Kyranou Marianna, Puntillo Kathleen, Dunn Laura B, Aouizerat Bradley E, Paul Steven M, Cooper Bruce A, Neuhaus John, West Claudia, Dodd Marylin, Miaskowski Christine
Author Affiliations: School of Nursing (Drs Kyranou, Puntillo, Aouizerat, Paul, Cooper, Dodd, and Miaskowski and Ms West), School of Medicine (Drs Dunn and Neuhaus), and the Institute for Human Genetics (Dr Aouizerat), University of California, San Francisco.
Cancer Nurs. 2014 Nov-Dec;37(6):406-17. doi: 10.1097/NCC.0000000000000131.
The diagnosis of breast cancer, in combination with the anticipation of surgery, evokes fear, uncertainty, and anxiety in most women.
Study purposes were to examine in patients who underwent breast cancer surgery how ratings of state anxiety changed from the time of the preoperative assessment to 6 months after surgery and to investigate whether specific demographic, clinical, symptom, and psychosocial adjustment characteristics predicted the preoperative levels of state anxiety and/or characteristics of the trajectories of state anxiety.
INTERVENTIONS/METHODS: Patients (n = 396) were enrolled preoperatively and completed the Spielberger State Anxiety inventory monthly for 6 months. Using hierarchical linear modeling, demographic, clinical, symptom, and psychosocial adjustment characteristics were evaluated as predictors of initial levels and trajectories of state anxiety.
Patients experienced moderate levels of anxiety before surgery. Higher levels of depressive symptoms and uncertainty about the future, as well as lower levels of life satisfaction, less sense of control, and greater difficulty coping, predicted higher preoperative levels of state anxiety. Higher preoperative state anxiety, poorer physical health, decreased sense of control, and more feelings of isolation predicted higher state anxiety scores over time.
Moderate levels of anxiety persist in women for 6 months after breast cancer surgery.
Clinicians need to implement systematic assessments of anxiety to identify high-risk women who warrant more targeted interventions. In addition, ongoing follow-up is needed to prevent adverse postoperative outcomes and to support women to return to their preoperative levels of function.
乳腺癌的诊断，再加上对手术的预期，会使大多数女性产生恐惧、不确定感和焦虑情绪。
本研究旨在调查接受乳腺癌手术的患者从术前评估到术后6个月期间状态焦虑评分的变化情况，并探究特定的人口统计学、临床、症状和心理社会适应特征是否能预测术前状态焦虑水平和/或状态焦虑轨迹特征。
干预措施/方法：术前招募了396名患者，并在6个月内每月完成一次斯皮尔伯格状态焦虑量表。采用分层线性模型，将人口统计学、临床、症状和心理社会适应特征作为状态焦虑初始水平和轨迹的预测因素进行评估。
患者在手术前经历了中度焦虑水平。较高的抑郁症状水平、对未来的不确定感，以及较低的生活满意度、控制感和应对困难程度，预测了术前较高的状态焦虑水平。术前较高的状态焦虑、较差的身体健康状况、控制感下降和更多的孤独感预测了随着时间推移状态焦虑得分会更高。
乳腺癌手术后女性会持续6个月存在中度焦虑水平。
临床医生需要对焦虑进行系统评估，以识别需要更有针对性干预的高危女性。此外，需要持续随访以预防术后不良后果，并支持女性恢复到术前的功能水平。
