Devine Danielle, Parker Patricia A, Fouladi Rachel T, Cohen Lorenzo
Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Psychooncology. 2003 Jul-Aug;12(5):453-62. doi: 10.1002/pon.656.
A social-cognitive processing model was used to examine the association of social support with intrusive thoughts and avoidance in predicting adjustment in 53 patients receiving an experimental vaccine for the treatment of either metastatic melanoma (n=24) or metastatic renal cell cancer (n=29). Social support, intrusive thoughts/avoidance, psychological distress and quality of life were assessed on the day of the first treatment, on the day of the final treatment, and 1 month after the end of treatment during a routine follow-up visit. Social support at the beginning of treatment was negatively associated with psychological distress and positively associated with mental health quality of life (QOL) 1 month after treatment, and these associations were mediated by intrusive thoughts/avoidance at the end of treatment. There was also an interaction between social support and intrusive thoughts/avoidance at the beginning of treatment in predicting both psychological distress and mental health QOL 1 month after treatment. Specifically, for patients with lower levels of support, greater intrusive thoughts/avoidance was associated with greater psychological distress and poorer mental health QOL 1 month after treatment. However, there was no association between intrusive thoughts/avoidance and adjustment in patients with high levels of social support. These results suggest that social support buffers the negative association between intrusive thoughts/avoidance and psychological adjustment. Overall, the results are consistent with a social-cognitive processing model of post-trauma reactions among cancer patients. Our results highlight the need to assess patients' perceived support and to further develop and assess the benefits of interventions to increase patients' supportive networks and to facilitate cognitive processing of the cancer experience.
采用社会认知加工模型，对53例接受实验性疫苗治疗转移性黑色素瘤（n = 24）或转移性肾细胞癌（n = 29）的患者进行研究，以检验社会支持与侵入性思维及回避行为之间的关联，这些因素对患者的适应情况具有预测作用。在首次治疗当天、末次治疗当天以及治疗结束后1个月的常规随访中，对社会支持、侵入性思维/回避行为、心理困扰及生活质量进行评估。治疗开始时的社会支持与心理困扰呈负相关，与治疗后1个月的心理健康生活质量（QOL）呈正相关，且这些关联由治疗结束时的侵入性思维/回避行为介导。在预测治疗后1个月的心理困扰和心理健康QOL方面，治疗开始时的社会支持与侵入性思维/回避行为之间也存在交互作用。具体而言，对于支持水平较低的患者，较高的侵入性思维/回避行为与治疗后1个月更严重的心理困扰及更差的心理健康QOL相关。然而，对于社会支持水平较高的患者，侵入性思维/回避行为与适应情况之间并无关联。这些结果表明，社会支持缓冲了侵入性思维/回避行为与心理调适之间 的负向关联。总体而言，这些结果与癌症患者创伤后反应的社会认知加工模型一致。我们的研究结果凸显了评估患者感知到的支持的必要性，并进一步开发和评估干预措施的益处，这些干预措施旨在增加患者的支持网络，并促进对癌症经历的认知加工。
