Von Ah Diane, Kang Duck-Hee
Enhancing Quality of Life in Chronic Illness, Indiana University School of Nursing, Indianapolis, USA.
J Adv Nurs. 2008 Mar;61(6):676-89. doi: 10.1111/j.1365-2648.2007.04563.x.
This study examined factors associated with mood disturbance prior to, during and after adjuvant therapy.
Breast cancer is the most common cancer in women worldwide. Mood disturbance affects between 20% and 30% of women with breast cancer and is associated with other debilitating symptoms. However, factors associated with mood disturbance across the breast cancer diagnosis-treatment trajectory are not clearly understood.
A stress-coping framework guided this longitudinal study. A convenience sample of 49 American women with newly diagnosed breast cancer aged 37-77 years completed questionnaires assessing age, optimism, disease stage, type of adjuvant therapy, lymph node status, emotional support, aid (tangible) support, perceived stress and mood disturbance. Data were collected over an 18-month period in 2002-2003 at three time points: prior to, during and after adjuvant therapy. Descriptive statistics, Pearson's correlation and multiple regression were used.
At all three time points, higher stress was significantly related to greater mood disturbance. Perceived stress mediated the relationship between (1) emotional support and mood disturbance prior to and after adjuvant therapy and between (2) aid support and mood disturbance during adjuvant therapy. In addition, the type of support that was most important to mood disturbance varied over time. Emotional support was related to reduced mood disturbance prior to and after adjuvant therapy, whereas aid support was most important during adjuvant therapy.
Nurses may use this information to develop interventions that bolster appropriate types of support to reduce stress and ultimately lower mood disturbance. Further research across cultures is needed.
本研究调查了辅助治疗前、治疗期间及治疗后与情绪障碍相关的因素。
乳腺癌是全球女性中最常见的癌症。情绪障碍影响20%至30%的乳腺癌女性患者,且与其他使人衰弱的症状相关。然而,在乳腺癌诊断-治疗过程中与情绪障碍相关的因素尚未完全明确。
一项应激-应对框架指导了这项纵向研究。一个由49名年龄在37 - 77岁之间新诊断为乳腺癌的美国女性组成的便利样本完成了问卷调查,评估年龄、乐观程度、疾病分期、辅助治疗类型、淋巴结状态、情感支持、援助(实际)支持、感知压力和情绪障碍。数据于2002 - 2003年的18个月期间在三个时间点收集:辅助治疗前、治疗期间和治疗后。使用了描述性统计、皮尔逊相关性分析和多元回归分析。
在所有三个时间点,较高的压力均与更严重的情绪障碍显著相关。感知压力介导了(1)辅助治疗前后情感支持与情绪障碍之间以及(2)辅助治疗期间援助支持与情绪障碍之间的关系。此外,对情绪障碍最重要的支持类型随时间而变化。情感支持与辅助治疗前后情绪障碍的减轻相关,而援助支持在辅助治疗期间最为重要。
护士可利用这些信息制定干预措施,加强适当类型的支持以减轻压力并最终降低情绪障碍。需要开展跨文化的进一步研究。