Abstract: Objective　To explore the impact of family-involved psycho-cognitive care on the distress level and positive coping strategies of patients with breast cancer after mastectomy. Methods　Eighty-one patients with breast cancer taking mastectomy at Xi'an Central Hospital from February 2022 to February 2023 were selected for the randomized controlled trial, and were divided into a control group (40 cases) and an observation group (41 cases) by the random number table method. The control group were (53.28±4.51) years old; there were 22 cases of stage Ⅰ, 16 cases of stage Ⅱ, and 2 cases of stage Ⅲ. The observation group were (53.34±4.47) years old; there were 23 cases of stage Ⅰ, 14 cases of stage Ⅱ, and 4 cases of stage Ⅲ. The control group received conventional care, and the observation group family-involved psycho-cognitive care. The distress levels, positive coping strategies [using the Coping Strategies Questionnaire (CSQ)], cancer-related fatigue [using the Cancer Fatigue Scale (CFS)], and self-care ability [using the Self-Care Ability Scale (ESCA)] were compared between the two groups before and three months after the intervention by t and χ2 test. Results　Three months after the intervention, the scores of physical strength, religion, emotions, family, and practice of psychological distress in the observation group were lower than those in the control group [(3.51±0.66) vs. (4.92±0.89), (3.14±0.71) vs. (4.22±0.90), (3.97±0.65) vs. (5.38±0.95), (3.52±0.88) vs. (5.07±1.23), and (4.33±1.00) vs. (5.62±0.93)], with statistical differences between the two groups (all P<0.05). The score of DT in the observation group was lower than that in the control group [ (3.54±0.57) vs. (4.60±0.75)], with a statistical difference between the two groups (P<0.05). The scores of in self-blame, fantasy, and avoidance of CSQ in the observation group were lower than those in the control group [(0.41±0.06) vs. (0.62±0.09), (0.52±0.08) vs. (0.69±0.03), and (0.43±0.04) vs. (0.62±0.06)], with statistical differences between the two groups (all P<0.05); the scores of seeking help, problem-solving, and rationalization in the observation group were higher than those in the control group [(0.69±0.06) vs. (0.48±0.05), (0.63±0.06) vs. (0.49±0.05), and (0.69±0.07) vs. (0.56±0.05)], with statistical differences between the two groups (all P<0.05). The scores of physical fatigue, cognitive fatigue, and emotional fatigue of CFS in the observation group were lower than those in the control group [(15.37±1.84) vs. (22.61±2.41), (9.66±1.43) vs. (13.10±1.51), and (8.02±1.23) vs. (12.97±1.64)], with statistical differences between the two groups (P<0.05). The scores of health knowledge, self-care skills, self-concept, and self-responsibility of ESCA in the observation group were higher than those in the control group [(49.58±4.40) vs. (42.35±4.83), (41.85±3.80) vs. (37.06±3.11), (30.29±3.38) vs. (27.16±3.88), and (27.30±2.29) vs. (24.11±2.04)], with statistical differences between the two groups (all P<0.05). Conclusion　Family-involved psycho-cognitive care for patients taking breast cancer mastectomy can effectively reduce their pain levels, cancer-related fatigue, active coping strategies, and self-care ability.

Key words:

Breast cancer, Family-involved psycho-cognitive care, Breast cancer mastectomy, Pain level, Active coping strategies, Cancer-related fatigue

摘要：

目的　探讨家属协同心理认知护理对乳腺癌切除术患者痛苦程度及积极应对方式的影响。方法　采用前瞻性研究，选取西安市中心医院在2022年2月至2023年2月期间收治的81例乳腺癌切除术患者作为研究对象，通过随机数字表法分为对照组（40例）和观察组（41例）。对照组采用常规护理，年龄（53.28±4.51）岁，肿瘤分期：Ⅰ期22例，Ⅱ期16例，Ⅲ期2例；观察组采用家属协同心理认知护理，年龄（53.34±4.47）岁，肿瘤分期：Ⅰ期23例，Ⅱ期14例，Ⅲ期4例。比较两组患者干预前及干预3个月后痛苦程度、积极应对方式［采用应对方式问卷（CSQ）］、癌因性疲乏［采用癌症疲乏量表（CFS）］及自护能力［自我护理能力测定量表（ESCA）］，统计学方法采用t检验、χ²检验。结果　干预3个月后，观察组的体力、宗教、情感、家庭、实际心理痛苦程度分别为（3.51±0.66）分、（3.14±0.71）分、（3.97±0.65）分、（3.52±0.88）分、（4.33±1.00）分，均低于对照组［（4.92±0.89）分、（4.22±0.90）分、（5.38±0.95）分、（5.07±1.23）分、（5.62±0.93）分］，观察组DT评分为（3.54±0.57）分，低于对照组（4.60±0.75）分，两组比较差异均有统计学意义（均P<0.05）；观察组CSQ评分中自责、幻想、退避评分分别为（0.41±0.06）分、（0.52±0.08）分、（0.43±0.04）分，均低于对照组［（0.62±0.09）分、（0.69±0.03）分、（0.62±0.06）分］，求助、解决问题、合理化等维度评分分别为（0.69±0.06）分、（0.63±0.06）分、（0.69±0.07）分，均高于对照组［（0.48±0.05）分、（0.49±0.05）分、（0.56±0.05）分］，两组比较差异均有统计学意义（均P<0.05）；观察组CFS评分中躯体疲劳、认知疲劳、情感疲劳维度评分分别为（15.37±1.84）分、（9.66±1.43）分、（8.02±1.23）分，均低于对照组［（22.61±2.41）分、（13.10±1.51）分、（12.97±1.64）分］，两组比较差异均有统计学意义（均P<0.05）；观察组ESCA评分中健康知识、自护技能、自我概念、自我责任维度分别为（49.58±4.40）分、（41.85±3.80）分、（30.29±3.38）分、（27.30±2.29）分，均高于对照组［（42.35±4.83）分、（37.06±3.11）分、（27.16±3.88）分、（24.11±2.04）分］，两组比较差异均有统计学意义（均P<0.05）。结论　对乳腺癌切除术患者给予家属协同心理认知护理，能够有效降低其痛苦程度及癌因性疲乏，提高积极应对方式及自护能力。

关键词:

乳腺癌, 家属协同心理认知护理, 乳腺癌切除术, 痛苦程度, 积极应对方式, 癌因性疲乏