术后恢复中的应对策略和心理困扰：对接受保乳手术妇女的重复测量研究

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing Pub Date : 2025-02-25 DOI:10.1016/j.apjon.2025.100674

Jennifer R. Majumdar , Margaret Barton-Burke , Jaime L. Gilliland , Nalini N. Jairath

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引用次数: 0

摘要

目的保乳手术（breast - conservation surgery， BCS）是早期乳腺癌的标准治疗方法，但患者在康复过程中往往会出现明显的心理困扰和身体症状。本研究旨在探讨前因、身体症状（疼痛和恶心）、心理困扰和应对策略之间的关系，以改善BCS恢复期妇女对术后挑战的管理。方法：这项重复测量的描述性研究涉及75名在国家癌症研究所指定中心接受前哨淋巴结活检的BCS妇女。参与者在术后第1天（POD1）和第14天完成了国家综合癌症网络（NCCN）痛苦温度计和应对方式量表。采用双变量分析、多元线性回归和结构方程模型来评估前因、应对策略和痛苦之间的关系。对开放式答复的主题内容进行定性分析。结果寻求社会支持(POD1均值= 1.25；POD14平均= 1.20)和计划性问题解决(POD1平均= 1.19；POD14（平均= 1.04）是最常用的应对策略，而承担责任和对抗性应对的使用最少。总体应对策略的使用在POD1和POD14之间有所减少，可能反映了恢复适应。焦虑的显著预测因子包括逃避-回避应对(β = 0.415, P <；0.001),社会支持(β= 0.270,P = 0.02),恶心的历史(β= 0.517,P & lt;0.001)，年龄（β = 0.293, P = 0.007）。应对策略对前因与痛苦之间的关系没有中介作用。结论社会支持和计划性问题解决等适应性应对策略在缓解BCS康复过程中的痛苦中起关键作用。干预措施应强调促进这些策略并针对高危人群，如年轻患者和有恶心史的患者。尽管存在局限性，但本研究强调了支持适应性应对对改善术后预后的重要性，并为未来的研究提供了基础。

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Coping strategies and psychological distress in postoperative recovery: A repeated-measures study in women undergoing breast-conserving surgery

Objective

Breast-conserving surgery (BCS) is the standard treatment for early-stage breast cancer, yet patients often experience significant psychological distress and physical symptoms during recovery. This study aimed to explore the relationships between antecedents, physical symptoms (pain and nausea), psychological distress, and coping strategies utilized by women recovering from BCS to improve management of postoperative challenges.

Methods

This repeated-measures descriptive study involved 75 women who underwent BCS with sentinel lymph node biopsy at a National Cancer Institute-designated center. Participants completed the National Comprehensive Cancer Network (NCCN) Distress Thermometer and Ways of Coping Instrument on Postoperative Day 1 (POD1) and POD14. Bivariate analyses, multiple linear regression, and structural equation modeling were conducted to evaluate associations between antecedents, coping strategies, and distress. Open-ended responses were qualitatively analyzed for thematic content.

Results

Seeking social support (POD1 mean = 1.25; POD14 mean = 1.20) and planful problem-solving (POD1 mean = 1.19; POD14 mean = 1.04) were the most frequently used coping strategies, while accepting responsibility and confrontive coping were least utilized. Overall coping strategy use decreased between POD1 and POD14, likely reflecting recovery adaptation. Significant predictors of distress included escape-avoidance coping (β = 0.415, P < 0.001), social support (β = 0.270, P = 0.02), history of nausea (β = 0.517, P < 0.001), and age (β = 0.293, P = 0.007). Coping strategies did not mediate the relationship between antecedents and distress.

Conclusions

Adaptive coping strategies such as social support and planful problem-solving play a critical role in mitigating distress during BCS recovery. Interventions should emphasize fostering these strategies and addressing high-risk groups, such as younger patients and those with a history of nausea. Despite limitations, this study underscores the importance of supporting adaptive coping to improve postoperative outcomes and provides a basis for future research.

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