Changes in psychological adjustment over the course of treatment for breast cancer: the predictive role of social sharing and social support
Changes in psychological adjustment over the course of treatment for breast cancer: the predictive role of social sharing and social support
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DOI：
10.1002/pon.3420
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发表时间：
2014-03-01
期刊：
影响因子：
3.6
通讯作者：
Dauchy, Sarah
中科院分区：
文献类型：
--
作者：
Boinon, Diane;Sultan, Serge;Dauchy, Sarah
背景道德败坏是一种存在性痛苦综合征，发生在相当少的癌症患者中，并与更多的身体问题有关。丧失尊严涉及一系列具体的生存问题。本研究探讨是否身体问题的数量和士气低落之间的关联是介导的尊严损失。方法本横断面研究使用以下标准化自我报告问卷调查了N = 112例早期和晚期混合肿瘤部位住院患者：国家综合癌症网络（NCCN）的身体问题列表，痛苦温度计（DT），患者尊严量表（PDI），道德败坏量表（DS），患者健康问卷-9（PHQ-9）和疾病特异性社会支持量表（ISSS-8）。通过控制年龄、性别、治愈与姑息治疗阶段和社会支持的多元回归分析来检验中介假设。结果患者报告M = 4.7（SD = 6.0）尊严相关的问题，20%表现出中度至重度士气低落。尊严的丧失显著介导了81%的身体问题对士气低落的影响（Sobel z（s）= 4.4，p <0.001）。相反，我们发现道德败坏只介导了身体问题和尊严丧失之间53%的关联（z（s）= 3.7，p <0.001）。结论通过支持中介假说，我们的研究结果表明，尊严的损失部分解释了身体问题和士气低落之间的关联。早期认识到尊严相关的存在问题和干预措施，以提高尊严感可能会防止癌症患者的士气低落。结果提供了一个概念之间的联系存在的关注（尊严的丧失）和存在的痛苦（士气低落）作为两种方法存在的痛苦癌症患者。版权所有（c）2013约翰威利父子有限公司
Background Demoralization is a syndrome of existential distress that occurs in a substantial minority of cancer patients and is associated with a higher number of physical problems. Loss of dignity refers to a range of specific existential concerns. This study examines whether the association between number of physical problems and demoralization is mediated by loss of dignity. Methods This cross-sectional study examined N = 112 inpatients with mixed tumor sites at early and advanced disease stages using the following standardized self-report questionnaires: Physical problems list of the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT), Patient Dignity Inventory (PDI), Demoralization Scale (DS), Patient Health Questionnaire-9 (PHQ-9) and Illness-Specific Social Support Scale Short Version-8 (ISSS-8). The mediation hypothesis was tested by multiple regression analyses controlling for age, gender, curative versus palliative treatment phase, and social support. Results Patients reported M = 4.7 (SD = 6.0) dignity-related problems; 20% showed moderate to severe demoralization. Loss of dignity significantly mediated 81% of the effect of the number of physical problems on demoralization (Sobel z(s) = 4.4, p < .001). Testing the reverse direction, we found that demoralization mediated only 53% of the association between physical problems and loss of dignity (z(s) = 3.7, p < .001). Conclusions By supporting the mediation hypothesis, our results indicate that loss of dignity partially explains the association between physical problems and demoralization. Early recognition of dignity-related existential concerns and interventions to enhance the sense of dignity may prevent demoralization in patients with cancer. Results provide a conceptual link between existential concerns (loss of dignity) and existential distress (demoralization) as two approaches to existential suffering in patients with cancer. Copyright (c) 2013 John Wiley & Sons, Ltd.