Northouse L L, Templin T, Mood D, Oberst M
College of Nursing, Wayne State University, Detroit, MI 48202, USA.
Psychooncology. 1998 Jan-Feb;7(1):37-48. doi: 10.1002/(SICI)1099-1611(199801/02)7:1<37::AID-PON314>3.0.CO;2-#.
A comprehensive comparison of couples' adjustment to benign (n = 73 couples) and malignant breast disease (n = 58 couples) at the time of diagnosis and at two follow-up assessments at 60 days and 1 year is reported. Specific objectives were to: (a) compare the concurrent stress, resources, appraisal, and patterns of adjustment of couples in the benign and malignant groups; (b) compare the psychosocial responses of patients versus spouses; and (c) determine the amount of correspondence in levels of adjustment reported by patients and their husbands over time. Multiple instruments with reported reliability and validity were used to measure study variables: Smilkstein Stress Scale, Dyadic Adjustment Scale, Family APGAR, Social Support Questionnaire, Mishel Uncertainty in Illness Scale, Beck Hopelessness Scale, Brief Symptom Inventory, and Psychosocial Adjustment to Illness Scale. Mixed design analyses of covariance (ANCOVA) were used to assess differences between and among couples and examine changes in study variables over time. Significant differences were found in the resources, appraisal, and patterns of adjustment reported by couples in the benign and malignant groups. Couples facing breast cancer reported greater decreases in their marital and family functioning, more uncertain appraisals, and more adjustment problems associated with the illness. In addition, there was a high degree of correspondence between the levels of adjustment reported by women with breast cancer and their husbands over time. Couples who reported high distress or a high number of role problems at diagnosis were likely to remain highly distressed at 60 days and 1 year. Study findings underscore the importance of assisting couples, not just patients, to manage the adjustment difficulties associated with breast cancer.
本文报告了一项针对夫妻在诊断时以及诊断后60天和1年的两次随访评估中，对良性乳腺疾病（73对夫妻）和恶性乳腺疾病（58对夫妻）适应情况的全面比较。具体目标如下：（a）比较良性和恶性组夫妻的同时期压力、资源、评估及适应模式；（b）比较患者与配偶的心理社会反应；（c）确定患者及其丈夫在不同时间报告的适应水平的对应程度。使用了多种具有报告可靠性和有效性的工具来测量研究变量：斯米尔斯坦压力量表、二元适应量表、家庭APGAR问卷、社会支持问卷、米舍尔疾病不确定感量表、贝克绝望量表、简明症状量表以及疾病心理社会适应量表。采用混合设计协方差分析（ANCOVA）来评估夫妻之间的差异，并检验研究变量随时间的变化。结果发现，良性和恶性组夫妻在资源、评估及适应模式方面存在显著差异。面对乳腺癌的夫妻报告其婚姻和家庭功能下降幅度更大、评估更不确定，且与疾病相关的适应问题更多。此外，随着时间推移，乳腺癌女性及其丈夫报告的适应水平之间存在高度对应关系。在诊断时报告高度痛苦或大量角色问题的夫妻，在60天和1年时可能仍会高度痛苦。研究结果强调了不仅要帮助患者，还要帮助夫妻应对与乳腺癌相关的适应困难的重要性。
