Lv Gaorong, Zhao Di, Li Guopeng, Qi Meiling, Dong Xiaoling, Li Ping
Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Gastrointestinal Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Asia Pac J Oncol Nurs. 2022 Apr 11;9(6):100064. doi: 10.1016/j.apjon.2022.04.003. eCollection 2022 Jun.
Surgical treatment, particularly for gastrointestinal cancer, is a burdensome prospect for many patients. Psychological stress is a common complaint; however, little is known about its patterns in perioperative patients. This study aimed to identify distinct trajectories of perioperative stress and explore antecedent factors and hospitalization outcomes among different trajectories in patients with gastrointestinal cancer.
A longitudinal study was conducted on 203 patients with gastrointestinal surgical cancer at a specialized oncology hospital in China. Psychological stress was assessed at five perioperative time points (1-3 days before surgery; 1-3 days, 4-6 days, 7-9 days after surgery, and before discharge). A growth mixture model was used to analyze the potential stress trajectories. Multinomial logistic regression was used to identify the characteristics associated with different trajectories.
Three stress trajectories were identified: recovery class (RC, 60.6%), chronic class (CC, 29.5%), and deterioration class (DC, 9.9%). Compared with CC, RC exhibited a shorter length of stay and better recovery quality, and was related to employment, low illness perception, and positive coping; DC reported lower recovery quality from 7 to 9 days after surgery to discharge and was associated with poor education level, history of surgery, stoma, smoking, and preoperative insomnia.
Most surgical patients were insulated from stress due to psychosocial resources, and thus displayed good recovery. However, many patients had moderate stress that did not improve or worsen over the perioperative period, which still needs to be screened and provided with early stress management.
手术治疗，尤其是针对胃肠道癌症的手术，对许多患者来说是一个沉重的前景。心理压力是常见的问题；然而，对于围手术期患者心理压力的模式却知之甚少。本研究旨在识别围手术期压力的不同轨迹，并探讨胃肠道癌症患者不同轨迹中的先行因素和住院结局。
在中国一家专科医院对203例接受胃肠道手术的癌症患者进行了一项纵向研究。在围手术期的五个时间点（手术前1 - 3天；手术后1 - 3天、4 - 6天、7 - 9天以及出院前）评估心理压力。采用生长混合模型分析潜在的压力轨迹。使用多项逻辑回归来识别与不同轨迹相关的特征。
识别出三种压力轨迹：恢复类（RC，60.6%）、慢性类（CC，29.5%）和恶化类（DC，9.9%）。与CC相比，RC的住院时间较短且恢复质量较好，与就业、低疾病认知和积极应对有关；DC报告从手术后7 - 9天到出院期间恢复质量较低，且与低教育水平、手术史、造口、吸烟和术前失眠有关。
大多数手术患者由于社会心理资源而免受压力影响，因此恢复良好。然而，许多患者在围手术期存在中度压力，且没有改善或恶化，这仍需要进行筛查并提供早期压力管理。
