五种干预措施对癌症儿童主要照顾者心理韧性影响的网状Meta分析

采用网状Meta分析评价不同干预措施对癌症儿童主要照顾者心理韧性的影响。检索国内外数据库自建库至2021年8月公开发表的癌症儿童主要照顾者心理韧性干预的相关文献,共纳入6项研究,涉及5种干预措施,合计327例癌症儿童主要照顾者。研究结果表明,自我表露干预（MD=29.08,95%CI：16.35～41.24）、同伴教育干预（MD=23.58,95%CI：9.80～37.43）与常规护理相比有统计学意义（P＜0.05）,其排序的优劣顺序为：自我表露干预、同伴教育干预、同伴支持干预、自我同情训练、常规护理、压力管理干预。目前证据表明,自我表露干预可能是提高癌症儿童主要照顾者心理韧性的最优干预措施,但还需大样本临床研究证实。

     

癌症幸存者家庭复原力的研究进展

通过对国内外相关文献的检索,在对癌症幸存者及家庭复原力概念、测量工具进行综述的基础上从内外环境两方面,包括社会人口学因素、家庭因素、心理因素、社会支持等来详细阐述癌症幸存者家庭复原力影响因素的研究进展,并提出心理、运动以及社会支持等临床护理干预措施,总结了我国癌症幸存者家庭复原力的发展局限性,同时也为未来的发展方向提出一定的见解,旨在进一步促进我国开展癌症幸存者家庭复原力的相关研究提供一定的参考性建议与指导。

     

癌症患者照顾者对病情告知偏好质性研究的Meta整合

系统评价有关癌症患者照顾者对于病情告知偏好的质性研究,为构建符合家庭需求的病情告知模式提供依据。系统检索相关中英文文献并进行质量评价,运用Meta整合的方法整合结果。共纳入17篇文献,提取出27个研究结果,归纳为6个类别,形成2个整合结果：照顾者对于是否告知癌症患者病情有不同的做法和考量;照顾者期望个性化、委婉、有助于癌症患者维持希望的病情告知模式。医护人员应全面动态评估照顾者的病情告知偏好和患者意愿,共同商讨符合家庭需求的病情告知策略,帮助他们有效沟通和应对。

     

阿尔兹海默氏症患者的家属照顾者(隐形的病患)健康状况探讨

台湾地区有超过91.5%的阿尔兹海默症照顾者为家庭成员。他们平均对轻度、中度和重度此症患者的全部照顾时间为2166、4299和5871小时。根据一项以“中国人健康问卷”所做的调查,照顾者身体健康状况平均值为2.73(标准差0.85);心理健康状况平均值为2.74(标准差0.8);社会健康状况平均值为2.98(标准差0.78);在压力的排序上以情绪上的压力和困扰为最高(3.02)。这些数据显示照顾者的身心健康已受到严重的负面影响。因此,照顾者应该首先照顾好自身,才能给予被照顾者亲属更好的必要照顾。     

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。     

中国大陆宁养照顾对癌症末期患者生活质量之影响

宁养工作强调全人的照顾,不但能维持原有的生活方式,而且能提高生活的品质。本研究旨在探讨癌症末期患者在宁养照顾介入后,生活质量的改变。研究分为试验组（n=630）和对照组（n=241）。研究的结果显示癌症末期患者经过宁养介入后,其身、心、灵、社会之生活品质大幅度改善。而对照组患者仅在身体生活质量方面有显著改变。因此对医疗人员、社会大众的临终关怀观念的推广及教育是迫切需要的,立法更是不容忽视的课题,正确的立法才能真正推动宁养工作的发展。     

家庭癌症告知过程及类型分析

将癌症告知看作一个家庭过程,以患者-家属为分析单位,阐述确诊及病程信息如何在家庭中流动,以及告知过程中患者和家属的角色演变。研究者对12位肺癌患者、7位家庭照护者和2位医生进行半结构访谈,并对访谈数据进行主题分析。家庭癌症告知是一个关乎患癌事实如何在家庭内流动的过程。围绕确诊、治疗和临终安排三个阶段,详细阐述了病患和家人的多种角色的演变,并基于此构建了两种家庭告知的理想类型：病患决策型和家属代理型。患者以往家庭角色、家庭沟通系统和疾病具身性体验是家庭癌症告知过程的重要影响因素。

     

生命尊严的确立和制度化

人的生命尊严在基督教有完整论证,但其证立需借助神性。理性尊严观、德性尊严观、自主尊严观等确立了人的内在尊严,但同时排除了人的生命尊严。医学伦理学和生命伦理学一方面频繁使用"生命尊严";另一方面对"尊严"循理性主义解释,导致"尊严无用论"和"尊重取代论"出现。人的生命尊严亟需哲学论证。人与万物的物质差异是生命尊严的存在论基础;人与人之间对生命之至上性、关键权益性、神圣不可侵犯性的价值互认是生命尊严的价值论根据。我国生命尊严的制度化有长足进步,但人的生命、健康、安全还面临许多威胁,把生命尊严作为一项制度伦理原则十分必要。     

儿童癌症家庭的社会生态抗逆力探析

深入探究儿童癌症家庭的经验与困境,对11个儿童癌症家庭进行半结构式访谈,通过谈话和观察收集研究资料,使用社会生态抗逆力理论作为分析视角。研究发现,儿童癌症家庭的整体抗逆力较为脆弱,疾病成为家庭日常运转的中心,家庭经济压力较大,缺少专业协助,社会交往减少,处于社会孤立状态。依据社会生态抗逆力理论模型,提出家庭、经济和社会系统层面的社会生态抗逆力提升路径,指出促进家庭团结,提供专业协助,促进社会交往,营造社会归属感等,都有利于增进儿童癌症家庭抗逆力,帮助家庭更好地应对疾病及相关问题。

     

临终患者与家属进行临终互动的影响因素研究进展

通过文献综述的方式,梳理了近几年国内外关于临终患者与家属的临终互动的研究,归纳了临终互动的影响因素和可供参考的互动策略。疾病阶段、文化特点、沟通习惯和环境等因素均会影响临终患者和家属进行临终互动的意愿、内容偏好和沟通方式,针对不同的影响因素应该采取相对应的互动策略。明确临终互动的影响因素有助于患者和家属发现对方的潜在需求,有助于临床医务工作者进一步开展相关研究,为探索临终互动干预方案提供证据支持。     

Caregivers of adults with cancer: Multidimensional correlates of psychological distress

The relationship between psychological distress and intrapersonal, family, and socioecological variables was examined in 77 caregivers of adults actively receiving cancer treatment. Results indicated that a sizable minority (29%) of caregivers was experiencing clinically significant psychological distress. Furthermore, family disturbances and maladaptive coping strategies were most predictive of psychological distress in this sample. The clinical implications of these findings in relation to the assessment and treatment of both patients and caregivers are discussed.     

Telephone-Based Behavioral Activation for Improving Sleep Quality in Family Caregivers of People With Dementia: A Pilot Randomized Controlled Trial

Sleep disturbances are common among family caregivers of people with dementia (PWD). Although behavioral activation (BA) shows the potential to improve sleep quality, to date, evidence for this treatment’s feasibility and efficacy for family caregivers of PWD is limited. Therefore, this study pilot tested an evidence-based BA protocol for improving sleep quality in Chinese family caregivers of PWD. The BA intervention involved eight weekly individual telephone-based sessions designed to teach caregivers specific BA techniques. Sleep quality and depression were measured using the Chinese versions of the Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiologic Studies Depression (CES-D) Scale, respectively. This study also measured leisure activity, positive aspect of caregiving, caregiving burden, health status, and relationship satisfaction. All participants were asked to complete the assessments on paper at baseline and immediately after the intervention. After completing the pilot randomized controlled trial, semistructured interviews were conducted to explore participants’ experiences participating in the BA intervention. A total of 71 family caregivers of PWD (35 in the intervention group and 36 in the control group) were recruited. The majority of participants were female (n = 53, 74.65%), and their mean age was 54.07 years (SD = 10.95). Compared with controls, caregivers in the intervention group displayed significantly greater improvement in sleep quality, as well as perceptions of positive aspects of caregiving and reduction of depression. Most participants were very satisfied with the intervention. These findings suggest that individual telephone-based BA interventions are feasible, acceptable, and effective in improving sleep quality and psychological health in family caregivers of PWD. These results contribute to the literature by providing evidence for developing effective, accessible, and sustainable BA interventions for family caregivers of PWD.     

Stress Reduction for Family Caregivers in Chronic Mental Illness: Implications of a Work Stress Management Perspective

In several studies involving a total of 291 family caregivers for schizophrenia sufferers, the stressors that arise from caregiving were identified. Also identified were the outcomes for caregivers, which often include psychological distress. Caregivers develop various stress-reduction techniques, but this article explores the utility of applying the principles of work stress management to caregiver well-being. An organizational psychology perspective suggests that a comprehensive focus must include not only how individuals can learn to manage the emotional demands of their work, but also how the work of caregiving can be made less stressful for them. Suggestions from a work stress management perspective highlight the possible contributions of worker participation in policy formulation and a collaborative relationship between family and professional caregivers. Potentially fruitful research directions are noted.     

Feasibility of a Telephone Intervention for HIV Patients and Their Informal Caregivers

Objectives: To assess the feasibility of a telephone intervention for HIV-positive patients and their caregivers. Methods: HIV-positive participants, some co-enrolled with their informal caregiver, enrolled in this randomized study. Intervention-arm participants (124 patients and 76 caregivers; dyads assigned to same arm) received up to 12 scheduled calls from an interventionist over 6 months. Results: An average of 7.6 (SD = 3.0) calls to each participant was completed; 66.5% received at least 6 calls; 43.0% received more than 75% of the intervention (defined as ‘study adherent’). Having a higher T-cell count was associated with call adherence (p = .014); cocaine use was associated with reduced call adherence for both patients (p = .019) and caregivers (p = .083). Common telephone themes included problems with mood, relationships, finances, housing, and work; interventions (e.g., referral for mental health care) were initiated in response to these. Participant satisfaction was high, and many reported benefits from the intervention. Conclusions: Using a telephone intervention with HIV-positive patients and their caregivers is a feasible and potentially beneficial intervention.     

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。