自我表露和反刍思维在头颈癌术后患者自我形象与病耻感的并行中介效应及护理对策 [中文引用][英文引用]

目的  探讨自我表露和反刍思维在头颈癌术后患者自我形象与病耻感的中介效应，为制订针对性干预措施提供参考依据。方法  按疾病类型采用配额抽样法，选取 2022 年 8 月— 2023 年 4 月在山东省某三级甲等综合医院住院的 390 例头颈癌术后患者作为研究对象，使用一般资料调查问卷、头颈部恶性肿瘤患者羞耻与耻辱量表（shame and stigma scale in headand neck cancer，SSS-HNC）、痛苦表露指数量表（distress disclosure index，DDI）、反刍思维量表（ruminative responses scale，RRS）、自我形象量表（body image scale，BIS）进行调查。使用 AMOS 24.0 软件构建自我表露和反刍思维在自我形象和病耻感的中介效应结构方程模型，并采用 Bootstrap 法检验中介效应。结果  360 例患者完成研究。头颈癌患者病耻感、自我表露、反刍思维与自我形象得分分别为（37.9±11.0）分、（28.9±7.3）分、（56.5±12.4）分和（13.9±5.6）分；病耻感与自我表露呈负相关（r=-0.386，P<0.001），与自我形象、反刍思维呈正相关（r=0.455、0.565，均 P<0.001）；自我表露、反刍思维在头颈癌术后患者病耻感和自我形象间存在并行中介效应，中介效应占总效应的 38.82%。结论  头颈癌术后患者自我形象不仅直接影响病耻感，而且通过自我表露和反刍思维间接影响病耻感。临床医护人员可通过提高患者自我形象水平和自我表露能力，降低其反刍思维水平，从而减轻病耻感。

Objective To explore the mediating effects of self-disclosure and rumination on stigma and self-image in patients with head and neck cancer after surgery，so as to provide a reference for targeted intervention. Methods A total of 390 postoperative patients with head and neck cancer who were hospitalized in a Class III Grade A general hospital in Shandong Province were selected by quota sampling method according to disease type. The general information questionnaire，shame and stigma scale in head and neck cancer distress disclosure index，ruminative responses scale and body image scale were used to investigate. Results A total of 360 patients with head and neck cancer after surgery completed the survey. The scores of stigma，self-image，rumination and self-disclosure were（37.9±11.0），（13.9±5.6），（56.5±12.4）and（28.9±7.3），respectively. There was a negative correlation between stigma and selfdisclosure in patients with head and neck cancer after surgery（r=-0.386，P<0.001），and a positive correlation with self-image and rumination（r=0.455，0.565，all P<0.001）. Self-disclosure and rumination had parallel mediating effects on stigma and self-image in patients with head and neck cancer after surgery，and the mediating effect accounted for 38.82% of the total effect. Conclusion The degree of self-image of postoperative patients with head and neck cancer not only directly affects the level of stigma，but also indirectly affects stigma through the mediating effect of self-disclosure and rumination. In clinical work，measures can be taken to improve the level of self-image and self-disclosure ability of patients，reduce the level of rumination and reduce the stigma of patients.