肺癌患者获知癌症诊断后的心身应激轨迹研究

Informed Consent is a fundamental right of patient, but the possible negative impacts of disclosing cancer diagnosis and the adverse reaction from some patients with certain personality traits would stop relatives and clinicians to tell them about the truth. As Lung Cancer became to the most popular cancer in China,we will recruit at least 240 newly diagnosed Lung Cancer patients who are unaware of their diagnosis to develop this prospecitvely longitudinal study about the disclosure of cancer diagnosis. This study includes 7 times investigations, we would try to investigate the heterogeneity of psychological adjustment before and after disclosure of diagnosis with Growth Modeling, explore the impact of personality,cognitive appraisal, coping style, social support and other factors on the trajectories；Then 100 Lung Cancer patients with the personlity traits of chronic stress trajectory whom are also unware of their diagnosis would be selected into two groups, the intervention group will get a 8 weeks group psychological intervention and individual intervention, MCMQ, QOL and HADs will be assessed by patients themselves before,2,4 and 6 mongths after grouping.By comparing the scores of MCMQ,QOL and HADs between these two groups and analysing the change of chronic stress trajectory, we will investigate the effect of psychological intervention,so as to provide the basis for the personalization way in disclosing of cancer diagnosis.

知情权是癌症患者的一项基本权利，但告知对患者可能产生的负性影响，以及具备某种人格特质的患者在得知实情后的不良反应，成为了阻止告知患者实情的关键。针对我国发病率最高的恶性肿瘤- - 肺癌，本研究拟招募240名以上首诊肺癌且对诊断不知情的患者进行7次问卷调查，以开展诊断知情的前瞻性纵向研究。通过借助构建成长模型，探索知情前后情绪状态及生活质量的变化探索可能存在的肺癌诊断告知应激轨迹，来探讨人格特质、认知评价、应对方式、社会支持等因素在癌症诊断告知应激过程中的作用；招募100名慢性应激轨迹特征的肺癌不知情患者进行心理干预对照试验，通过为期8周的团体干预和个体心理干预，比较对照组和干预组在入组前、入组后第2、4、6个月的应对方式、生活质量、情绪变化及慢性应激轨迹的变化来分析心理干预的效果，为开辟癌症诊断告知个性化途径提供依据。

本研究对559名新确诊的肺癌患者进行调查，发现超过70%患者对于真实病情告知态度持赞成态度。病情告知态度与人格无关，与医学应对方式及领悟社会支持有关。家属更倾向向乐观患者告知实情。系统探讨了肺癌患者确诊初期人格、社会支持、应对方式、负性认知与生活质量、情绪之间的交互关系。前瞻性地跟踪随访了284例患者，借助潜变量增长混合模型揭示了肺癌患者确诊后1年内心理水平的动态变化趋势和心理调适过程的影响因素。64.3%肺癌患者遵循弹性应激轨迹，14.5%遵循恢复轨迹；12%肺癌患者遵循慢性应激轨迹，9.2%呈现延迟应激轨迹。相较于弹性应激轨迹，慢性应激轨迹的患者领悟社会支持更低、负性认知、疼痛更严重，更悲观，而是否知情并没有显著影响。长期纵向数据提示肺癌患者是否知晓真实病情并不是负性情绪的影响因素，人格、社会支持、负性认知模式及疼痛症状的作用更显著。研究还开展了团体心理干预，发现干预后慢性应激轨迹特点肺癌患者的社会功能及负性认知较干预前改善。本研究针对肺癌新确诊患者进行心理轨迹追踪研究，通过本研究结果促进寻找保护因素来增强肺癌患者确诊后的心理抗逆能力，为针对性地面向肺癌人群开展心理干预奠定了理论及实践基础。