乳腺癌患者习得性无助感现状及其影响因素分析

doi:10.3761/j.issn.1672-9234.2024.01.012

摘要/Abstract

摘要：

目的探讨乳腺癌患者习得性无助感现状并分析其影响因素。方法于2021年12月—2022年8月，选取广东省某三级甲等肿瘤专科医院收治的303例乳腺癌患者作为调查对象，采用一般情况调查表、习得性无助感量表、一般自我效能感量表和社会支持评定量表进行调查。结果 303例乳腺癌患者习得性无助感得分（62.30±9.92）分；家庭月收入（ β=-0.217）、临床分期（ β=0.119）、是否保乳（ β=0.269）、自我效能感（ β=-0.260）、社会支持总分（ β=-0.294）是习得性无助感的主要影响因素，可预测乳腺癌患者习得性无助感53.4%的变异。结论乳腺癌患者习得性无助感水平较高。临床护理人员应注意评估患者习得性无助感水平，重点关注家庭月收入低、切除乳房和临床分期高的患者，并制订患者自我效能感和社会支持增进策略，从而降低其习得性无助感。

关键词: 乳腺癌, 习得性无助感, 自我效能感, 社会支持

Abstract:

Objective To explore the status of learned helplessness in breast cancer patients and analyze its influencing factors. Methods From December 2021 to August 2022, 303 patients with breast cancer who were admitted to a tertiary A-level cancer hospital in Guangdong Province were selected as the subjects for investigation, and were assessed with the general information questionnaire, Learned Helplessness Scale(LHS), General Self-Efficacy Scale(GSES), and Social Support Rating Scale(SSRS). Results The score of learned helplessness in 303 breast cancer patients was(62.30±9.92). Family monthly income ( β=-0.217), clinical staging ( β=0.119), breast-conserving surgery( β=0.269), self-efficacy( β=-0.260), and total social support score( β=-0.294) were the main influencing factors of learned helplessness, which could predict 53.4% of the total variation. Conclusion The level of learned helplessness in breast cancer patients is relatively high. Clinical nursing staffs should pay attention to evaluating the level of learned helplessness of patients, focusing on patients with low family monthly income, mastectomy and advanced clinical staging, and developing strategies to enhance patients’ self-efficacy and social support, thereby reducing their level of learned helplessness.

Key words: Breast cancer, Learned helplessness, Self-efficacy, Social support

李思琴, 路虹, 吴漫波, 李慧君, 高纪东, 王梦颖, 陈灵玫, 车美悦. 乳腺癌患者习得性无助感现状及其影响因素分析[J]. 中华护理教育, 2024, 21(1): 68-72.

LI Siqin, LU Hong, WU Manbo, LI Huijun, GAO Jidong, WANG Mengying, CHEN Lingmei, CHE Meiyue. Analysis of learned helplessness status and influencing factors in breast cancer patients[J]. Chinese Journal of Nursing Education, 2024, 21(1): 68-72.

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参考文献 23

[1]	Xia CF, Dong XS, Li H, et al. Cancer statistics in China and United States,2022:profiles,trends,and determinants[J]. Chin Med J(Engl), 2022, 135(5):584-590.
[2]	Sedighi Z, Sharifi-Daeamadi P. Effectiveness of an educational package to overcome learned helplessness(LH) on mental health in women with breast cancer[J]. RJMS, 2020, 27(5):49-61.
[3]	Sedighi ZSS, Daramadi PS. The effectiveness of training to overcome the learned helplessness on promoting life expectancy and the mental health in women with breast cancer[J]. Zanko J Med Sci, 2020, 20(67):33-49.
[4]	Seligman ME. Learned helplessness[J]. Annu Rev Med, 1972, 23:407-412. pmid: 4566487
[5]	Sand L, Strang P, Milberg A. Dying cancer patients’ experiences of powerlessness and helplessness[J]. Support Care Cancer, 2008, 16(7):853-862. doi: 10.1007/s00520-007-0359-z
[6]	Eskelinen M, Korhonen R, Selander T, et al. Agreement between hopelessness/helplessness and Montgomery-Asberg Depression Rating Scale in healthy individuals and in patients with benign breast disease and breast cancer:a prospective case-control study in Finland[J]. Anticancer Res, 2015, 35(4):2215-2221. pmid: 25862881
[7]	Šprah L, Šoštarič M. Psychosocial coping strategies in cancer patients[J]. Radiol Oncol, 2004, 38(1):35-42.
[8]	Moyano S, Scolnik M, Vergara F, et al. Evaluation of learned helplessness,perceived self-efficacy,and functional capacity in patients with fibromyalgia and rheumatoid arthritis[J]. J Clin Rheumatol, 2019, 25(2):65-68. doi: 10.1097/RHU.0000000000000769
[9]	Smallheer BA, Dietrich MS. Social support,self-efficacy,and helplessness following myocardial infarctions[J]. Crit Care Nurs Q, 2019, 42(3):246-255. doi: 10.1097/CNQ.0000000000000265 pmid: 31135475
[10]	Schwarzer R, Born A. Optimistic self-beliefs:assessment of gen-eral perceived self-efficacy in thirteen cultures[J]. World Psychology, 1997, 3(1-2):177-190.
[11]	陈彬. 医学多因素分析设计样本例数估算:多因素分析设计样本例数综合估算法[J]. 伤害医学(电子版), 2012, 1(4):58-60.
	Chen B. Sample size methodology for multivariate analysis:synthetic estimate method for sample size in multivariate analysis[J]. Inj Med, 2012, 1(4):58-60.
[12]	武晓艳, 曾红, 马绍斌, 等. 习得性无助量表研制及其与人格相关研究[J]. 中山大学学报(医学科学版), 2009, 30(3):357-361.
[13]	王娜, 史金凤, 赵蓉, 等. 原发性肝癌介入治疗患者习得性无助感的影响因素分析[J]. 中国实用护理杂志, 2022, 38(18):1400-1405.
	Wang N, Shi JF, Zhao R, et al. Influencing factors of learned helplessness in patients with primary liver cancer treated by interventional therapy[J]. Chin J Prac Nurs, 2022, 38(18):1400-1405.
[14]	孙雯倩, 林雁, 陈柳淇, 等. 晚期消化道肿瘤患者家庭照顾者习得性无助的现状及影响因素分析[J]. 中国实用护理杂志, 2022, 38(8):624-629.
[15]	王才康, 胡中锋, 刘勇. 一般自我效能感量表的信度和效度研究[J]. 应用心理学, 2001, 7(1):37-40.
	Wang CK, Hu ZF, Liu Y. Evidences for reliability and validity of the Chinese version of general self-efficacy scale[J]. Chin J Appl Psychol, 2001, 7(1):37-40.
[16]	肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994, 4(2):98-100.
[17]	Pryce CR, Azzinnari D, Spinelli S, et al. Helplessness:a systematic translational review of theory and evidence for its relevance to understanding and treating depression[J]. Pharmacol Ther, 2011, 132(3):242-267. doi: 10.1016/j.pharmthera.2011.06.006
[18]	Trindade IA, Mendes AL, Ferreira NB. The moderating effect of psychological flexibility on the link between learned helplessness and depression symptomatology:a preliminary study[J]. J Context Behav Sci, 2020, 15:68-72. doi: 10.1016/j.jcbs.2019.12.001
[19]	Hamidi F, Jalilian H. Effects of mindfulness-based cognitive therapy on attributional styles of students[J]. Q J Fam Res, 2019, 15(4):85-102.
[20]	Smallheer BA, Vollman M, Dietrich MS. Learned helplessness and depressive symptoms following myocardial infarction[J]. Clin Nurs Res, 2018, 27(5):597-616. doi: 10.1177/1054773816689752 pmid: 28129708
[21]	罗小珍, 雷晓珍, 孙强, 等. 团体正念认知疗法对化疗期乳腺癌患者心理弹性和自我效能的影响[J]. 临床精神医学杂志, 2022, 32(4):291-293.
	Luo XZ, Lei XZ, Sun Q, et al. Effect of group mindfulness cognitive therapy on the psychological resilience and self-efficacy of breast cancer patients during chemotherapy[J]. J Clin Psychiatry, 2022, 32(4):291-293.
[22]	邵显清, 吴鑫华, 张紫阳, 等. 家属同步健康教育对乳腺癌患者术后自我效能和功能锻炼依从性的影响[J]. 癌症进展, 2017, 15(2):208-210,214.
[23]	韩静, 张莉, 汪宝银, 等. 乳腺癌患者疾病接纳干预方案的构建及可行性研究[J]. 中华护理教育, 2020, 17(10):874-879.
	Han J, Zhang L, Wang BY, et al. The development of disease acceptance intervention and its feasibility evaluation for patients with breast cancer[J]. Chin J Nurs Educ, 2020, 17(10):874-879.