“为癌症患者心理赋能”的临床干预路径

“为患者心理赋能”是近年来医疗健康领域出现的一种新的积极医疗照护理念,其关注点是个体的能力而非缺陷,它强调医疗实践应该为改善健康和生活质量建立患者激励结构。首先梳理了赋能的概念发展与心理结构,随后引证多个实证研究总结出为癌症患者心理赋能的四条临床干预路径,指出医患共同决策、同伴支持、赋能教育以及认知行为压力管理的赋能价值。最后结合已有成果和研究中发现的问题,提出癌症心理赋能干预发展建议,有利于进一步开展临床研究和实践探索。

     

癌症病人的生活质量及心理干预研究

本研究在前期研究的基础上进一步探讨癌症病人的生活质量状况和心理干预的效果。运用病例对照实验设计 ,选用生活质量问卷 (QLQ C3 0 )作为主要测查工具 ,采用两因素混合实验方差分析统计方法 ,对 1 2 0名住院化疗病人进行了比较分析。结果显示 :躯体功能 (PF)、角色功能 (RF)、情绪功能(EF)、认知功能 (CF)和整体生活质量 (QL)得分在治疗前后和实验与对照组之间的交互作用均显著和非常显著 ;症状量表和单项症状中交互作用显著和非常显著的有 :疲乏 (FA)、呼吸困难 (DY)、失眠 (SL)、食欲丧失 (AP)。因此 ,化疗对病人的生活质量有明显的影响 ,经心理干预后癌症病人的各种功能状况和症状得到不同程度的改善。     

Measuring Psychological Development With the Rorschach

The aim of this study was to develop and to provide an initial validation of a Rorschach index measuring developmental progress and growth. The Developmental Index (DI) was created in a 3-step, sequential strategy with adult and child data in which we (a) selected potential DI variables from quantitative research literature and from data available to us, (b) identified an optimal group of DI variables and created the DI equation using an independent nonpatient sample, and (c) provided an initial cross-validation of the DI using an independent clinical sample. Age and age rank categorization groups from normative data associated with the Wechsler intelligence scales (Wechsler, 2003, 2008) and contrasts between adults and children served as criteria for development. These samples include a large amount of data from a diverse international subject pool using the Comprehensive System of the Rorschach. Interim validity checks were undertaken to ensure the analytic strategy was sound. The DI includes 12 variables with individual weights determined by regression analysis. The initial independent cross-validation of the DI with a clinical sample revealed that it discriminated well between children and adults. Thus, initial support for this scale as a measure of psychological development across cultures and geography was established, but future research is needed. Clinical implications and specific research needs are presented.     

癌症晚期宁养医疗服务决策的功利主义评价

面对日益增多的癌症晚期患者,为了帮助该患病群体在制定医疗服务决策时保证医学疗护手段科学性,又能确保医疗决策伦理价值的正确性,以功利主义伦理理论为进路,通过讨论癌症晚期患者积极抗肿瘤医治、放弃治疗与宁养医疗服务三种不同医疗模式可能带来的结果与效用,阐明宁养医疗服务是癌症晚期患者全面利益观的体现,论证了其伦理价值取向的合理性,从而为广大群众能转变观念,接受、制定并执行宁养疗护计划提供依据与伦理支持,以期广泛推广。     

Psychological Disturbances in Patients With Sphincter of Oddi Dysfunction

Sphincter of Oddi dysfunction (SOD) is a functional gastrointestinal disorder (FGID), which causes pancreatobiliary-type pain, cholestasis, and/or pancreatitis. Only a few studies have assessed the level of psychological distress in this population compared to healthy subjects or patients with other gastrointestinal disorders. In this study, we examined the self-reported level of psychological distress and certain psychiatric symptoms of SOD patients, and we compared them to depressed patients as well as healthy subjects. The results indicate that SOD patients have significantly lower levels of global and specific symptoms compared to depressed patients. When compared to healthy subjects, SOD patients expressed significantly higher levels of irritability–oversensitivity, and there was a trend toward higher levels of somatization.     

Hope as a Psychological Factor Affecting Quality of Life in Patients With Psoriasis

Clinical observations and medical reports indicate that psoriasis has a tremendous impact on patients’ lives, lowering their quality in many important areas. However, the vast majority of research deals only with health-related issues. This study aimed to compare the general quality of life of psoriasis patients and healthy volunteers by examining psychological variables thought to modify the quality of life. 42 patients with psoriasis and 42 healthy volunteers matched for gender, age and education level were tested. Flanagan Quality of Life Scale was used to evaluate general quality of life. Basic hope level was assessed with Basic Hope Inventory. Trait hope was estimated using Trait Hope Scale. Psoriasis Area Severity Index was used to assess the severity of the disease. Psoriasis patients have a significantly lower overall quality of life (p?=?0.05), modified by Physical and Material Well-being (p?=?0.01), Personal Development and Fulfillment (p?=?0.03), and Recreation (p?=?0.04). They also have lower levels of trait hope (p?=?0.04) and its agency component (p?=?0.01). There were moderate, negative significant correlations with basic hope and such components of quality of life as Physical and Material Well-being (p?=?0.03, r?=?? 0.34) and Relations with other People (p?=?0.02, r?=?? 0.35). These results support the hypothesis of a reduced general quality of life and trait hope in psoriatics. Thus, psychological help for people suffering from dermatological disorders might be as important as medical intervention. Basic hope can be treated as a resource in coping with these disorders and trait hope as a resource conducive to well-being.     

Personality Factors Associated With Psychological Distress in Testicular Cancer Survivors

The aim of this study was to investigate symptoms of anxiety and depression in testicular cancer survivors (TCSs) and to identify personality traits associated with psychological distress in these patients by means of the MMPI (Hathaway &; McKinley, 1943 Hathaway, S. R. and McKinley, J. C. 1943. The Minnesota Multiphasic Personality Inventory, Minneapolis: University of Minnesota Press.  [Google Scholar]). A total of 50 TCSs and 50 age-adjusted healthy men participated in the study, and we used the following self-report instruments: Montgomery–Asberg Depression Rating Scale (Montgomery &; Asberg, 1979 Montgomery, S. and Åsberg, M. 1979. A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134: 382–389. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), Hamilton Anxiety Rating Scale (Hamilton, 1959 Hamilton, M. 1959. The assessment of anxiety states by rating. British Journal of Medical Psychology, 32: 50–55. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar], 1969 Hamilton, M. 1969. Diagnosis and rating of anxiety. British Journal of Psychiatry, 3: 76–79.  [Google Scholar]), Spielberger's State–Trait Anxiety Inventory (Spielberger, 1970 Spielberger, C. D. 1970. “Anxiety as an emotional state”. In Anxiety: Current trends in theory and research, Edited by: Spielberger, C. New York: Academic.  [Google Scholar], 2005 Spielberger, C. D. 2005. State–Trait Anxiety Inventory for adults, Redwood City, CA: Mind Garden.  [Google Scholar]), and the MMPI. TCSs displayed higher rates on all psychopathology scales studied compared to controls, but the majority of the patients' scores were within the “normal range,” indicating rather mild psychological distress. TCSs' MMPI profiles showed higher rates on Scales 1, 3, 6, and 9 compared to controls; and within the TCSs sample, symptoms of depression were most closely associated with Scales 3 and 5. Similarly, anxiety symptoms were mainly associated with Scale 3. These findings indicate that TCSs present mild symptoms of psychological distress, mainly anxiety and depressive symptoms, suggesting that careful assessment and consultation in TC patients is essential to help them deal with distress after treatment and to minimize possible risk factors.     

心理干预在化疗患者中的应用

本研究针对化疗患者常见的恶心呕吐、烦躁不安等副作用．运用心理行为技术．采用病例对照研究方法,对129名化疗患者进行了比较研究。结果为：各项情绪指标和总的情绪状况以及恶心呕吐反应。干预组患者比对照组改善明显;生活质量各指标在组问和组内比较中,有不同程度的改善,角色、社会、认知功能和疼痛症状在两组比较中改善不明显。由此认为,对化疗患者实施恰当的心理行为技术．干预效果是明显的     

Development and Implementation of a Multicultural Consultation Service Within an Academic Medical Center

A major challenge for our field is to ensure we meet the growing demand for culturally sensitive and responsive evidence-based practices to keep up with changing demographics in the U.S. as well as calls to action by our field. To address the mental health imperative to improve the multicultural competence of clinicians and to provide appropriate care, it is important to create opportunities for clinicians to receive training in this area. One route to meet these demands is to provide ongoing multicultural peer consultation to clinical providers. This model also facilitates direct application to clinical work. To that end, we present herein a model for developing and implementing a multicultural peer consultation team. In our implementation, our consultation team aimed to function as therapy for therapists in the context of provision of empirically supported, principle-driven cognitive and behavioral therapies, with a consultation focus on multicultural perspectives and multicultural competence. We demarcate consultation needs within an academic medical center, identify facilitators and barriers to implementation of the service, and provide recommendations for future directions. Moreover, herein we present a case study to demonstrate the process of multicultural peer consultation.     

肿瘤化疗患者的心理分析和指导

肿瘤是一种常见的恶性疾病、病死率很高,化疗是主要治疗方法。由于化疗毒副作用较大,会引起肿瘤患者出现生理上和心理上较大的变化,产生烦躁、焦虑、沮丧等心理活动,并有可能引起病情的恶化,因此极有必要对病人进行心理指导。本文从心理方面对化疗患者进行指导探讨,使医务人员在治疗过程中能帮助患者减轻痛苦,体现人道主义精神。     

The Development of a Substance Abuse Treatment Program for Forensic Patients With Cognitive Impairment

The Substance Abuse and Mental Illness (SAMI) program combines cognitive rehabilitation and dual‐diagnosis substance abuse treatment within a stages of change context. This article describes the development, implementation, and preliminary outcome analysis of the SAMI program in a forensic hospital.     

Development and Implementation of Health and Wellness CBT for Individuals With Depression and HIV

Rates of depression are reported to be between 22% to 33% in adults with HIV, which is double that of the general population. Depression negatively affects treatment adherence and health outcomes of those with medical illnesses. Further, it has been shown in adults that reducing depression may improve both adherence and health outcomes. To address the issues of depression and nonadherence, Health and Wellness (H&W) cognitive behavioral therapy (CBT) and medication management (MM) treatment strategies have been developed specifically for youth living with both HIV and depression. H&W CBT is based on other studies with uninfected youth and upon research on adults with HIV. H&W CBT uses problem solving, motivational interviewing, and cognitive-behavioral strategies to decrease adherence obstacles and increase wellness. The intervention is delivered in 14 planned sessions over a 6-month period, with three different stages of CBT. This paper summarizes the feasibility and acceptability data from an open depression trial with 8 participants, 16 to 24 years of age, diagnosed with HIV and with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis of depression, conducted at two treatment sites in the Adolescent Trials Network (ATN). Both therapists and subjects completed a Session Evaluation Form (SEF) after each session, and results were strongly favorable. Results from The Quick Inventory of Depressive Symptomatology–Clinician (QIDS-C) also showed noteworthy improvement in depression severity. A clinical case vignette illustrates treatment response. Further research will examine the use of H&W CBT in a larger trial of youth diagnosed with both HIV and depression.     

集体心理干预对癌症患者应对方式影响的研究

为了探索集体心理干预对癌症患者应对方式的影响,本研究在90名癌症患者中随机选取46人进行干预研究。为考察干预效果,在干预后分别以医学应对方式问卷各维度因子的前测得分为协变量,以医学应对方式问卷各维度因子的后测得分为因变量,进行2(分组:实验组、对照组)×2(性别:男、女)×3(年龄:低龄组、中龄组、高龄组)的三因素协方差分析。结果表明,经过集体心理干预的实验组在应对方式各分量表上的得分要显著高于对照组,集体心理干预在性别和年龄上不存在显著差异。研究结果表明集体心理干预能够有效地改善癌症患者的应对方式。     

乳腺癌患者的心理状况及相关因素分析

乳腺癌患者常常被各种心理问题所困扰,特别是乳腺癌根治术对女性性特征所带来的严重影响,各种心理问题更为突出。这些心理问题不但影响患者的生活质量,而且影响疾病的发生、发展及转归。本文回顾了患者的个人因素、疾病本身和治疗因素及其他社会心理因素与心理状况的关系,对乳腺癌患者进行心理干预、临床的综合诊治和防治过程提供新思路。     

Dispositional Mindfulness,Psychological Distress,and Posttraumatic Growth in Cancer Patients

Cancer has different psychological and physical outcomes. The present study was conducted to examine psychological distress, posttraumatic growth, and dispositional mindfulness in cancer patients. A total of 109 cancer patients entered the research. The Five-Facet Mindfulness Questionnaire (FFMQ), the Depression Anxiety Stress Scales (DASS-21), and the Posttraumatic Growth Inventory (PTGI) were used for data collection. The regression analysis revealed that dispositional mindfulness can be a significant predictor of psychological distress and posttraumatic growth in cancer patients. The results also showed that mindfulness is related significantly to psychological outcomes and adaptation in cancer patients and should be further addressed in cancer treatment.     

A Longitudinal Investigation of Psychological Disorders in Patients Prior and Subsequent to a Diagnosis of Ovarian Cancer

This longitudinal study investigated levels of anxiety and depression in women who underwent clinical investigations to diagnose a possible ovarian cancer. Women completed the Hospital Anxiety and Depression Scale (HADS), prior to clinical investigations (Time 1), after receiving diagnostic results (Time 2) and at 3 months follow-up (Time 3). Thirty women completed the assessments at Time 1 and Time 2, and 22 women were re-assessed at Time 3. The majority of the sample (56%) scored as a case of anxiety prior to clinical investigations. A significant decrease in anxiety and depression across time was found. Levels of anxiety and depression between women with a subsequent cancer diagnosis and women with a benign result were not significantly different. This study showed that clinical investigations are a highly anxiety-provoking event. In addition, the diagnosis of cancer did not significantly elevate or maintain levels of anxiety and depression compared to a benign diagnosis.     

Evaluation of Breast Cancer Patients with Genetic Risk in a University Hospital: Before and After the Implementation of a Heredofamilial Cancer Unit

The identification of patients at risk for breast cancer by genetic testing has proven to reduce breast cancer mortality. In 2010, due to a lack of systematization in hereditary cancer assistance in our center, we implemented a multidisciplinary Heredofamilial Cancer Unit (HFCU). We analyze if the HFCU improved the rates of referrals and preventive management of breast cancer patients with genetic risk. We retrospectively compared family history records, referrals of high-risk patients to genetic counseling, and detection and management of patients with BRCA1/2 mutations in two cohorts of breast cancer patients diagnosed before (first period: 2007–2010) and after the creation of the HFCU (second period: 2010–2013). In the first period, 893 patients were included, and 902 were included in the second. Due to the inability to establish their genetic risk, 142 patients (15.9%) vs. 70 (7.8%) were excluded from analysis (p?<?0.001). Among the evaluable patients, 194 (25.8%) vs. 223 (26.8%) fulfilled one or more risk criteria (p?=?0.65). Family history documentation in patient’s medical records (92.4 vs. 97.8%, p?<?0.001) and referral rate (26.3 vs. 52%, p?<?0.0001) significantly increased in the second period. Eight BRCA1/2 mutations were detected among patients referred in the first period and 17 among those referred to the HFCU. The rate of preventive surgeries in patients with BRCA mutations significantly increased in the second period (25 vs. 76.5%, p?=?0.03). In conclusion, there was a clear improvement in family history records, referrals, and preventive surgeries in breast cancer patients with genetic risk after the implementation of the HFCU.     

肺癌患者心理疾病相关问题研究进展

从心理学角度对肺癌患者的发病率、死亡率及影响肺癌患者心理疾病的一些相关因素进行研究。突出了心理疾病不仅影响肺癌的发病率及死亡率,而且可以通过下丘脑-垂体-肾上轴、交感神经系统和自身免疫系统等方面影响肺癌的进展及转移。揭示了心理因素与肺癌的诊治、发生及发展密切相关。因此,通过对肺癌患者心理疾病相关问题的研究,可以为研究肺癌的发生、发展、治疗及为肺癌患者心理疾病的预防和干预提供一定的依据。