Månsson A, Colleen S, Hermerén G, Johnson G
Department of Urology, University Hospital, Lund, Sweden.
Br J Urol. 1997 Jul;80(1):50-7. doi: 10.1046/j.1464-410x.1997.00210.x.
To investigate: (i) if early psychosocial intervention after cystectomy for bladder cancer can assist psychosocial rehabilitation; (ii) if the outcome of such intervention correlates with the patient's psychological defensive strategies as revealed with the meta-contrast technique (MCT); and (iii) if the patient's general philosophical outlook is important in this context.
Of 50 patients who had undergone radical cystectomy for bladder cancer, 17 received an ileal conduit, 17 a continent urinary reservoir with abdominal stoma and 16 an orthotopic neobladder. Twenty-four of the patients were randomized to psychosocial intervention, comprising weekly counselling 4-9 weeks after surgery. All patients were then evaluated with the Sickness-Impact Profile (SIP) standard questionnaire and the MCT (a projective test of percept-genetic model) was used to reflect individual defensive strategies at the subconscious or unconscious level. The patient's general philosophical outlook was recorded before and after surgery.
There was no significant difference in the results of the SIP between the intervention and the non-intervention group, as a whole or in its psychosocial dimension. However, intervention benefited patients with continent cutaneous diversion, whose scores on the psychosocial SIP dimension were lower than in the groups with ileal conduit diversion or orthotopic bladder replacement (P < 0.05). The MCT analysis of defensive strategies identified three clusters of patients characterized mainly by isolation and repression, repression and stereotypy or sensitivity and stereotypy. Analysis for cluster identification showed no significant SIP score differences between intervention and non-intervention groups. In an analysis of single defensive strategies, stereotypy was associated with higher total SIP score, but not significantly. Three clusters of philosophical outlook were identified; in one cluster, characterized by a belief in a supernatural power and philosophical interest, the psychosocial SIP scores were lower in the patients who obtained emotional support and the reverse in a cluster with contrary attitudes, although neither differences were significant.
Psychosocial intervention assisted the psychosocial rehabilitation of patients with continent cutaneous urinary diversion. Defensive strategies and philosophical outlook generally did not influence the outcome of intervention. However, such programmes may be helpful for some patients, mainly those with a basically pessimistic disposition, a general interest in philosophical questions and often using defensive strategies of stereotypy and repression.
调查：（i）膀胱癌膀胱切除术后早期心理社会干预是否有助于心理社会康复；（ii）这种干预的结果是否与用元对比技术（MCT）揭示的患者心理防御策略相关；以及（iii）在这种情况下患者的一般哲学观是否重要。
50例接受膀胱癌根治性膀胱切除术的患者中，17例行回肠代膀胱术，17例行带腹壁造口的可控性尿流改道术，16例行原位新膀胱术。24例患者被随机分配接受心理社会干预，包括术后4 - 9周每周一次的咨询。然后用疾病影响量表（SIP）标准问卷对所有患者进行评估，并使用MCT（一种感知发生模型的投射测试）来反映潜意识或无意识水平的个体防御策略。记录患者手术前后的一般哲学观。
干预组和非干预组在SIP结果方面，总体或心理社会维度均无显著差异。然而，干预对行可控性皮肤造口尿流改道的患者有益，其心理社会SIP维度得分低于行回肠代膀胱术或原位膀胱替代术的组（P < 0.05）。对防御策略的MCT分析确定了三类患者，主要特征分别为孤立与压抑、压抑与刻板或敏感与刻板。聚类分析显示干预组和非干预组之间SIP得分无显著差异。在对单一防御策略的分析中，刻板与较高的SIP总分相关，但无显著相关性。确定了三类哲学观；在一类以相信超自然力量和哲学兴趣为特征的患者中，获得情感支持的患者心理社会SIP得分较低，而在态度相反的一类患者中则相反，尽管两者差异均不显著。
心理社会干预有助于行可控性皮肤造口尿流改道患者的心理社会康复。防御策略和哲学观一般不影响干预结果。然而，此类项目可能对某些患者有帮助，主要是那些性格基本悲观、对哲学问题普遍感兴趣且经常使用刻板和压抑防御策略的患者。
