肺癌患者支持性照护需求的预测模型及其干预机制研究

Effective supportive care is one of the key elements to promote physical and psychological rehabilitation of the patients with lung cancer. However, precedent studies have indicated that many supportive care needs among the patients with lung cancer were unmet. What are the factors that affect the supportive care needs among patients with lung cancer? Which kind of scheme could achieve favorable intervention effect? What is potential mechanism of providing supportive care to enhance the quality of life among patients with lung cancer? These issues need to be studied..Based upon systematic literature review, this study proposes a hypothetical predictive model of supportive care needs among patients with lung cancer. By using structural equation model, the relationship among variables will be verified, and the path coefficients of predictive factors of supportive care needs will be analyzed, thereby a theoretical predictive model will be constructed. Meanwhile, due to the variety in the characteristics of patients with lung cancer, the specific content and the intensity of the supportive care needs will be described. Based on the predictive model, a supportive care plan will be designed specifically for each patient with non-small cell lung cancer from perioperative period to chemotherapy according to the comprehensive assessment of their needs and influencing factors. Subjective indicators including psychological distress, unmet supportive care needs, quality of life, and objective biological indicators will be combined to evaluate the intervention effects. The intervention mechanism of supportive care needs will also be explored. The expected outcomes of this study will provide evidences for developing a standardized plan of supportive care and synergistic therapy for patients with lung cancer.

有效的支持性照护是促进肺癌患者身心康复的要素之一。然而前期研究发现肺癌患者存在大量未满足的支持性照护需求。哪些因素影响肺癌患者的支持性照护需求？何种方案才能达到良好的干预效果？支持性照护提升肺癌患者生命质量的作用机制是什么？这些问题有待研究。.本课题拟在系统文献综述的基础上提出肺癌患者支持性照护需求的预测假设模型；通过结构方程模型验证分析各变量之间的路径关系和作用系数，构建肺癌患者支持性照护需求的理论模型，揭示不同特征肺癌患者支持性照护需求的内容和程度；以构建的模型为依据，对非小细胞肺癌患者从围手术期至化疗期纵向追踪，在全面评估患者支持性照护需求及影响因素的基础上制定并实施支持性照护干预方案，针对性地予以照护提供，以主观指标心理困扰、需求满足、生命质量和生物学客观指标相结合，评价干预效果，并探究支持性照护干预的作用机制。研究结果为制定标准化支持性照护方案、协同肺癌的治疗措施提供参考依据。

背景：有效的支持性照护是促进肺癌患者身心康复的要素。前期研究发现肺癌患者存在大量未满足的支持性照护需求，但哪些因素影响肺癌患者支持性照护需求、如何有效干预以及干预方案的作用机制有待研究。..内容：在系统文献综述基础上提出肺癌患者支持性照护需求预测假设模型；通过结构方程模型分析变量间的路径关系和作用系数，构建肺癌患者支持性照护需求理论模型；以构建的模型为依据，对肺癌患者从围手术期至化疗期纵向追踪，在评估患者支持性照护需求及影响因素的基础上制定并实施支持性照护干预方案，于入院时（T0）、术后出院时（T1）、首次化疗入院时（T2）和第3次化疗入院时（T3）收集资料，以主观指标心理困扰、需求满足、生命质量和生物学客观指标相结合，评价干预效果并探究其作用机制。..结果：支持性照护需求的直接预测变量为症状困扰、护理服务满意度、疾病进展恐惧、社会支持及面对应对；间接预测变量为D型人格、病耻感及屈服应对。两组患者评价指标在不同测量时点组内比较显示：干预组支持性照护需求、心理困扰、IL-6、TNF-α呈下降趋势，需求获得、社会支持、生活质量呈上升趋势，差异有统计学意义；两组患者评价指标组间比较显示：重复测量方差分析提示两组患者支持性照护需求、需求获得、生活质量、心理困扰得分受时间效应、交互效应和分组效应影响（P＜0.01），社会支持受交互效应和分组效应的影响（P＜0.01）；干预组支持性照护需求及心理困扰均低于对照组，需求获得、生活质量、社会支持得分高于对照组，差异有统计学意义（P＜0.05）；两组患者组间神经免疫内分泌指标变化趋势显示：T1到T3干预组较对照组CD3+及CD4+呈上升趋势，NE（去甲肾上腺素）呈下降趋势，差异有统计学意义（P<0.05）。..意义：基于支持性照护需求预测模型的干预方案，可有效满足肺癌患者支持照护性需求，提升其生命质量；同时，还可能通过提升机体免疫能力促进患者社会心理康复；该方案可为制定其他癌症类型患者支持性照护干预策略提供参考。