以质量求发展，以服务铸品牌

护理学报 ›› 2021, Vol. 28 ›› Issue (15): 48-53.doi: 10.16460/j.issn1008-9969.2021.15.048

• 调查研究 • 上一篇    下一篇

社会关系质量在乳腺癌幸存者病耻感与社交回避及苦恼间的中介效应

王硕1a, 吕利明2, 张立瑶1a, 马俊杰1b, 孔荣华3   

  1. 1.淄博市中心医院 a.护理部;b.急诊科,山东 淄博 255000;
    2.山东中医药大学 护理学院,山东 济南 250355;
    3.山东第一医科大学附属肿瘤医院 乳腺外科二病区,山东 济南 250000
  • 收稿日期:2021-04-22 出版日期:2021-08-10 发布日期:2021-09-10
  • 通讯作者: 吕利明（1968-）,女,山东济南人,硕士,教授。E-mail:liminglv1@163.com
  • 作者简介:王硕（1994-）,女,山东淄博人,硕士,护师。
  • 基金资助:
    山东省社科规划研究项目（19CSHJ14）

Mediating Effect of Social Relational Quality Between Stigma and Social Avoidance and Distress among Breast Cancer Survivors

WANG Shuo1a, LV Li-ming2, ZHANG Li-yao1a, MA Jun-jie1b, KONG Rong-hua3   

  1. 1a. Dept. of Nursing Administration; 1b. Dept. of Emergency, Zibo Central Hospital, Zibo 255000, China;
    2. School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan 250355, China;
    3. Dept. of Breast Surgery, the Affiliated Tumor Hospital of Shandong First Medical University, Jinan 250000, China
  • Received:2021-04-22 Online:2021-08-10 Published:2021-09-10

PDF (PC)

571

赞

摘要： 目的 探讨乳腺癌幸存者社会关系质量在病耻感与社交回避及苦恼间的中介效应。方法 采用便利抽样法,选取于2019年5—9月在山东第一医科大学附属肿瘤医院、山东中医药大学附属医院乳腺外科门诊及病房复诊的228例乳腺癌幸存者作为研究对象,采用一般情况调查表、社会影响量表、社会关系质量量表和社交回避及苦恼量表对其进行调查,采用结构方程模型检验社会关系质量在病耻感与社交回避及苦恼间的中介效应。结果 乳腺癌幸存者病耻感、社会关系质量、社交回避及苦恼总分分别为（56.63±9.68）分、（50.53±6.08）分、（9.39±6.63）分;社会关系质量与病耻感、社交回避及苦恼总分均呈负相关（r=-0.463,-0.552;P<0.01）,病耻感与社交回避及苦恼总分呈正相关（r=0.532,P<0.01）;结构方程模型结果显示,病耻感对社交回避及苦恼有直接（正向）效应（β=0.421,P<0.01）,社会关系质量对社交回避及苦恼有直接（负向）效应（β=-0.404,P<0.01）,社会关系质量在病耻感与社交回避及苦恼之间起部分中介效应（β=0.211,P<0.01）。结论 乳腺癌幸存者社交回避及苦恼处于中等水平,社会关系质量在病耻感与社交回避及苦恼间起部分中介效应。建议在改善乳腺癌幸存者社交状况的干预工作中应重视社会关系质量的影响,以增强该人群的社会关系质量为依托,减轻病耻感,促进其社会交往。

关键词: 乳腺癌幸存者, 社会关系质量, 病耻感, 社交回避及苦恼, 中介效应

Abstract: Objective To explore the mediating effect of social relationship quality between stigma and social avoidance and distress among breast cancer survivors. Methods By convenience sampling method, a total of 228 breast cancer survivors who visited in the outpatient and ward of breast surgery department of the Affiliated Tumor Hospital of Shandong First Medical University and the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from May to September in 2019, were surveyed by general information questionnaire, Social Impact Scale, Social Relational Quality Scale and Social Avoidance and Distress Scale. Structural equation modeling was used for evaluate the mediating effect of social relationship quality between stigma and social avoidance and distress. Results The total score of stigma, social relationship quality, social avoidance and distress of breast cancer survivors was 56.63±9.68, 50.53±6.08, and 9.39±6.63 respectively. Social relationship quality was negatively correlated with stigma and social avoidance and distress (r=-0.463, -0.552; P<0.01) but stigma was positively with social avoidance and distress (r=0.532, P<0.01). Structural equation modeling showed that stigma had direct (positive) effect on social avoidance and distress (β=0.421, P<0.01); social relationship quality had direct (negative) effect on social avoidance and distress (β=-0.404, P<0.01) and social relationship quality played a partial mediating effect between stigma and social avoidance and distress (β=0.211, P<0.01). Conclusion Social avoidance and distress of breast cancer survivors are at the mediate level, and social relationship quality plays a partial mediating effect between stigma and social avoidance and distress. It is suggested that attention should be paid to the influence of social relationship quality in the intervention work to improve the social status of breast cancer survivors, so as to enhance the social relationship quality of the population, reduce the stigma and promote their social interaction.

Key words: breast cancer survivor, social relational quality, stigma, social avoidance and distress, mediating effect

中图分类号: 

  • R473.73
[1] Dirven L, vande Poll-Franse LV, Aaronson NK, et al. Controversies in Defining Cancer Survivorship[J]. Lancet Oncol, 2015,16(6):610-612.DOI:10.1016/S1470-2045(15)70236-6.
[2] Chen W, Zheng R, Baade PD, et al.Cancer Statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132. DOI:10.3322/caac.21338.
[3] Hinzey A, Gaudier-Diaz MM, Lustberg MB, et al.Breast Cancer and Social Environment: Getting by with a Little Help from Our Friends[J]. Breast Cancer Res, 2016, 18(1): 54. DOI:10.1186/s13058-016-0700-x.
[4] Tripathi L, Datta SS, Agrawal SK, et al.Stigma Perceived by Women Following Surgery for Breast Cancer[J].Indian J Med Paediatr Oncol,2017,38(2):146-152.DOI:10.4103/ijmpo.ijmpo_74_16.
[5] Grynberg D, López-Pérez B.Facing Others’ Misfortune: Personal Distress Mediates the Association between Maladaptive Emotion Regulation and Social Avoidance[J]. PLoS One, 2018, 13(3):e0194248.DOI:10.1371/journal.pone.0194248.
[6] Jakobsen K, Magnus E, Lundgren S, et al.Everyday Life in Breast Cancer Survivors Experiencing Challenges: A Qualitative Study[J]. Scand J Occup Ther, 2018, 25(4):298-307. DOI:10.1080/11038128.2017.1335777.
[7] 林玉珍, 廖瑞梅, 刘美凤, 等. 282例乳房缺失患者社交回避与苦恼得分特征分析[J]. 护理学报, 2016, 23(10):57-59. DOI:10.16460/j.issn1008-9969.2016.10.057.
[8] 江晨霞. 社会关系质量对肺癌患者社交回避及苦恼的影响[J]. 护理学杂志, 2016, 31(9):82-84. DOI:10.3870/j.issn.1001-4152.2016.09.082.
[9] Takada S, Weiser SD, Kumbakumba E, et al.The Dynamic Relationship between Social Support and HIV-related Stigma in Rural Uganda[J]. Ann Behav Med, 2014, 48(1):26-37. DOI:10.1007/s12160-013-9576-5.
[10] 郑新宇,王秋丽. 2015年欧洲肿瘤内科学会《原发性乳腺癌诊断、治疗及随访指南》解读[J]. 中国实用外科杂志, 2016, 36(7):763-770. DOI:10.7504/CJPS.ISSN1005-2208.2016.07.14.
[11] 肖顺贞. 临床科研设计[M]. 北京: 北京大学医学出版社, 2008:151.
[12] Fife BL, Wright ER.The Dimensionality of Stigma: A Comparison of Its Impact on the Self of Persons with HIV/AIDS and Cancer[J]. J Health Soc Behav, 2000, 41(1):50-67.
[13] Pan AW, Chung L, Fife BL, et al.Evaluation of the Psychometrics of the Social Impact Scale: A Measure of Stigmatization[J]. Int J Rehabil Res, 2007, 30(3):235-238. DOI:10.1097/MRR.0b013e32829fb3db.
[14] 王欣, 高婕. 癌症患者病耻感的测评工具及现状水平的研究进展[J]. 护士进修杂志, 2019, 34(4):314-318. DOI: 10.16821/j.cnki.hsjx.2019.04.006.
[15] Hou WK, Lam WW, Law CC, et al.Measuring Social Relational Quality in Colorectal Cancer: The Social Relational Quality Scale (SRQS)[J]. Psychooncology, 2009, 18(10): 1097-1105. DOI:10.1002/pon.1500.
[16] 孙丽媛. 乳腺癌术后患者伤残接受度影响因素分析及其团体心理辅导干预效果研究[D].天津:天津医科大学, 2016.
[17] Watson D, Friend R.Measurement of Social-evaluative Anxiety[J]. J Consult Clin Psychol, 1969, 33(4):448-457. DOI: 10.1037/h0027806.
[18] 汪向东, 王希林, 马弘. 心理卫生评定量表手册[M]. 增订版. 北京: 中国心理卫生杂志社, 1999:241-244.
[19] Podsakoff PM, MacKenzie SB, Lee JY, et al. Common Method Biases in Behavioral Research: A Critical Review of the Literature and Recommended Remedies[J]. J Appl Psychol, 2003, 88(5):879-903.DOI:10.1037/0021-9010.88.5.879.
[20] 吴明隆. 结构方程模型: AMOS的操作与应用[M]. 2版. 重庆: 重庆大学出版社, 2010:52-53.
[21] 郑春娆, 王惠珍. 乳腺癌术后患者病耻感现状及影响因素分析[J]. 护理学报, 2018, 25(2):7-9. DOI:10.16460/j.issn1008-9969.2018.02.007.
[22] 汪利侠. 癌症患者病耻感探因以及心理干预策略[J]. 心理月刊, 2019, 18(14):66-67.DOI:10.19738/j.cnki.psy.2019.18.043.
[23] Tong X, Chen J, Park SP, et al.Social Support for People with Epilepsy in China[J]. Epilepsy Behav, 2016, 64(Pt A): 224-232. DOI:10.1016/j.yebeh.2016.08.010.
[24] 崔娟, 孙香莲, 杨科, 等. 乳腺癌术后患者身体意象和性调节现状及影响因素分析[J]. 护理学报, 2021,28(6):1-5. DOI:10.16460/j.issn1008-9969.2021.06.001.
[25] 王艳. 结肠造口患者病耻感对社交回避和苦恼影响的路径研究[D]. 青岛:青岛大学, 2018.
[26] Link BG, Mirotznik J, Cullen FT.The Effectiveness of Stigma Coping Orientations: Can Negative Consequences of Mental Illness Labeling be Avoided[J]. J Health Soc Behav, 1991, 32(3):302-320.
[27] Trusson D, Pilnick A.Between Stigma and Pink Positivity: Women’s Perceptions of Social Interactions during and after Breast Cancer Treatment[J]. Sociol Health Illn, 2017, 39(3):458-473. DOI:10.1111/1467-9566.12486.
[28] Bloom JR, Stewart SL, Johnston M, et al.Sources of Support and the Physical and Mental Well-being of Young Women with Breast Cancer[J]. Soc Sci Med, 2001, 53(11): 1513-1524. DOI:10.1016/s0277-9536(00)00440-8.
[29] Ettridge KA, Bowden JA, Chambers SK, et al.“Prostate Cancer Is Far More Hidden..”: Perceptions of Stigma, Social Isolation and Help-seeking among Men with Prostate Cancer[J]. Eur J Cancer Care (Engl), 2018, 27(2):e12790. DOI:10.1111/ecc.12790.
[30] 石颖, 王守琦, 英杰, 等. 患者病耻感的干预研究进展[J]. 护理学杂志,2016,31(22):104-108.DOI:10.3870/j.issn.1001-4152.2016.22.104.
[31] 张飒乐, 姚晚侠, 李英, 等. 叙事医学干预对乳腺癌根治术后病耻感的影响[J]. 护理研究, 2019, 33(13):2231-2234. DOI:10.12102/j.issn.1009-6493.2019.13.010.
[32] 章华丽, 董咏梅, 蔡希, 等. 社会目标模式随访管理对原发性肝癌肝动脉栓塞化疗患者社会关系质量的影响[J]. 中华现代护理杂志, 2016,22(30):4375-4378.DOI:10.3760/cma.j.issn.1674-2907.2016.30.020.
[33] 遆燕燕. 责任-亲情交互护理对脑中风合并癫痫患者社会回避苦恼、社会关系质量和疲乏的影响[J]. 包头医学, 2019, 43(2):47-50. DOI:1007-3507(2019)02-0047-04.
[1] 薛婷, 姜文彬, 陈强, 崔孟元, 刘美艳, 姜永梅. 亚健康状况在新护士职业适应能力与留职意愿间的中介效应分析[J]. 护理学报, 2021, 28(9): 48-53.
[2] 郭亚娟, 刘丽爽, 霍娟娟, 张慧, 王拥军. 脑卒中老年患者快感缺失在自我怜悯与创伤后应激障碍的中介效应[J]. 护理学报, 2021, 28(8): 72-76.
[3] 谢小敏, 李亚莉, 梁亚红, 冯蓓, 林燕, 江逊. 功能失调性态度在父母教养方式与青少年抑郁症状间的中介效应[J]. 护理学报, 2021, 28(13): 52-57.
[4] 张政, 安逸群, 孙丽娜, 丁淑贞. 成人依恋在维持性血液透析患者恐惧疾病进展与自我管理间的中介效应分析[J]. 护理学报, 2021, 28(12): 43-48.
[5] 曾巍, 林美玲, 陈亚岚. 共情在高职实习护生正念与临床沟通能力间的中介效应[J]. 护理学报, 2021, 28(10): 57-61.
[6] 陈洁, 郑一宁. 自我效能感在护士工作场所欺凌与工作满意度的中介效应[J]. 护理学报, 2020, 27(3): 58-61.
[7] 袁汝娟, 孙欣. 痴呆患者家庭照顾者连带病耻感的研究进展[J]. 护理学报, 2020, 27(23): 32-36.
[8] 王亚男, 刘化侠, 张淑香, 何静, 袁迎迎. 523例住院脑卒中患者自我概念与病耻感的相关性分析[J]. 护理学报, 2020, 27(21): 61-63.
[9] 梁亚红, 李莉, 黄静, 王佳, 谢小敏. 心理资本在实习护生情绪智力与职业获益感的中介效应[J]. 护理学报, 2020, 27(20): 44-48.
[10] 杨云芳, 佘东立, 貟蓓, 韩琳. 护士心理资本在工作压力和职业倦怠间的中介效应[J]. 护理学报, 2020, 27(19): 62-66.
[11] 程丽楠, 仲朝阳, 陈茜, 张凤英, 胡秀英. 一般自我效能在本科大专护生生命意义感与亲社会行为间的中介效应[J]. 护理学报, 2020, 27(19): 47-51.
[12] 韩凤萍, 仲莉莉, 钱莉, 云青萍, 纪颖, 孙静. 社区护士情绪劳动在情绪智力与职业成功感的中介效应分析[J]. 护理学报, 2020, 27(18): 68-72.
[13] 胡小春, 王叶, 姜月, 刘可. 家庭坚韧力在多发性骨髓瘤患者社会支持与恐惧疾病进展间的中介效应[J]. 护理学报, 2020, 27(14): 30-34.
[14] 郑雯雯, 鲁春红, 吕桂兰, 王芳. 222例维持性血液透析患者的病耻感现状及影响因素分析[J]. 护理学报, 2020, 27(14): 44-48.
[15] 赵肖肖, 郝雅楠. 工作幸福感在新护士公平敏感性与人际关系困扰间的中介效应[J]. 护理学报, 2020, 27(13): 33-35.
Viewed
Full text


Abstract

Cited
  Shared   
[1] 谢小敏, 李亚莉, 梁亚红, 冯蓓, 林燕, 江逊. 功能失调性态度在父母教养方式与青少年抑郁症状间的中介效应[J]. 护理学报, 2021, 28(13): 52 -57 .
[2] 赵喜娟, 杨明莹, 张江, 钱阳凤, 陶诗琪, 耿艺, 王娅. 缺血性脑卒中偏瘫患者出院计划评估体系的构建[J]. 护理学报, 2021, 28(13): 58 -61 .
[3] 郑霞, 胡雅, 周洁, 尚攀婷, 韩辉, 卢惠明. 封闭负压引流术治疗阴茎癌腹股沟淋巴结清扫术后伤口二期愈合患者的护理[J]. 护理学报, 2021, 28(13): 62 -64 .
[4] 刘敏利, 周春兰, 龙艳娟, 肖秀英, 黄玉楼, 黄小娜, 李小贞, 龚秀群, 李苏城, 黄锦航, 彭小平, 耿丽, 梁美燕. 珠海市金湾区老年人轻度认知障碍现况调查及影响因素分析[J]. 护理学报, 2021, 28(13): 74 -78 .
[5] 孔海燕, 章新琼, 张洪辉, 王婷婷, 王爱梅. 2型糖尿病患者心脏病知识问卷的汉化及信效度研究[J]. 护理学报, 2021, 28(15): 1 -4 .
[6] 李玮彤, 宋玉磊, 陈宇婧, 徐桂华. 养老机构老年人综合能力评估等级划分方式的研究[J]. 护理学报, 2021, 28(15): 5 -9 .
[7] 杜艳丽, 王璐, 廖雨风, 马纯华, 阮宏兵, 张雅, 牛耿. 临床情境模拟结合标准化病人教学法在培养护生压疮风险评估能力的应用[J]. 护理学报, 2021, 28(15): 10 -14 .
[8] 王丽, 王海燕, 钟颖嫦, 李利, 陈丽珊, 佘凤华, 邹丹凤, 朱碧丽, 王媛媛. 特需医疗中心开展护理管家服务实践的效果观察[J]. 护理学报, 2021, 28(15): 15 -19 .
[9] 宋嘉婷, 黄绮华, 肖文莉, 杨钻钻, 罗辉芳. 灸法防治肿瘤患者化疗不良反应的文献计量学分析[J]. 护理学报, 2021, 28(15): 20 -24 .
[10] 陈思萍, 何小俊. 提高公众心肺复苏培训后技能保留率的研究进展[J]. 护理学报, 2021, 28(15): 25 -29 .