癌症患者的心理社会适应：一项混合方法的顺序解释性研究

摘要(中文译文)

乳腺癌是女性死亡的主要原因。乳腺癌患者从诊断到治疗过程中经历着动态且异质性的心理社会适应。然而，关于乳腺癌患者心理社会适应的异质性水平及其影响因素的认识仍然有限。探讨乳腺癌患者从诊断到化疗阶段的心理社会适应轨迹，并探索影响其心理社会适应的促进因素和障碍因素。采用潜类别增长模型分析心理社会适应轨迹的潜在类别。采用Colaizzi七步法分析质性数据。共识别出三种不同的乳腺癌患者心理社会适应轨迹：高稳定适应组、中等下降适应组和低水平上升适应组。三个心理社会适应类别中的个体具有相同的增长轨迹，但表现出不同的增长模式。类别1为“高稳定适应组”，共51人（占总样本的30.9%），平均截距为176.85（P<0.001），斜率为-0.032（P=0.977）。类别2为“中等下降适应组”，共54人（占总样本的32.7%），平均截距为142.77（P<0.001），斜率为-1.78（P=0.381）。类别3为“低水平上升适应组”，共60人（占总样本的36.4%），平均截距为105.04（P<0.001），斜率为13.13（P<0.001）。不同轨迹组的预测因素包括月收入、手术方式和病理分期。通过半结构化访谈，识别出促进因素和障碍因素的三个主题。促进因素包括个人资源、社会资源和家庭资源，障碍因素包括并发症和药物不良反应、沉重的经济负担以及认知变化。乳腺癌患者从诊断到化疗过程中经历着动态且异质性的心理社会适应。本研究中识别出的轨迹预测因素和障碍因素可帮助医疗保健提供者提供个性化、有针对性的干预措施和方案，以促进乳腺癌患者的心理社会适应。

Abstract

Breast cancer is the leading cause of death among women. Breast cancer patients experience dynamic and heterogeneous psychosocial adaptation from diagnosis through treatment. However, knowledge of the levels of heterogeneity in psychosocial adaptation and its influencing factors in breast cancer patients is limited. To examine the psychosocial adaptation trajectories of breast cancer patients from diagnosis to the chemotherapy phase and to explore the facilitators and barriers influencing their psychosocial adaptation. Latent class growth modeling was used to analyze the latent classes of psychosocial adaptation trajectories. Colaizzi's seven-step method was used to analyze the qualitative data. Three distinct psychosocial adaptation trajectories were identified in breast cancer patients: high-stable, moderate-declining, and low-increasing adaptation groups.The individuals within the three psychosocial adaptation categories share identical growth trajectories but exhibit different growth patterns. Category 1, the "High-stable adaptation group", comprised 51 individuals (30.9% of the total sample), with an average intercept of 176.85 (P<0.001) and a slope of -0.032 (P=0.977). Category 2, the "Moderate-declining adaptation group", included 54 individuals (32.7% of the total sample), with an average intercept of 142.77 (P<0.001) and a slope of -1.78 (P=0.381). Category 3, the "Low-increasing adaptation group" consisted of 60 individuals (36.4% of the total sample), with an average intercept of 105.04 (P<0.001) and a slope of 13.13 (P<0.001). Predictive factors for different trajectory groups included monthly income, type of surgery, and pathological stage. Through semi-structured interviews, three themes were identified for facilitators and barriers. Facilitators included personal resources, social resources, and family resources, while barriers included complications and adverse drug reactions, heavy economic burden, and cognitive changes. Breast cancer patients experience dynamic and heterogeneous psychosocial adaptation from diagnosis to chemotherapy. The trajectory predictors and barriers identified in this study can assist healthcare providers in offering personalized, targeted interventions and plans to promote psychosocial adaptation in breast cancer patients.

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