Potential profile analysis and influencing factors of benefit finding for esophageal cancer caregivers
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摘要:
目的 探讨食管癌患者照顾者疾病获益感的潜在类别特征，并分析不同类别照顾者获益感的特征差异。 方法 采用便利抽样法，选取2020年11月—2021年6月在南充市某三甲医院胸外科及肿瘤科就诊的食管癌患者照顾者共311名为研究对象。使用简易应对方式问卷、一般自我效能感量表及疾病获益感量表修订版对食管癌患者的照顾者进行调查。 结果 疾病获益感表现为3种不同潜在类别(“获益感低下型”“获益感中等型”“获益感偏高型”)，依次占比17.4%(54例)、53.7%(167例)、28.9%(90例)。相较于“获益感低下型”，倾向于采用积极应对方式的照顾者归属于“获益感偏高型”的概率更大(OR=1.322，P＜0.001)。自我效能感得分越高的照顾者归属于“获益感偏高型”的概率更大(OR=1.341，P＜0.001)。回归分析显示，积极应对方式、自我效能感、照顾者年龄、患者医疗费用支付方式、自理能力、疾病分期均是食管癌照顾者疾病获益感的影响因素(P＜0.05)。 结论 照顾者疾病获益感处于中等偏低水平并且具有明显的分类特征。医护人员可根据不同类别照顾者采取针对性的护理干预措施以提高其疾病获益感水平。 Abstract:Objective To explore the potential category characteristics of benefit finding by caregivers of esophageal cancer patients and analyze the differences in benefit finding among different categories of caregivers. Methods The convenience sampling method was used to select 311 esophageal cancer patients treated in the Department of Thoracic Surgery and Oncology at a tertiary hospital in Nanchong City from November 2020 to June 2021. The caregivers of patients with esophageal cancer were invested in a simplified coping style questionnaire, general self-efficacy scale, and revised Chinese version of the benefit finding scale. Results Benefit finding was classified into low benefit finding, moderate benefit finding, and high benefit finding accounting for 17.4% (54 cases), 53.7% (167 cases), 28.9% (90 cases) respectively. Caregivers who tended to adopt a positive coping style were more likely to belong to the high benefit finding than the low benefit finding (OR=1.322, P < 0.001). Caregivers with higher self-efficacy scores were more likely to belong to the high benefit finding (OR=1.341, P < 0.001). The results of regression analysis showed that positive coping style, self-efficacy, caregiver age, payment method of medical expenses, self-care ability, and disease stage were the factors influencing the benefit finding of caregivers of esophageal cancer (P < 0.05). Conclusion The benefit findings of caregivers are at a moderate to low level and have distinct classification characteristics. Healthcare professionals can take targeted nursing interventions based on the different categories of caregivers to improve benefit finding. -
Key words:
- Esophageal cancer /
- Caregiver /
- Benefit finding /
- Potential profile analysis /
- Tumor nursing care
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表 1 不同模型拟合参数指标的比较(n=311)
Table 1. Comparison of fitting parameters of different models (n=311)
模型 K log(L) AIC BIC aBIC Entropy P值 类别比例 LMR BLRT 1 10 -4 224.388 8 468.777 8 506.174 8 474.458 0 0 0 0 2 16 -4 000.972 8 033.944 8 093.781 8 043.034 0.839 < 0.001 < 0.001 0.624/0.376 3 22 -3 929.100 7 902.199 7 984.475 7 914.699 0.838 0.002 < 0.001 0.190/0.521/0.289 4 28 -3 895.884 7 847.767 7 952.481 7 863.675 0.860 0.272 < 0.001 0.180/0.286/0.405/0.129 
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表 2 不同类别照顾者一般人口学资料及患者资料比较
Table 2. Comparison of general demographic data and patient data in different types of caregivers
项目 获益感低下型(n=54) 获益感中等型(n=167) 获益感偏高型(n=90) 统计量 P值 照顾者性别[例(%)] 6.629a 0.036 男性 22(40.7) 73(43.7) 53(58.9) 女性 32(59.3) 94(56.3) 37(41.1) 照顾者年龄[例(%)] 15.707b ＜0.001 ＜40岁 6(11.1) 46(27.5) 26(28.9) 40~60岁 30(55.6) 94(56.3) 57(63.3) ＞60岁 18(33.3) 27(16.2) 7(7.8) 照顾者婚姻状况[例(%)] 18.543a 0.001 已婚 44(81.5) 158(94.6) 86(95.6) 未婚 3(5.5) 7(4.2) 2(2.2) 离异 7(13.0) 2(1.2) 2(2.2) 家庭人均月收入[例(%)] 13.086b 0.001 ＜2 000元 28(51.9) 40(24.0) 26(28.9) 2 000~4 000元 18(33.3) 80(47.9) 36(40.0) ＞4 000元 8(14.8) 47(28.1) 28(31.1) 与患者的关系[例(%)] 9.876a 0.007 配偶 22(40.7) 51(30.5) 15(16.7) 子女 29(53.7) 108(64.7) 68(75.6) 兄弟姐妹 2(3.7) 7(4.2) 5(5.5) 其他 1(1.9) 1(0.6) 2(2.2) 患者医疗费用支付方式[例(%)] 36.961a ＜0.001 职工医疗保险 6(11.1) 24(14.4) 13(14.4) 城乡居民医疗保险 34(63.0) 133(79.6) 76(84.5) 自费 9(16.7) 5(3.0) 1(1.1) 其他 5(9.2) 5(3.0) 0 自理能力[例(%)] 9.777b 0.008 完全自理 23(42.6) 105(62.9) 42(46.7) 部分自理 22(40.7) 50(29.9) 44(48.9) 完全不能自理 9(16.7) 12(7.2) 4(4.4) 病程[例(%)] 24.125b ＜0.001 ＜6个月 9(16.7) 66(39.5) 39(43.3) 6个月~1年 11(20.3) 40(24.0) 35(38.9) ＞1年 34(63.0) 61(36.5) 16(17.8) 目前治疗方式[例(%)] 59.250a ＜0.001 手术 16(29.6) 90(53.9) 72(80.0) 化疗或放疗 22(40.7) 68(40.7) 16(17.8) 其他 16(29.6) 9(5.4) 2(2.2) 疾病分期[例(%)] 49.362b ＜0.001 Ⅰ期 3(5.6) 20(12.0) 21(23.3) Ⅱ期 7(13.0) 56(33.5) 43(47.8) Ⅲ期 24(44.4) 78(46.7) 24(26.7) Ⅳ期 20(37.0) 13(7.8) 2(2.2) 积极应对方式(x±s，分) 10.80±4.32 16.07±5.47 22.08±7.15 66.563c ＜0.001 自我效能感(x±s，分) 17.98±5.06 21.89±4.46 27.08±5.32 65.151c ＜0.001 注：a为χ2值，b为H值，c为F值。本表仅列出差异有统计学意义的项目。
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表 3 变量赋值情况
Table 3. Variable assignment
变量 赋值方法 照顾者性别 男性=1，女性=2 照顾者年龄 ＜40岁=1，40~60岁=2，＞60岁=3 照顾者婚姻状况 以“离异”为参照，已婚=(1，0)，未婚=(0，1) 家庭月收入 ＜2 000元=1，2 000~4 000元=2，＞4 000元=3 与患者的关系 以“其他”为参照，子女=(1，0，0)，兄弟姐妹=(0，1，0)，配偶=(0，0，1) 患者医疗费用支付方式 以“其他”为参照，职工医保=(1，0，0)，城乡居民医疗保险=(0，1，0)，自费=(0，0，1) 自理能力 完全自理=1，部分自理=2，完全不能自理=3 病程 ＜6个月=1，6个月~1年=2，＞1年=3 目前治疗方式 以“其他”为参照，手术=(1，0)，化疗或放疗=(0，1) 疾病分期 Ⅰ期=1，Ⅱ期=2，Ⅲ期=3，Ⅳ期=4 积极应对方式 连续性变量，以实际值赋值 自我效能感 连续性变量，以实际值赋值
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表 4 照顾者疾病获益感影响因素分析
Table 4. Analysis of factors influencing the sense of caregivers benefit from disease
项目 类别 获益感中等型 获益感偏高型 OR值 95% CI P值 OR值 95% CI P值 照顾者性别 男性 0.753 0.296~1.912 0.550 1.494 0.479~4.658 0.489 照顾者年龄 ＜40岁 17.210 1.952~151.726 0.010 31.103 2.173~445.267 0.011 40~60岁 4.613 0.971~21.901 0.054 11.017 1.387~87.514 0.023 照顾者婚姻状况 已婚 0.623 0.032~11.972 0.754 1.286 0.019~89.188 0.907 未婚 0.171 0.005~5.642 0.322 0.169 0.001~28.000 0.496 家庭人均月收入 ＜2 000元 0.794 0.216~2.922 0.729 1.199 0.249~5.782 0.821 2 000~4 000元 1.593 0.456~5.560 0.465 1.851 0.436~7.867 0.404 与患者的关系 配偶 19.735 0.147~2 656.748 0.233 3.332 0.009~1 297.283 0.692 子女 7.066 0.064~776.052 0.415 1.107 0.004~343.529 0.972 兄弟姐妹 142.845 0.357~57 164.987 0.105 33.655 0.030~37 942.846 0.327 患者医疗费用支付方式 职工医疗保险 9.051 1.099~74.572 0.041 3.342 1.183~16.364 0.027 城乡居民医疗保险 17.956 2.864~112.586 0.002 0.843 0.488~11.167 0.289 自费 1.189 0.100~14.166 0.891 0.749 0.566~10.549 0.231 自理能力 完全自理 5.705 1.023~31.814 0.047 11.158 1.239~100.462 0.031 部分自理 1.237 0.246~6.223 0.796 3.339 0.399~27.951 0.266 病程 ＜6个月 0.618 0.121~3.150 0.562 0.653 0.089~4.781 0.675 6个月~1年 0.718 0.185~2.793 0.633 1.419 0.248~8.120 0.694 目前治疗方式 手术 2.472 0.186~32.930 0.493 4.967 0.150~164.986 0.370 化疗或放疗 0.417 0.053~3.296 0.407 0.140 0.007~2.804 0.199 疾病分期 Ⅰ期 3.842 0.203~72.549 0.369 7.091 0.181~278.450 0.296 Ⅱ期 13.339 1.167~152.511 0.037 10.894 0.433~274.077 0.147 Ⅲ期 9.730 1.519~62.345 0.016 28.653 2.060~398.447 0.012 积极应对方式 1.165 1.052~1.290 0.003 1.322 1.177~1.485 ＜0.001 自我效能感 1.139 1.013~1.280 0.029 1.341 1.173~1.535 ＜0.001 注：各项分别以照顾者性别为女性、照顾者年龄＞60岁、婚姻状况为离异、人均月收入为＞4 000元、与患者的关系为其他、医疗费用支付方式为其他(包括商业保险、大病医疗保险等)、完全不能自理、病程＞1年、目前治疗方式为其他、疾病分期为Ⅳ期为参照。
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