Longitudinal Study Of Psychological Distress And Its Influencing Factors In Patients Undergoing Esophageal Cancer Surgery

Objective:Investigate the dynamic change trajectory of the psychological distress level and quality of life of patients with esophageal cancer surgery at different time points,analyze the influencing factors of psychological distress at each time point,look for independent risk factors that can be intervened.Provide reference basis for medical staff to identify psychological distress early,guide the dynamic management of clinical psychological distress,and formulate continuous nursing management plans.Methods:This study adopts a prospective longitudinal research design,and selects 132 patients who underwent esophageal cancer surgery in a tertiary general hospital in Chongqing from March 2019 to October 2020 who met the research standards in the Department of Thoracic and Cardiovascular Surgery.General data Questionnaire,The Hospital Anxiety and Depression Scale,HADS,EORTC QLQ-C30 and EORTC QLQ-OES18,using questionnaires to identify patients undergoing esophageal cancer surgery before surgery(T1),at discharge(T2),and 3 months after surgery(T3)And the HADS score and quality of life score at 4 time points in 6 months(T4)after surgery.According to the HADS score,the patients were divided into high psychological distress group(any subscale HADS≥11)and low psychological distress group(any subscale HADS≤10),and the differences in general information and quality of life between the two groups were compared and analyzed.And apply single factor analysis of variance and multivariate logistic regression to analyze its independent risk factors.Results:1 HADS scores of patients undergoing esophageal cancer surgery: 1day before surgery(T1),patients with esophageal cancer surgery had the highest anxiety score(6.83±2.47),and 6 months after surgery(T4)the lowest anxiety score(4.14±1.60);1 day before surgery(T1)The depression score was the highest(5.47±1.89),and the depression score was the lowest(4.38±1.24)at 6 months after surgery(T4).There was a statistically significant difference in HADS scores between patients at the 4 time points(P<0.05),and the HADS scores at the 4 time points showed a downward trend,and the differences were statistically significant(P<0.05)2 The results of the EORTC QLQ C-30 score showed that at each time point of T1-T4,the scores of the functional dimensions and the comprehensive quality of life of the patients in the high PD group were significantly lower than those of the patients in the low PD group,and the scores of the symptoms in the high PD group were all Significantly higher than the low PD group,the difference in quality of life scores between the two groups at each time point was statistically significant(P<0.05).The EORTC QLQ OES-18 score results showed that at each time point from T1 to T4,the symptom dimension scores of the patients in the high PD group were significantly higher than those in the low PD group,and the difference in the quality of life scores between the two groups of patients at each time point was statistically significant(P<0.05).3 The results of a univariate analysis of psychological distress in patients with esophageal cancer surgery showed: family monthly income,work status,education level,medical conditions,preoperative comorbidities,postoperative chest catheterization time,postoperative hospitalization days,postoperative pathological staging,Postoperative complications,the difference was statistically significant(P<0.05).4 The results of logistic regression analysis of the psychological distress of patients at each time point from T1-T4 showed that:(1)The independent risk factors for psychological distress in patients undergoing esophageal cancer surgery one day before surgery are family monthly income per capita(P=0.037,OR=13.789,95%CI 1.757-157.897),emotional function(P=0.002,OR=0.879,95%CI 0.810-0.955),financial difficulties(P=0.041,OR=1.038,95%CI 1.002-1.075),dysphagia(P=0.047,OR=0.917,95%CI 0.841-0.999);(2)The independent risk factors for psychological distress in patients undergoing esophageal cancer surgery one day before discharge were postoperative complications(P=0.03,OR=12.432,95%CI 1.267-116.232),emotional function(P=0.021,OR=0.856,95%CI 0.892–0.984),loss of appetite(P=0.026,OR=0.939,95%CI 0.888–0.993),dysphagia(P=0.029,OR=1.042,95%CI 1.007–1.113),pain(P= 0.024,OR=1.102,95%CI1.057–1.153);(3)The independent risk factors for psychological distress in patients undergoing esophageal cancer surgery at 3 months after surgery are:emotional function(P=0.024,OR=0.883,95%CI 0.792–0.984),social function(P=0.011,OR=0.882,95 %CI 0.801–0.972),dysphagia(P=0.047,OR=0.917,95%CI 0.841–0.999),fatigue(P=0.034,OR=1.092,95%CI1.007–1.183),reflux(P=0.015,OR=0.911,95%CI 0.811–0.932);(4)The independent risk factors for psychological distress in patients with esophageal cancer surgery 6 months after surgery are: emotional function(P=0.008,OR=0.900,95% CI 0.832–0.972),reflux(P=0.023,OR=1.125,95 % CI 1.017–1.245).Conclusion:1 The HADS score of patients undergoing esophageal cancer surgery changes dynamically from T1 to T4,and the overall anxiety score of the patient shows a downward trend over time.One day before surgery(T1),the anxiety score is the highest,and 6 months after the operation(T4)the anxiety score is the lowest.,The change trajectory of depression score is the same as that of anxiety score.It is suggested that the psychological distress of such patients should be paid attention to and be dynamically evaluated.2 The psychological distress of patients undergoing esophageal cancer surgery is affected by a variety of independent risk factors.The independent risk factors for psychological distress on the day before surgery(T1)are family monthly income,emotional function,financial difficulties,and dysphagia;one day before discharge(T2)The independent risk factors for psychological distress are postoperative complications,emotional function,loss of appetite,dysphagia,and pain;the independent risk factors for psychological distress for 3 months(T3)after surgery are:emotional function,social function,dysphagia,fatigue,Reflux;the independent risk factors for psychological distress at 6 months after surgery(T4)are: emotional function and reflux.Medical staff should pay attention to strengthening the burden of family financial burden,low emotional function,low social function,and patients with dysphagia,reflux,loss of appetite,pain,and fatigue.According to the different characteristics of patients,prospectively implement physical and mental and symptomatic interventions to reduce The level of psychological distress,thereby improving the health-related quality of life throughout the course of illness.