血液腫瘤住院患者的心理調適與復原力之縱貫性研究

The Health-Related Resilience and Psychological Adaptation Effects in Patients with Hematological Cancer during Hospitalization: A Longitudinal Study

陳文香(Wen-Xiang Chen) ； 羅惠敏(Hui-Min Lo)

《腫瘤護理雜誌》 22卷2期 (2022/12) Pp. 5-20

https://doi.org/10.6880/TJON.202212_22(2).01

摘要

背景：血液腫瘤屬於慢性疾病，患者因長期病程，其心理狀態與復原力展現皆易產生不可預測或持續性的變化。過去研究多採固定時間點測量，未考慮到面臨的處置與時間變化的影響，瞭解患者在各時期的心理調適與復原力變化，將有助於溝通及適切性照護處置。目的：探討血液腫瘤患者隨著不同病程階段其心理調適與復原力的變化情況，以及隨著病程時間階段的影響因子。方法：採縱貫式研究設計，以方便取樣招募55位血液腫瘤個案，分別於在接受骨髓穿刺檢查（T1）、確立診斷（T2）、接受化學治療後三個月（T3）與造血幹細胞移植後二個月（T4），此四個時段點以「基本資料表」、「醫院焦慮憂鬱量表」、「赫氏希望指量表」及「復原力量表」進行資料的收集。結果：研究發現血液腫瘤患者從接受診斷到治療期間其焦慮、憂鬱與復原力呈負相關，相對地希望狀態與復原力呈正相關。個案的焦慮和憂鬱在診斷期間最為嚴重，隨著時間呈遞減的趨勢，而希望狀態和復原力在治療期間狀態最佳，尤其在接受造血幹細胞移植後得分最高。結論與建議：研究結果證實血液腫瘤病患在面臨疾病的診斷期確實有較大的心理困擾，建議護理人員能早期的評估血液腫瘤病人的焦慮、憂鬱及情緒支持；臨床健康照護專業人也應強化病人的希望程度來因應心理壓力以維持復原力，並提升血液腫瘤病患生活品質。

關鍵字

血液腫瘤病人 ； 心理調適 ； 復原力 ； 縱貫性研究

並列摘要

BBackground & Significance: Because of the therapies and methods involved in its treatment, hematological cancer patients often face unpredictable changes in resilience and psychological status over the long course of their disease. Most studies have used fixed-term measurements that do not consider time variance and its effects. We investigated changes in hematological cancer patients' psychological adaptation and resilience over time to facilitate communication and nursing interventions. Purposes: This study examines resilience growth patterns and psychological adaptation effect in hematological cancer patients and how various variables affect factors during the 4 stages. Methods: This was a longitudinal study. A purposive sampling survey was conducted by using structured questionnaires to collect data after bone marrow biopsy (T1); initial disease diagnosis (T2); 3 months after chemotherapy (T3); and 2 months after hematopoietic stem cell transplantation (T4). Fifty-five subjects with the diagnosis of hematology cancer patients provided data for descriptive and inferential analysis. Measurement included the Herth Hope Index (HHI), Spiritual Health Scale (SHS), Hospital Anxiety and Depression Scale (HADS), and Connor-Davidson Resilience Scale (CDRS). Results: The main results revealed that: (1) the anxiety and depression variables were negatively correlated with resilience over time; in contrast, the hope showed positive correlations with resilience; (2) the significant change of anxiety and depression takes place during the disease diagnosis period. The highest anxiety and depression scores were found at T1, T2. As to the resilience and hope, the scores at T4 were highest. Conclusions and Suggestions: Our results indicate that participants in this study had a higher level of anxiety and depression during the disease diagnosis period. Therefore, study findings recommend that nurses strengthen the early assessment of anxiety, depression, and emotional support in hematological cancer patients. In addition, healthcare professionals should enhance hematological cancer patients' hope grade to cope with psychological distress for the period of treatment in order to maintain resilience. The result can be used as a reference in clinical care for hematological cancer patients to improve their quality of life.

並列關鍵字

hematological cancer patients ； psychological adaptation ； resilience ； longitudinal study

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