孟加拉国一家三级护理医院姑息治疗病房中转移性乳腺癌女性的应对策略。

Coping strategy among the women with metastatic breast cancer attending a palliative care unit of a tertiary care hospital of Bangladesh.

机构信息

Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.

Department of Non-Communicable Diseases, Bangladesh University of Health Sciences, Dhaka, Bangladesh.

出版信息

PLoS One. 2023 Jan 13;18(1):e0278620. doi: 10.1371/journal.pone.0278620. eCollection 2023.

DOI:10.1371/journal.pone.0278620

PMID:36638085

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9838864/

Abstract

BACKGROUND

Breast cancer is one of the leading cancers among the Bangladeshi women. Coping helps these patients to adjust with this life-changing disease. Each individual has unique and different coping mechanism. But we know a little regarding their coping strategies. This study aims to explore the different coping strategies adopted by the women with metastatic (stage IV) breast cancer attending the palliative care unit and their relationship with the common mental health issues like anxiety and depression.

METHODS

This cross-sectional study was conducted among 95 patients with metastatic (stage IV) breast cancer attending the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh from April 2021 to September 2021. Data was collected by face-to-face interview using a structured questionnaire adapted from Hospital Depression and Anxiety Scale (HADS), Brief COPE inventory and Eastern Cooperative Oncology Group (ECOG) performance scale. Pearson correlation test was used to find the relationships between various domains of coping strategies and psychological variables. Correlation matrix was done to observe the internal correlation among different coping strategies. Kruskal-Wallis H test was done to find the relationship between different coping strategies and ECOG performance status.

RESULT

The mean age of the respondents was 48.9 ± 9.9 years. Most of them were married (94.7%), Muslim (92.6%) and homemakers (82.1%). Commonly used coping strategies by the patients were: acceptance (median 10; IQR 10), religion (median 9; IQR 8-10) and instrumental support (median 9; IQR 6-10). Significantly strong positive correlation was found between emotional and instrumental support (R = 0.7; p = 0.01), planning, acceptance and active coping (R = 0.7; p = 0.01); behavioral disengagement, self distraction and denial (R = 0.5; p = 0.01). Significantly fair negative correlation was observed between active coping and depression (R = -0.4, p <0.001). Patients with better performance status on ECOG scale (Grade 0-2) leaned more on the positive coping strategies like instrumental support, emotional support, positive reframing and venting.

CONCLUSION

Different coping strategies, especially positive coping helps the patients to adapt with their disease over time. All women suffering from breast cancer should be routinely screened and assessed for psychological distress and ensure early intervention and management to promote a better quality of life.

摘要

背景

乳腺癌是孟加拉国女性中最常见的癌症之一。应对有助于这些患者适应这种改变生活的疾病。每个人都有独特而不同的应对机制。但我们对他们的应对策略知之甚少。本研究旨在探讨接受姑息治疗的转移性（IV 期）乳腺癌妇女采用的不同应对策略及其与焦虑和抑郁等常见心理健康问题的关系。

方法

本横断面研究于 2021 年 4 月至 2021 年 9 月在孟加拉国 Bangabandhu Sheikh Mujib 医科大学姑息医学系对 95 名转移性（IV 期）乳腺癌患者进行。通过面对面访谈使用改编自医院抑郁和焦虑量表（HADS）、简要应对量表（Brief COPE inventory）和东部合作肿瘤学组（ECOG）的结构化问卷收集数据。采用 Pearson 相关检验来发现应对策略的不同领域与心理变量之间的关系。相关矩阵用于观察不同应对策略之间的内部相关性。采用 Kruskal-Wallis H 检验来发现不同应对策略与 ECOG 表现状态之间的关系。

结果

受访者的平均年龄为 48.9 ± 9.9 岁。他们大多数是已婚（94.7%）、穆斯林（92.6%）和家庭主妇（82.1%）。患者常用的应对策略包括：接受（中位数 10；IQR 10）、宗教（中位数 9；IQR 8-10）和工具性支持（中位数 9；IQR 6-10）。情绪和工具性支持之间存在显著的强正相关（R = 0.7；p = 0.01），计划、接受和积极应对之间存在显著的强正相关（R = 0.7；p = 0.01）；行为脱离、自我分心和否认之间存在显著的弱负相关（R = 0.5；p = 0.01）。积极应对与抑郁之间存在显著的弱负相关（R = -0.4，p <0.001）。ECOG 量表表现状态较好（等级 0-2）的患者更倾向于使用积极的应对策略，如工具性支持、情感支持、积极的重新构建和宣泄。