Psychological distress in Chinese lung cancer patients: prediction, psychosocial mechanisms, and intervention
- Autores: Xu Tian
- Directores de la Tesis: María Francisca Jiménez Herrera (dir. tes.)
- Lectura: En la Universitat Rovira i Virgili ( España ) en 2023
- Idioma: español
- Número de páginas: 278
- Tribunal Calificador de la Tesis: Mireia Llauradó Serra (presid.), Lourdes Rubio Rico (secret.), Krister Paul Gustav Axelsson (voc.)
- Programa de doctorado: Programa de Doctorado en Enfermería y Salud por la Universidad de Barcelona y la Universidad Rovira i Virgili
- Materias:
- Enlaces
- Tesis en acceso abierto en: TDX
- Resumen
- español
Esta tesis tiene como objetivo desarrollar una herramienta predictiva válida para identificar pacientes con cáncer de pulmón con alto riesgo de sufrimiento psicológico, para explorar posibles mecanismos psicosociales de sufrimiento psicológico en pacientes con cáncer de pulmón, para evaluar más a fondo el papel de la reducción del estrés basada en la atención plena (MBSR) en el tratamiento pacientes con cáncer de pulmón y, en última instancia, para evaluar la eficacia de un programa MBSR de 4 semanas sobre la angustia psicológica en pacientes con cáncer de pulmón y dilucidar los posibles mecanismos psicosociales para ejercer la eficacia. Esta tesis diseña siete estudios separados basados en la encuesta transversal, la revisión sistemática y el metanálisis, y el ensayo controlado aleatorio (RCT), y varios métodos, como el análisis de correlación, el análisis de varianza de medidas repetidas (ANOVA) y la ecuación estructural. modelado, se utilizan para lograr los objetivos de investigación en los estudios anteriores. Sobre la base de estos siete estudios, esta tesis desarrolla un algoritmo predictivo fácil de usar con una precisión moderada para identificar a los pacientes con alto riesgo de sufrimiento psicológico, revela que el apoyo social puede contribuir directamente a mejorar el sufrimiento psicológico o puede contribuir indirectamente a mejorar el sufrimiento psicológico. al mejorar la confrontación para hacer frente al cáncer, disminuir el estrés percibido y aumentar la autoestima, revela que la atención plena puede aliviar indirectamente la angustia psicológica al mejorar el apoyo social, disminuir el estigma percibido y reducir el nivel de percepción de la enfermedad y el estrés percibido, demuestra los efectos positivos de MBSR sobre estados psicológicos en pacientes con cáncer de pulmón, muestra los beneficios del MBSR de 4 semanas para la angustia psicológica, el apoyo social, la atención plena y el estigma percibido en pacientes con cáncer de pulmón, y también aclara los mecanismos por los cuales el MBSR alivia la angustia psicológica al mejorar la social. apoyo, mejora de la atención plena, y disminuir el estigma percibido.
- català
Aquesta tesi té com a objectiu desenvolupar una eina predictiva vàlida per identificar pacients amb càncer de pulmó amb alt risc de patiment psicològic, explorar possibles mecanismes psicosocials de malestar psicològic en pacients amb càncer de pulmó, per avaluar encara més el paper de la reducció de l'estrès basada en la consciència (MBSR) en el tractament. pacients amb càncer de pulmó i, finalment, avaluar l'eficàcia d'un programa MBSR de 4 setmanes sobre malestar psicològic en pacients amb càncer de pulmó i dilucidar els possibles mecanismes psicosocials d'exercir l'eficàcia. Aquesta tesi dissenya set estudis separats basats en l'enquesta transversal, la revisió sistemàtica i la metaanàlisi i l'assaig controlat aleatoritzat (ECA) i diversos mètodes, com ara l'anàlisi de correlació, l'anàlisi de la variància amb mesures repetides (ANOVA) i l'equació estructural. modelització, s'utilitzen per assolir els objectius de recerca en els estudis anteriors. A partir d'aquests set estudis, aquesta tesi desenvolupa un algorisme predictiu fàcil d'utilitzar amb una precisió moderada per identificar pacients amb alt risc de patiment psicològic, revela que el suport social pot contribuir directament a millorar el malestar psicològic o indirectament pot contribuir a millorar el malestar psicològic. millorant l'enfrontament amb el càncer, disminuint l'estrès percebut i augmentant l'autoestima, demostra que la consciència pot alleujar indirectament el malestar psicològic millorant el suport social, disminuint l'estigma percebut i reduint el nivell de percepció de la malaltia i l'estrès percebut, demostra els efectes positius de MBSR sobre estats psicològics en pacients amb càncer de pulmó, mostra els beneficis de l'MBSR de 4 setmanes per a l'angoixa psicològica, el suport social, la consciència i l'estigma percebut en pacients amb càncer de pulmó, i també dilucida els mecanismes pels quals el MBSR alleuja el malestar psicològic millorant la societat. suport, millora de la consciència, i la disminució de l'estigma percebut.
- English
Background: Psychological distress is a multifactorial and unpleasant emotional experience, involving changes in psychological, social, spir-itual, and physical aspects, with greatly impact on the psychological and physical well-being of cancer patients. Compared to other cancers, lung cancer patients had the highest incidence of psychological dis-tress. Notably, psychological distress is associated with many adverse consequences, such as poor treatment adherence and decreased therapeutic effectiveness. Therefore, the use of validated tools for early and accurate detection of those at high risk of psychological distress from overall lung cancer patients is critical. Unfortunately, there are currently no screening tools for psychological distress specifically for lung cancer patients. Furthermore, the exact psychosocial mechanisms of psychological distress in patients with lung cancer have not yet been clarified, resulting in no effective interventions to effectively alleviate psychological distress.
Objectives: The current thesis aims to firstly develop a valid predictive tool for identifying those at high risk for psychological distress from overall lung cancer patients, and then to explore possible psychosocial mechanisms of psychological distress in lung cancer patients, and next to further evaluate the role of mindfulness-based stress reduction (MBSR) in treating lung cancer patients, and ultimately to evaluate the efficacy of a 4-weeks MBSR program on psychological distress in lung cancer patients and elucidate possible psychosocial mechanisms of exerting efficacy.
Methods: The current thesis designs seven separate studies, and various methods are used in different studies to achieve different objec-tives. Study 1 uses cross-sectional design to collect possible risk factors of psychological distress in lung cancer patients with the convenience sampling, and then uses structural equation model (SEM) and coincidence rate to develop and validate predictive algorithm, respec-tively. Study 2 to 5 also use cross-sectional design to collect data on social support, mindfulness, coping style, perceived stress, self-esteem, perceived stigma, illness perception, and distress thermometer (DT), and then use correlation analysis and structural equation modeling to determine the influence pathways and magnitude between different factors. Study 6 is designed as a meta-analysis, including retrieving literature published before November 2021 from PubMed, EMBASE, Cochrane Library, PsycINFO, China National Knowledge Infrastructure (CNKI), and Wanfang databases, assessing risk of bias using Cochrane risk of bias assessment tool, evaluating the efficacy of MBSR in lung cancer patients by designing psychological variables and quality of life (QoL) as outcomes, and grading the level of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Study 7 is a single-center, single-blinded, longitudi-nal, randomized controlled trial, which includes a four-week MBSR or a waiting-list group. In this study, the efficacy and mechanisms of the four-week MBSR were evaluated by using independent sample t-test, repeated measure analysis of variance (ANOVA), and structural equation modeling to analyze outcome measures at pre-intervention (T0), the immediate post-intervention (T1), 1 month (T2), and 3 months (T3). Statistical analyses in the first to fifth studies and the seventh study were conducted using Statistical Package for the Social Sciences (SPSS) version 22.0 and AMOS version 21.0 (Chicago, IL, United States); however, statistical analyses in the sixth study were conducted using RevMan 5.4 (Cochrane Collaboration, Oxford, United Kingdom) and STATA 14.0 (StataCorp, Texas, USA).
Results: In study 1, 441 participants sent back validated question-naires, and the SEM analysis showed that educational level (ß = 0.151, P = 0.004), residence (ß = 0.146, P = 0.016), metastasis (ß = 0.136, P = 0.023), pain degree (ß = 0.133, P = 0.005), family history (ß = ¿0.107, P = 0.021), and tumor, node, and metastasis stage (ß = ¿0.236, P < 0.001) were independent predictors for psychological distress. The model built with these predictors showed an area under the curve of 0.693. A cutoff of 66 predicted clinically significant psychological distress with a sensitivity, specificity, positive predictive value, and negative predictive value of 65.41%, 66.90%, 28.33%, and 89.67%, respectively. The coincidence rate between predictive algorithm and distress thermometer was 64.63%.
Study 2 and 3 consistently suggested that social support had significant direct effects on psychological distress, with a ß of ¿0.58 in the second study and a ß of ¿0.710 in the third study. Furthermore, study 2 revealed that confrontation coping and perceived stress partially mediated the association between social support and psychological dis-tress, and study 3 illustrated that self-esteem partially mediated the relationship between social support and psychological distress. Study 4 that mindfulness had a direct effect on psychological distress, re-porting a ß of ¿0.107; however, and the direct association between mindfulness and psychological distress was not detected in the fifth study. Furthermore, study 4 revealed the indirect association between mindfulness and psychological distress through the chain mediating role of stigma and social support, and study 5 revealed that mindful-ness indirectly influenced psychological distress through affecting ill-ness perception alone or simultaneously affecting both the illness perception and perceived stress.
Study 6 found that MBSR significantly relieved cancer-related fatigue (standard mean difference [SMD], ¿1.26; 95% confidence interval [CI], ¿1.69 to ¿0.82; moderate evidence) and negative psychological states (SMD, ¿1.35; 95% CI, ¿1.69 to ¿1.02; low evidence), enhanced positive psychological states (SMD, 0.91; 95% CI, 0.56¿1.27; moderate evi-dence), and improved quality of sleep (MD, ¿2.79; 95% CI, ¿3.03 to ¿2.56; high evidence). Evidence on MBSR programs¿ overall treatment effect for QoL revealed a trend toward statistical significance (p = 0.06, low evidence).
Study 7 demonstrated that the four-week MBSR significantly alleviated psychological distress (F=15.05, P<0.001), decreased perceived stigma (F=8.260, P=0.005), and improved social support (F=16.465, P<0.001), and enhanced mindfulness (F=17.207, P<0.001) compared with usual care at T1, T2, and T3. All variables significantly changed over time except for copying style (P=0.250). The changes in social support, mindfulness, and perceived stigma mediated the efficacy of the four-week MBSR program on psychological distress (ß=-0.292, P=0.005; ß=-0.358, P=0.005).
Conclusions: Based on the results of seven separate studies, various conclusions are drawn, which are summarized below in the order of study.
i. Study 1 develops an easy-to-use predictive algorithm with moderate accuracy, which benefits to identify patients at high risk of psychological distress.
ii. Study 2 and 3 reveal that social support may directly contribute to ameliorate psychological distress, or may indirectly contribute to ameliorate psychological distress by enhancing confrontation coping with cancer, decreasing perceived stress, and increasing self-esteem; and study 4 and 5 unfold that mindfulness may indirectly alleviate psychological distress by enhancing social support, decreasing perceived stigma, and reducing the level of illness perception and perceived stress.
iii. Study 6 demonstrates the positive effects of MBSR on psycho-logical states in lung cancer patients, implying that intervention protocols based on this approach should be recommend-ed as a part of the rehabilitation program for lung cancer pa-tients.
iv. Study 7 shows the benefits of the 4-weeks MBSR for psycho-logical distress, social support, mindfulness, and perceived stigma in lung cancer patients, and it also elucidates the mechanisms by which the MBSR alleviate psychological distress by improving social support, enhancing mindfulness, and decreasing perceived stigma, thereby providing insights into applying the MBSR to reduce psychological distress among lung cancer patients.
- español
