aSchool of Psychology bDiscipline of Surgery, The University of Sydney cMelanoma Institute Australia dPatricia Ritchie Centre for Cancer Care and Research, Mater Hospital eDepartment of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Melanoma Res. 2014 Jun;24(3):252-60. doi: 10.1097/CMR.0000000000000059.
The present study qualitatively assessed the psychosocial impacts experienced by stage III melanoma patients and caregivers throughout the course of the disease, and the coping responses they utilized in an attempt to promote psychosocial adjustment. The purpose of the study was to inform the development of a supportive care strategy for this population. Nineteen stage III melanoma patients and 14 of their caregivers were recruited from the clinical research database of the Melanoma Institute Australia. Data were collected using semistructured telephone interviews and analysed using thematic analysis. Participants reported psychosocial impacts related to diagnosis (shock, panic and devastation), treatment (challenges and unsatisfactory care, pain and limitation, practical impacts, new roles and responsibilities for the caregiver, caregiver inadequacy) and survivorship (ongoing physical problems, watchful waiting, feeling abandoned). They also reported global themes relevant to multiple phases of the disease (emotional distress, disfigurement, injustice, caregiver devaluation). Coping responses were identified related to diagnosis (avoidance), treatment (confidence in the treatment team, taking action) and survivorship (finding a positive meaning, acceptance and moving on) as well as global themes pertaining to multiple disease phases (receiving support, helpful thinking, putting on a brave face, redirecting attention, religion). The current findings support routine screening for the presence of symptoms and psychological distress and appropriate referral when necessary, and for provision of psychosocial interventions to provide information and support to stage III melanoma patients and caregivers. In addition, provision of communication skills training to all health professionals treating melanoma, use of evidence-based strategies for improving patient/caregiver understanding and recall, and routine assessment of patient-reported outcomes to inform clinical practice would be helpful.
本研究定性评估了 III 期黑色素瘤患者及其护理人员在疾病过程中所经历的心理社会影响，以及他们为促进心理社会适应而采用的应对方式。本研究旨在为该人群制定支持性护理策略提供信息。从澳大利亚黑色素瘤研究所的临床研究数据库中招募了 19 名 III 期黑色素瘤患者和 14 名护理人员。使用半结构化电话访谈收集数据，并使用主题分析进行分析。参与者报告了与诊断相关的心理社会影响（震惊、恐慌和绝望）、治疗（挑战和不满意的护理、疼痛和限制、实际影响、护理人员新的角色和责任、护理人员不足）和生存（持续的身体问题、警惕等待、被抛弃的感觉）。他们还报告了与疾病多个阶段相关的全球主题（情绪困扰、毁容、不公平、护理人员贬值）。与诊断（回避）、治疗（对治疗团队的信心、采取行动）和生存（寻找积极的意义、接受和继续前进）以及与多个疾病阶段相关的全球主题（获得支持、有益的思维、装出勇敢的样子、重新调整注意力、宗教）相关的应对方式被确定。目前的研究结果支持对症状和心理困扰进行常规筛查，并在必要时进行适当转诊，以及为 III 期黑色素瘤患者及其护理人员提供心理社会干预，以提供信息和支持。此外，向所有治疗黑色素瘤的卫生保健专业人员提供沟通技巧培训、使用改善患者/护理人员理解和记忆的循证策略，以及常规评估患者报告的结果以告知临床实践，这将是有帮助的。
