Effects Of Synchronous, Staggered Cognitive Therapy Of Family Members On Stress Response Of Perioperative Patients With Lung Cancer

Objectives1.To understand the psychological situation and cognitive needs of lung cancer patients and their families around the different stage in the time of surgery;2. Taking psychological stress structure of more factors type, the process theory of cognitive treatment as the theoretical basis, to adopt short-term staged cognitive intervention on patients with lung cancer and its relatives in perioperative period;3. To evaluate the effect of intervention through the psychological scales, serum cortisol level, blood pressure and heart rate.Methods This was an experimental study. We confirmed the method of intervention by investigating the psychological status of97patients and97their families. After the revise of the manual and meatures,120hospitalized patients with lung cancer in the Second Xiang-Ya hospital of Central South University were selected to be samples. They were randomly divided into three groups,40in the patient-family group,40in the patient group and40in the control group. In the four point of perioperative period (24h be hospitalized,1day preoperative, the3th day postoperative and a day before discharge), the patient-family group took synchronous, staggered cognitive therapy of family members, the patient group took staggered cognitive therapy only on patients, while those in the control group were given routine care only. The outcome of serum cortisol level, blood pressure, heart rate, pain index, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Self-Rating Scale of Sleep(SRSS) were evaluated between pre and post intervention to analyze the effects of intervention.Results1. Results of pilot study: The total score in SDS of perioperative patients with lung cancer was36-51, with the average score of42.69±3.96. The severity of depression was0.45-0.64, with the average score of0.53±0.50.Of all patients,23(23.7%) were no depression,63(64.9%) were slight to mild depression, and11(11.3%) were moderate to severe depression, and none was severe depression. The average standard score in SAS of perioperative patients with lung cancer is49.65±5.96,34(35.10) were no anxiety,59(60.80%) were slight anxiety,4(4.10%) were moderate anxiety. The somatisation, compulsion and depression factors of SCL-90in family member is positively correlated with the standard score in SAS of perioperative patients (P<0.01). The compulsion factor of SCL-90in family member is negatively correlated with the depression severity of patients (P<0.01). The panic factor of SCL-90in family member is positively correlated with the depression severity of patients (P<0.05). The scores of seven factors including total scores, somatization, obsessive-compulsive behavior, depression, anxiety, phobic anxiety and psychoticism in SCL-90were higher than domestic norm(P<0.05).The score of paranoid ideation in SCL-90was lower than domestic norm(P<0.05).2.The baseline results of intervention part showed that the average level of serum cortisol was469.64±96.95, which was higher than normal adult.Of all patients,35.1%were anxiety,60.0%were depression. The average level of SRSS was24.30±5.60,3.3%were good sleep,83.3%were general sleep,13.4%were bad sleep. The results of multiple linear regression showed that there were age, nationality, family residence3variables which affected the serum cortisol level of lung cancer perioperative patients.3. Analysis of data after intervention:(1) Physiological responses:Serum cortisol difference of three groups the variance analysis before and after intervention showed that the decending of serum cortisol after the intervention:control group<patient group<patient-family group; Systolic pressure of three groups in the point of1day preoperative, the3th day postoperative and a day before discharge were different (P<0.05):There are statistically significant differences between control group and patient group, control group and patient-family group(P<0.05), but there are no statistically significant differences between patient-family group and patient group(P>0.05).Pain index between control group and patient-family group are different (P<0.05). (2) Psychological responses:The standard score of anxiety and severity of depression differences of three groups the variance analysis before and after intervention showed that the decending of the standard score of anxiety and severity of depression after the intervention:control group<patient-family group, patient group<patient-family group.There are no statistically significant differences between control group and patient group (P>0.05).(3) Behavior responses:Sleep among the three groups are different after the intervention (P<0.05).The decending of sleep after the intervention: control group<patient group, control group<patient-family group; There are no statistically significant differences between patient-family group and patient group (P>0.05).Conclusion1. The general psychological status of family members is bad and has certain effect to the depression status of perioperative patients with lung cancer.2.The serum cortisol level of patients be hospitalized is high, and related with the patient’s age, nationality and family residence.3. The incidence of depression in hospitalized patients with lung cancer is high with mild-to-moderate primarily.4. The C behavior patterns in hospitalized patients with lung cancer is obvious.5. Synchronous, staggered cognitive therapy of family members can effectively improve the physiological, psychological and behavior responses of patients.