| Objective Understanding the reasons of psychological distress among Chinese perioperative gastric cancer patients, identifying the main influent factors of psychological distress and investigating the intervention of therapeutic communication system in psychological distress of perioperative gastric cancer patients.Methods Twelve gastric cancer patients selected by purposive sampling were interviewed. At the same time, a cross-sectional study was taken. 165 gastric cancer patients were recruited continuously by convenient method in 3 departments of general surgery in the First Affiliated Hospital of Anhui Medical University. Distress Management (DM), Cancer Coping Modes Questionnaire (CCMQ) and Profile of Mood State-Short Form (POMS-SF) were used to collected information. In the experimental study, psychological distress patients were screened and randomly divided into 2 groups according to random numbers. The control group received the routine clinical care. The intervention group received therapeutic communication. DM, CCMQ and POMS-SF were recorded respectively after the intervention.Results Five themes were found including focus, role performance, attribution style, knowledge deficit and economic pressure in the qualitative research. As for the cross-sectional study, 134 (81.21%) patients suffered psychological distress in 165 patients. Single factor analysis results show that significant differences were found in different levels of psychological distress in gender, age, ECOG score (P<0.05) and Karnofsky score (P<0.01). Pain, worry, indigestion and fatigue were very common in problem list, the dimension of body, emotion, family and actual problems were significant correlated with score (P<0.01) except religious dimension (P<0.05). The common coping styles were confrontation, avoidance-suppression and resignation. Positive associations were found between DT scores and four sub-dimensions of coping: avoidance-suppression, resignation, fantasy, catharsis (P<0.01), while negative association was shown between DT scores and confronting sub-dimension (P<0.05) of coping. Statistically difference in avoidance-suppression, resignation, fantasy and catharses were found between different psychological distress groups (P<0.05). Loss of vigor-activity (VA), feel tension-anxiety (TA) and confusion-bewilderment (CB) were very common in gastric patients. Each sub-dimension was correlated with psychological distress (P<0.01), statically significant difference were found in difference distress levers (P<0.01) except VA (P<0.05). Refer to DM, Receiver operating characteristic curve (ROC) analysis shows that the POMS-SF had an optimal critical value (27.50), the optimal ratio of sensitivity (0.686), specificity (0.833) and the area under ROC was 0.797. Logistic regression analysis showed that Karnofsky (P<0.01), age, marital status, education, caregivers and resignation (P<0.05) showed significant difference in regression equation. The experimental study revealed distress showed downward trend in both the intervention group and the control group,the scores in the intervention group were significantly lower than those in the control group (P<0.01). As to the coping style, there were significant meliorations on confrontation, avoidance and suppression, resignation, fantasy and catharses in the experimental group (P<0.01), while only avoidance and suppression was lower than before in the control group (P<0.05). Moreover, the significant differences had come to light between two groups on CCMQ (P<0.05) except catharses (P=0.353). There were significant meliorations on TA, anger-hostility (AH), CB, depression-dejection (DD) and total mood score in the experimental group (P<0.05), while only total mood score were lower than before in the control group (P<0.01). Moreover, the significant differences had come to light between the two groups on POMS-SF (P<0.05) except fatigue-inertia (FI) and VA after the intervention.Conclusion The incidence of psychological distress in gastric cancer patients was very high, different representations of distress were found in preoperative gastric cancer patients. There are correlations between psychological distress with demographic variables, disease characteristics, coping styles and mood states. Different levers were found in the above motioned variables for different psychological distress. Karnofsky, age, marital status, education, caregivers and resignation seemed the main influence factors of distress. Pertinence and standardized therapeutic communication system is very feasible in clinical practice for the positive effects on psychological distress, coping style and mood states of peroperative gastric cancer patients through improvement in knowledge, skill and attitude of medical science. |
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