South Central Mental Illness Research,Education and Clinical Center,Houston,Texas.
Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety,Michael E. DeBakey VA Medical Center,Houston,Texas.
Palliat Support Care. 2018 Dec;16(6):712-718. doi: 10.1017/S1478951517000967. Epub 2017 Dec 28.
This article examines the associations of quantitatively refined trajectories of adjustment to cancer survivorship determined by previously published qualitative narrative analysis.
Patients completed measures of cancer-related worry (Cancer Related Worries Scale), depression (Patient Health Questionnaire-9), posttraumatic growth (Benefit Finding Scale), and open-ended survey questions 6, 12, and 18 months postdiagnosis of head and neck, esophageal, gastric, or colorectal cancer. Previously published narrative analysis revealed five distinct survivorship "paths," which were combined into four paths in the present article: Moving On, Seeing the World Differently, Taking One Day at a Time, and Never the Same. To determine the association of qualitatively determined paths with quantitatively assessed adjustment (i.e., Cancer Related Worries Scale, Patient Health Questionnaire-9, Benefit Finding Scale), we used linear multilevel modeling to regress the adjustment variables on time, path, the time-by-path interaction, and relevant covariates (age, stage, cancer site, ethnicity, and Deyo score).
There was a significant main effect of path on cancer worry, depression, and posttraumatic growth (p < 0.02 for all). Patients in the Moving On group reported consistently low worry, depression, and growth compared to the other groups. Patients in the Seeing the World Differently and Taking One Day at a Time paths both reported moderate worry and depression; but those in the Seeing the World Differently path reported the highest posttraumatic growth, whereas patients in the Taking One Day at a Time path reported little growth. Finally, patients in the Never the Same path reported the highest worry and depression but lowest posttraumatic growth.Significance of resultsThis longitudinal study reinforces the notion that cancer survivorship is not a one-size-fits-all experience nor a dichotomized experience of "distress" or "no distress." Additionally, this hypothesis-generating study suggests future directions for potential self-report measures to help clinicians identify cancer survivors' trajectory to develop a more patient-centered survivorship care plan.
本文通过先前发表的定性叙事分析，检验了癌症生存者适应轨迹的定量细化轨迹的相关性。
患者在诊断为头颈部、食管、胃或结直肠癌后 6、12 和 18 个月，完成了癌症相关担忧（癌症相关担忧量表）、抑郁（患者健康问卷-9）、创伤后成长（获益发现量表）和开放式调查问题的测量。先前发表的叙事分析揭示了五个不同的生存“路径”，在本文中合并为四个路径：继续前进、以不同的方式看待世界、一天一天地过、永远不一样。为了确定定性确定的路径与定量评估的调整（即癌症相关担忧量表、患者健康问卷-9、获益发现量表）之间的关联，我们使用线性多层模型将调整变量回归到时间、路径、时间-路径相互作用和相关协变量（年龄、阶段、癌症部位、种族和 Deyo 评分）。
路径对癌症担忧、抑郁和创伤后成长有显著的主效应（所有 p < 0.02）。继续前进组的患者报告的担忧、抑郁和成长一直较低，与其他组相比。在不同视角看待世界和每天只过一天的路径中的患者都报告了中等程度的担忧和抑郁；但是，在不同视角看待世界的路径中的患者报告了最高的创伤后成长，而在每天只过一天的路径中的患者报告了很少的成长。最后，在永远不一样的路径中的患者报告了最高的担忧和抑郁，但最低的创伤后成长。
这项纵向研究强化了这样一种观念，即癌症生存者的体验不是一刀切的，也不是“痛苦”或“无痛苦”的二分法体验。此外，这项产生假设的研究为潜在的自我报告措施指明了未来的方向，以帮助临床医生识别癌症幸存者的轨迹，从而制定更以患者为中心的生存护理计划。
