The mediating effect of positive perceptions on the relationship between caregiver readiness and disease uncertainty among caregivers of children with leukemia undergoing PICC catheterization
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摘要:
目的 探讨白血病PICC置管患儿家庭照顾者积极感受、照顾准备度、疾病不确定感现状，分析三者间的作用路径，为临床改善照顾者疾病不确定感提供依据。 方法 便利抽样法选取2024年1—6月于温州医科大学附属第二医院儿童血液内科住院的109名PICC置管的白血病患儿的家庭照顾者作为研究对象，采用一般资料表、疾病不确定感父母量表（PPUS）、照顾者积极感受量表（PAC），家属照顾准备度量表（CPS）进行调查，采用Pearson分析三者间的相关性。 结果 家庭照顾者PPUS得分为（89.54±12.98）分，PAC得分为（25.18±5.27）分，CPS量表得分为（24.07±3.38）分；照顾准备度与积极感受呈正相关关系（r=0.495, P＜0.01），照顾准备度、积极感受与疾病不确定感均呈负相关关系（r=-0.385、-0.408, 均P＜0.01）；积极感受在照顾准备度与疾病不确定感之间起到部分中介作用，积极感受的中介效应为0.179（95% CI：0.122~0.235，P＜0.001），占总效应的46.22%。 结论 积极感受在白血病PICC置管患儿家庭照顾者照顾准备度与疾病不确定感间存在中介作用，医护人员可通过提高照顾者照顾准备度，增强照顾者的积极感受，以减轻患儿照顾者的疾病不确定感。 Abstract:Objective To explore the current situation of caregiver readiness, positive perceptions, and illness uncertainty among family caregivers of children with leukemia undergoing PICC catheterization, and to analyze the relationships among the three variables, thereby providing evidence for clinical improvement aimed at reducing caregivers' sense of disease uncertainty. Methods Convenience sampling method was used to select the family caregivers. A total of 109 leukemia patients with PICC catheterization who admitted to the Department of Pediatric Hematology, the Second Affiliated Hospital of Wenzhou Medical University from January 2024 to June 2024 were recruited. General information form, prent's perception uncertainty in illness scale (PPUS), positive aspects of care giver scale (PAC), and care preparedness scale (CPS) were used for investigation. Pearson correlation analysis was applied to explore the correlations among the three variables. Results The mean PPUS score was (89.54±12.98) points, the PAC score was (25.18±5.27) points, and the CPS scale score was (24.07±3.38) points. There was a positive correlation between caregiver readiness and positive perception (r=0.495, P < 0.01). While caregiver readiness and positive perception were both negatively correlated with disease uncertainty (r=-0.385, -0.408, P < 0.01). Positive perceptions partially mediated the relationship between caregiver readiness and disease uncertainty, with a mediating effect value of 0.179 (95% CI: 0.122- 0.235, P < 0.001), accounting for 46.22% of the total effect. Conclusion Positive perceptions paly a partial mediating role in the relationship between caregiver readiness and disease uncertainty among caregivers of children with leukemia undergoing PICC catheterization. Medical staff can alleviate the uncertainty of illness among caregivers of sick children by improving their caregiver preparedness and enhancing their positive perceptions. -
Key words:
- Leukemia /
- Care readiness /
- Disease uncertainty /
- Positive perceptions
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表 1 白血病PICC置管患儿及家庭照顾者基本资料
Table 1. Basic information of leukemia patients undergoing PICC placement and family caregivers
项目 类别 例数(%) 患儿性别 男 58(53.21) 女 51(46.79) 年龄(岁) ≤4 20(18.35) 5～10 54(49.54) 11～14 35(32.11) 是否独生子女 是 71(64.22) 否 39(35.78) 疾病类型 急性淋巴细胞性白血病 94(86.24) 急性非淋巴细胞白血病 15(13.76) 置管时长(月) ＜3 21(19.27) 3～6 78(71.56) ＞6 10(9.17) 曾置管经历 有 4(3.67) 无 105(96.33) 医保类型 社会医疗保险 83(76.15) 商业保险 5(4.59) 自费 21(19.26) 照顾者性别 男性 10(9.17) 女性 99(90.83) 照顾者年龄(岁) ＜30 32(29.36) 30～39 67(61.47) ≥40 10(9.17) 文化程度 初中及以下 37(33.94) 高中/中专 32(29.36) 大专及以上 40(36.70) 婚姻状况 已婚 102(93.58) 离异 5(4.59) 其他 2(1.83) 家庭人均月收入(元) ＜3 000 46(42.20) 3 000～5 000 44(40.37) ＞5 000 19(17.43) 居住地 城镇 50(45.88) 农村 59(54.12) 是否患有慢性病 是 12(11.01) 否 97(88.99) 
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表 2 家庭照顾者PPUS、PAC及CPS量表得分情况
Table 2. PPUS, PAC, and CPS scale scores for family caregivers
项目 条目 分值范围(分) 得分(x±s，分) PPUS量表总得分 31 31~155 89.54±12.98 疾病状态不确定性 9 9~45 24.19±6.78 信息不明确性 13 13~65 40.84±7.64 信息缺乏性 5 5~25 13.21±4.29 不可预测性 4 4~20 12.07±3.36 PAC量表总得分 9 9~45 25.18±5.27 自我肯定 6 6~30 17.55±4.26 生活展望 3 3~15 7.51±3.66 CPS量表总得分 8 0~32 24.07±3.38
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表 3 照顾准备度、积极感受及疾病不确定感的相关性分析
Table 3. Correlation between care preparedness, positive perception, and disease uncertainty
项目 统计量 疾病不确定感 积极感受 积极感受 r值 -0.408 P值 ＜0.001 照顾准备度 r值 -0.385 0.495 P值 ＜0.001 ＜0.001
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表 4 积极感受在照顾准备度与疾病不确定感间的中介效应模型拟合效果
Table 4. The mediating effect of positive feelings between care readiness and uncertainty of illness
项目 χ2/df 拟合优度指数 调整拟合优度指数 规范拟合指数 增量拟合指数 比较拟合指数 近似残差均方根 本模型 2.451 0.911 0.920 0.906 0.947 0.939 0.955 标准 ＜5 >0.9 >0.9 >0.9 >0.9 >0.9 >0.9
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表 5 积极感受在照顾准备度与疾病不确定感间中介效应的路径系数
Table 5. Path coefficient of mediating effect of positive feelings between care readiness and uncertainty of illness
类别 效应量β 95% CI P值 占总效应比值(%) 照顾准备度→疾病不确定感 0.386 0.317~0.464 ＜0.001 - 照顾准备度→积极感受 0.207 0.105~0.313 ＜0.001 53.78 中介效应： 照顾准备度→积极感受→疾病不确定感 0.179 0.122~0.235 ＜0.001 46.22 注：“-”表示该路径(总效应)本身即为比较基准，不计算“占总效应比值”。
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