肺癌患者与照顾者社会支持、内心平静、心理困扰与决策疲劳的主客体互倚模型分析 [中文引用][英文引用]

目的  基于主客体互倚模型分析肺癌患者与照顾者社会支持、内心平静、心理困扰对决策疲劳的影响，为临床制定针对性决策支持方案提供依据，从而缓解二元决策疲劳，提升决策质量。方法  便利抽样法选取 2024 年 10 月至 2025 年 5月在本院肿瘤科就诊的 382 对肺癌患者与照顾者作为研究对象，使用社会支持评定量表、内心平静量表、凯斯勒心理困扰量表及决策疲劳量表进行调查，建立肺癌患者与照顾者社会支持、内心平静、心理困扰与决策疲劳的主客体互倚模型。结果  350对肺癌患者及其照顾者完成研究。患者的心理困扰与决策疲劳得分较高，而照顾者的社会支持与内心平静得分较高，组间比较，差异具有统计学意义（均 P<0.001）。主体效应方面，肺癌患者与照顾者的社会支持水平（β1=-0.373，β2=-0.425，均 P<0.001）与内心平静水平均能负向预测自身决策疲劳（β1=-0.139，β2=-0.124，均 P<0.05），心理困扰程度均能正向预测自身决策疲劳（β1=0.203，β2=0.189，均 P<0.001）；客体效应方面，患者与照顾者社会支持水平均能负向预测对方决策疲劳（β1=-0.093，β2=-0.153，均 P<0.05），心理困扰程度均能正向预测对方决策疲劳（β1=0.234，P<0.001；β2=0.159，P<0.05），但二者内心平静水平对对方决策疲劳均无影响（β1=-0.100，β2=-0.053，均 P>0.05）。结论  肺癌患者与照顾者的社会支持、心理困扰和自身与对方的决策疲劳存在主客体效应，患者与照顾者的内心平静和自身决策疲劳仅存在主体效应。医护人员应及时评估肺癌患者与照顾者的社会支持、内心平静及心理困扰情况，制定针对性干预方案，以降低双方决策疲劳水平。

Objective To examine the effects of social support,inner peace and psychological distress on decision fatigue based on the actor-partner interdependence model（APIM）among the patients with lung cancer and their caregivers,thereby to provide references for developing targeted support programs for alleviating binary decision fatigue and improving decision-making. Methods A convenience sample of 382 pairs of patients with lung cancer and their caregivers were recruited from the department of oncology in our hospital between October 2024 and May 2025. Data were collected with the social support rating scale,peace of mind scale, Kessler psychological distress scale and decision fatigue scale. An APIM was established to examine how social support,inner peace and psychological distress impacted on decision fatigue in patient-caregiver pairs. Results A total of 350 pairs of patients with lung cancer together with their caregivers completed the study. Compared with the patients,caregivers had significantly higher scores in social support and inner peace,while the patients had higher scores in psychological distress and decision fatigue（all P<0.001）. In terms of actors effects,the patients’and caregivers’own social support（β1=-0.373,β2=-0.425,respectively；both P<0.001）and inner peace （β1=-0.139,β2=-0.124；respectively,both P<0.05）negatively predicted their own decision fatigue,while their own psychological distress positively predicted their own decision fatigue（β1=0.203,β2=0.189；respectively,both P<0.001）. In terms of partner effects, the patients’and caregivers’social support negatively predicted mutual decision fatigue（β1=-0.093 and β2=-0.153,respectively, both P<0.05）,while psychological distress positively predicted their own decision fatigue（β1=0.234,P<0.001 and β2=0.159,P<0.05, respectively）. However,inner peace of both parties had an impact only on their own decision fatigue（β1=-0.100,β2=-0.053,both P > 0.05）. Conclusion Social support and psychological distress in patients with lung cancer and their caregivers demonstrate both actor and partner effects on their own and each other’s decision fatigue,while there is a subjective effect between the inner peace of patients and caregivers and their own decision-making fatigue. Healthcare professionals should promptly assess social support,inner peace and psychological distress in patients with lung cancer and their caregivers,therefore develop the targeted intervention strategies to reduce decision fatigue in both parties.