“一见便知。”衡量癌症患儿家长心理复原力的复杂性。
"I know it when I see it." The complexities of measuring resilience among parents of children with cancer.
作者信息
Rosenberg Abby R, Starks Helene, Jones Barbara
机构信息
Cancer and Blood Disorders Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M.S. M.B.8.501, PO Box B-6553, Seattle, WA, 98105, USA,
出版信息
Support Care Cancer. 2014 Oct;22(10):2661-8. doi: 10.1007/s00520-014-2249-5. Epub 2014 Apr 23.
PURPOSE
Promoting parent resilience may provide an opportunity to improve family-level survivorship after pediatric cancer; however, measuring resilience is challenging.
METHODS
The "Understanding Resilience in Parents of Children with Cancer" was a cross-sectional, mixed-methods study of bereaved and non-bereaved parents. Surveys included the Connor-Davidson Resilience scale, the Kessler-6 psychological distress scale, the Post-Traumatic Growth Inventory, and an open-ended question regarding the ongoing impact of cancer. We conducted content analyses of open-ended responses and categorized our impressions as "resilient," "not resilient," or "unable to determine." "Resilience" was determined based on evidence of psychological growth, lack of distress, and parent-reported meaning/purpose. We compared consensus impressions with instrument scores to examine alignment. Analyses were stratified by bereavement status.
RESULTS
Eighty-four (88 %) non-bereaved and 21 (88 %) bereaved parents provided written responses. Among non-bereaved, 53 (63 %) were considered resilient and 15 (18 %) were not. Among bereaved, 11 (52 %) were deemed resilient and 5 (24 %) were not. All others suggested a mixed or incomplete picture. Rater-determined "resilient" parents tended to have higher personal resources and lower psychological distress (p = <0.001-0.01). Non-bereaved "resilient" parents also had higher post-traumatic growth (p = 0.02). Person-level analyses demonstrated that only 50-62 % of parents had all three instrument scores aligned with our impressions of resilience.
CONCLUSIONS
Despite multiple theories, measuring resilience is challenging. Our clinical impressions of resilience were aligned in 100 % of cases; however, instruments measuring potential markers of resilience were aligned in approximately half. Promoting resilience therefore requires understanding of multiple factors, including person-level perspectives, individual resources, processes of adaptation, and emotional well-being.
目的
增强父母的心理韧性可能为改善儿科癌症患者家庭层面的生存状况提供契机；然而，衡量心理韧性具有挑战性。
方法
“了解癌症患儿父母的心理韧性”是一项针对丧偶和未丧偶父母的横断面混合方法研究。调查包括康纳-戴维森心理韧性量表、凯斯勒6项心理困扰量表、创伤后成长量表，以及一个关于癌症持续影响的开放式问题。我们对开放式回答进行了内容分析，并将我们的印象归类为“有心理韧性”、“没有心理韧性”或“无法确定”。“心理韧性”是根据心理成长的证据、无困扰以及父母报告的意义/目的来确定的。我们将一致的印象与量表得分进行比较，以检验一致性。分析按丧亲状况进行分层。
结果
84名（88%）未丧偶和21名（88%）丧偶父母提供了书面回复。在未丧偶父母中，53名（63%）被认为有心理韧性，15名（18%）没有。在丧偶父母中，11名（52%）被认为有心理韧性，5名（24%）没有。所有其他回复显示情况复杂或不完整。评估者确定为“有心理韧性”的父母往往拥有更多个人资源且心理困扰更少（p = <0.001 - 0.01）。未丧偶的“有心理韧性”父母也有更高的创伤后成长水平（p = 0.02）。个体层面分析表明，只有50 - 62%的父母所有三个量表得分与我们对心理韧性的印象一致。
结论
尽管有多种理论，但衡量心理韧性具有挑战性。我们对心理韧性的临床印象在100%的案例中是一致的；然而，衡量心理韧性潜在指标的量表在大约一半的案例中是一致的。因此，促进心理韧性需要了解多个因素，包括个体层面的观点、个人资源、适应过程和情绪健康。
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