌症患者的希望水平，第三部分为Jaloeice应对量表，用来测定癌症患者的应对方式，第四部分为肖水源的社会支持量表，用来测定癌症患者的社会支持水平。
研究结果
癌症化疗患者的希望总体平均分为38.32±4.44，不同癌症类型的患者希望水平之间没有差异(F=3.24，P＞0.05)，但家庭月收入的高低影响希望水平(F=4.53，P＜0.05)，即家庭收入越高，希望水平越高；癌症患者的应对方式总体均分为1.57±0.27，其中乐观应对方式得分最高，为2.02±0.38，情感应对方式得分最低，为0.93±0.55。癌症患者的社会支持总体均分为46.26±6.96，其中客观支持为12.05±3.18，主观支持为26.57±4.07，对支持的利用度为7.63±2.23。
希望总体与应对总体在统计学上无显著性意义(r=0.90，P＞0.05)，但希望总体与乐观、面对应对方式有非常显著的正相关关系(r=0.21，r=0.18，P＜0.01)，与自我依赖、保守应对方式有显著的正相关关系(r=0.14，r=0.15，P＜0.05)，与情感、听天由命应对方式存在非常显著的负相关关系(r=-0.26，r=-0.20，P＜0.01)。希望总体与社会支持总体存在非常显著的正相关关系(r=0.28，p＜0.01)，与客观支持、主观支持和对支持的利用度三个方面都存在非常显著的正相关关系(r=0.20，r=0.23，r=0.17，p＜0.01)。
研究结论
研究表明大部分癌症化疗患者获得了较高的希望水平，不同癌症类型患者的希望水平之间没有差异，但家庭月收入情况影响希望水平，家庭收入越高，希望水平越高；希望水平不受年龄、性别、教育水平、医疗费用支付情况、化疗次数的影响。癌症患者在化疗期间采用多种应对方式，希望水平与应对方式总体无相关关系，但与乐观、面对、自我依赖、保守、情感和听天由命应对方式有关。希望与社会支持存在非常显著的正相关关系，即癌症患者在化疗期间获得的社会支持越多，其希望水平越高。
因此，护士在护理癌症患者的过程中应指导患者采用积极的应对方式，避免采用消极的应对方式，并且充分地运用各方面的社会支持以提高患者的希望水平，树立其战胜疾病的信念，进而增进癌症患者的心理健康，提高其生活质量。
Cancer has become the most health threatening disease for human. Hope is one of the important components during the cancer treatment. Therefore, identifying the relationship between hope, coping style and social support in the patients with cancer is a meaningful study.
Objectives: The purpose of this research is to explore the level of hope in patients with cancer diagnosis during chemotherapy in China, to find whether there is different levels of hope in the patients with various cancer, and to identify the relationship of hope, coping style and social support.
Research Methods: 300 subjects who were first-time surgery of cancer were recruited from the inpatient chemotherapy ward in the first and the third affiliated hospitals of Harbin Medical University from December 1~(st) 2005 to June 31~(st) 2006. Five groups of patients with stomach, colon, rectum, lung and breast cancer completed the following questionares: the Herth Hope scale, the Jalowiec Coping Scale, social support scale and basic demographic form during their chemotherapy.
Results: The average score of hope in patients with cancer was 38.32±4.44.The level of hope had no different in the patients with various cancer (F=3.24, P＞0.05), but income had influence on hope. Hope level increased with income increased. The average score of coping style was 1.57±0.27, the highest score of coping style was optimistic coping style, emotive coping style was the lowest. The average score of social support was 46.26±6.96, for subjective social support was 12.05±3.18, objective social support was 26.57±4.07 and utilization of social support was 7.63±2.23.
Although there was no significant correlation between the average score of hope and the average total score of coping style in patients with cancer (r=0.90, P＞0.05), there was significantly positive correlation between hope and optimistic, confrontive, self-reliant and palliative coping style, and negative correlation between hope and emotive, fatalistic and evasive coping style.
There was also strong relationship between the average score of hope and average total score of social support, average scores of subjective social support, objective social support and utilization of social support (r=0.20, r=0.23, r=0.17, p＜0.01).
Conclusions: The research results showed that the most cancer patients during chemotherapy had higher level of hope. There is no different levels of hope in the patients with various cancer. Identified affecting factor of hope was income: hope level increased with income increased. But age, sex, education, the style of medical payment, chemotherapy times had no influence on hope. Cancer patients had used several coping styles during chemotherapy. More often used coping styles by the patients were as following: optimistic, confrontive, self-reliant and palliative coping style. Emotive, fatalistic and evasive coping styles were less used. Patients with cancer had obtained the relatively higher level of social support.
There was no significant relationship between hope and coping in patients with cancer, but there was correlation between hope and optimistic, confrontive, self-reliant, palliative, emotive, fatalistic and evasive coping style.
There was also strong relationship between hope and total social support score, scores of subjective social support, objective social support and utilization of social support. It suggests that the better social support patients with cancer get, the higher level of hope they hold. Therefore, nurses should advise patients to use positive coping styles and avoid using negative coping styles, to do their best to use social support to increase the level of hope, and help them build confidence of overcoming diseases, furthermore improve their mental health and promote their quality of life.
研究目的
本研究旨在探讨中国癌症化疗患者的希望水平，探讨不同癌症类型患者的希望水平之间是否存在差异；确定希望水平与癌症化疗患者的应对方式、社会支持状况之间的相关性。
研究方法
自2005年12月1日至2006年6月31日在哈尔滨医科大学第一临床医学院和哈尔滨医科大学第三临床医学院对首次手术治疗后正在进行化疗的300名住院癌症患者发放调查问卷，化疗次数选择在第一次至第六次期间。癌症患者的种类选择为胃癌、结肠癌、直肠癌、肺癌、乳腺癌。采用便利抽样的方法收集资料，调查问卷分为4个部分，第一部分为一般调查表，用来收集癌症患者的背景资料，第二部分为Herth希望量表，用来测定癌症患者的希望水平，第三部分为Jaloeice应对量表，用来测定癌症患者的应对方式，第四部分为肖水源的社会支持量表，用来测定癌症患者的社会支持水平。
研究结果
癌症化疗患者的希望总体平均分为38.32±4.44，不同癌症类型的患者希望水平之间没有差异(F=3.24，P＞0.05)，但家庭月收入的高低影响希望水平(F=4.53，P＜0.05)，即家庭收入越高，希望水平越高；癌症患者的应对方式总体均分为1.57±0.27，其中乐观应对方式得分最高，为2.02±0.38，情感应对方式得分最低，为0.93±0.55。癌症患者的社会支持总体均分为46.26±6.96，其中客观支持为12.05±3.18，主观支持为26.57±4.07，对支持的利用度为7.63±2.23。
希望总体与应对总体在统计学上无显著性意义(r=0.90，P＞0.05)，但希望总体与乐观、面对应对方式有非常显著的正相关关系(r=0.21，r=0.18，P＜0.01)，与自我依赖、保守应对方式有显著的正相关关系(r=0.14，r=0.15，P＜0.05)，与情感、听天由命应对方式存在非常显著的负相关关系(r=-0.26，r=-0.20，P＜0.01)。希望总体与社会支持总体存在非常显著的正相关关系(r=0.28，p＜0.01)，与客观支持、主观支持和对支持的利用度三个方面都存在非常显著的正相关关系(r=0.20，r=0.23，r=0.17，p＜0.01)。
研究结论
研究表明大部分癌症化疗患者获得了较高的希望水平，不同癌症类型患者的希望水平之间没有差异，但家庭月收入情况影响希望水平，家庭收入越高，希望水平越高；希望水平不受年龄、性别、教育水平、医疗费用支付情况、化疗次数的影响。癌症患者在化疗期间采用多种应对方式，希望水平与应对方式总体无相关关系，但与乐观、面对、自我依赖、保守、情感和听天由命应对方式有关。希望与社会支持存在非常显著的正相关关系，即癌症患者在化疗期间获得的社会支持越多，其希望水平越高。
因此，护士在护理癌症患者的过程中应指导患者采用积极的应对方式，避免采用消极的应对方式，并且充分地运用各方面的社会支持以提高患者的希望水平，树立其战胜疾病的信念，进而增进癌症患者的心理健康，提高其生活质量。
Cancer has become the most health threatening disease for human. Hope is one of the important components during the cancer treatment. Therefore, identifying the relationship between hope, coping style and social support in the patients with cancer is a meaningful study.
Objectives: The purpose of this research is to explore the level of hope in patients with cancer diagnosis during chemotherapy in China, to find whether there is different levels of hope in the patients with various cancer, and to identify the relationship of hope, coping style and social support.
Research Methods: 300 subjects who were first-time surgery of cancer were recruited from the inpatient chemotherapy ward in the first and the third affiliated hospitals of Harbin Medical University from December 1~(st) 2005 to June 31~(st) 2006. Five groups of patients with stomach, colon, rectum, lung and breast cancer completed the following questionares: the Herth Hope scale, the Jalowiec Coping Scale, social support scale and basic demographic form during their chemotherapy.
Results: The average score of hope in patients with cancer was 38.32±4.44.The level of hope had no different in the patients with various cancer (F=3.24, P＞0.05), but income had influence on hope. Hope level increased with income increased. The average score of coping style was 1.57±0.27, the highest score of coping style was optimistic coping style, emotive coping style was the lowest. The average score of social support was 46.26±6.96, for subjective social support was 12.05±3.18, objective social support was 26.57±4.07 and utilization of social support was 7.63±2.23.
Although there was no significant correlation between the average score of hope and the average total score of coping style in patients with cancer (r=0.90, P＞0.05), there was significantly positive correlation between hope and optimistic, confrontive, self-reliant and palliative coping style, and negative correlation between hope and emotive, fatalistic and evasive coping style.
There was also strong relationship between the average score of hope and average total score of social support, average scores of subjective social support, objective social support and utilization of social support (r=0.20, r=0.23, r=0.17, p＜0.01).
Conclusions: The research results showed that the most cancer patients during chemotherapy had higher level of hope. There is no different levels of hope in the patients with various cancer. Identified affecting factor of hope was income: hope level increased with income increased. But age, sex, education, the style of medical payment, chemotherapy times had no influence on hope. Cancer patients had used several coping styles during chemotherapy. More often used coping styles by the patients were as following: optimistic, confrontive, self-reliant and palliative coping style. Emotive, fatalistic and evasive coping styles were less used. Patients with cancer had obtained the relatively higher level of social support.
There was no significant relationship between hope and coping in patients with cancer, but there was correlation between hope and optimistic, confrontive, self-reliant, palliative, emotive, fatalistic and evasive coping style.
There was also strong relationship between hope and total social support score, scores of subjective social support, objective social support and utilization of social support. It suggests that the better social support patients with cancer get, the higher level of hope they hold. Therefore, nurses should advise patients to use positive coping styles and avoid using negative coping styles, to do their best to use social support to increase the level of hope, and help them build confidence of overcoming diseases, furthermore improve their mental health and promote their quality of life.
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