——管昀 韩满霞 补小康 郑雪梅 杜洪燕 朱宁 薛和玉 吴绍勇

【摘要】目的 降低乳腺癌术后化疗患者中重度心理痛苦发生率。方法 成立品管圈小组，对科室乳腺癌术后化疗存在中重度心理痛苦的患者进行现状分析，应用文献循证及头脑风暴法拟定对策并组织实施，包括心理痛苦识别技术、心灵减压方案、家庭参与等。结果 乳腺癌术后化疗患者中重度心理痛苦发生率由活动前的54.59%降低至活动后的22.96%。结论 将品管圈活动应用于中重度心理痛苦的乳腺癌术后化疗患者，可改善其负性情绪，提升其社会支持度、生存质量和主观幸福感。

【关键词】乳腺癌；化疗患者；心理痛苦；品管圈；问题解决型品管圈

中图分类号：R737.9 文献标识码：B

Reducing the Incidence of Moderate and Severe Psychological Distress in Breast Cancer Patients Undergoing Postoperative Chemotherapy/GUAN Yun,HAN Manxia,BU Xiaokang, et al.//Chinese Health Quality Management，2022,29(5):80-84

Abstract Objective To reduce the incidence of moderate and severe psychological distress in patients with breast cancer after postoperative chemotherapy. Methods A quality control circle group was established to analyze the status of patients with moderate and severe psychological distress in breast cancer undergoing postoperative chemotherapy. Evidence-based literature review and brainstorming method were used to formulate and implement countermeasures, including psychological distress recognition technology, psychological decompression program, family participation, etc.Results The incidence of moderate and severe psychological distress in breast cancer patients after postoperative chemotherapy decreased from 54.59% to 22.96%. Conclusion Applying quality control circle activities to breast cancer patients with moderate and severe psychological distress after postoperative chemotherapy can improve their negative emotions, social support, quality of life and subjective well-being.

Key words Breast Cancer;Chemotherapy Patients;Psychological Distress;Quality Control Circle;Problem Solving Quality Control Circle

First-author's address Department of Head and Neck Oncology,West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu,Sichuan,610041,China

1主题选定

全体圈员从本期达成性、上级重视度、重要性、圈能力等4个维度，按照权重评价法，对所有备选主题进行评价，最终选定“降低乳腺癌术后化疗患者中重度心理痛苦发生率”为本期活动主题。

名词定义：心理痛苦是一种不愉快的情绪体验，严重者可出现抑郁、焦虑、恐惧、孤独、生存和精神危机［1］。美国国家癌症综合癌症网络（National Comprehensive Cancer Network，NCCN)推荐使用心理痛苦温度计（Distress Thermometer，DT）测量患者的心理痛苦水平。DT为标有0分～10分共11个刻度的视觉模拟直尺式单一条目量表，具有良好的信效度，0分表示无痛苦，1分～3分为轻度痛苦，4分～6分为中度痛苦，7分～9分为重度痛苦，10分表示极度痛苦。张叶宁等［2］针对我国人群的研究也证实，DT得分分界点为4分时，敏感度（0.87)和特异度（0.72)最佳。故，本研究将DT评分≥4分作为中重度心理痛苦的诊断标准。

衡量指标：乳腺癌术后化疗患者中重度心理痛苦发生率=乳腺癌术后化疗患者发生中重度心理痛苦的人数÷乳腺癌术后化疗患者总人数（30 d）×100%。

选题背景：乳腺癌是女性常见癌症之一。乳腺癌患者的心理痛苦普遍存在［3］。在术后化疗中期，心理痛苦水平呈上升趋势［4］。持续的心理痛苦使患者的婚姻质量降低，生活质量和治疗依从性下降，自杀风险增加［5-7］。因此，降低乳腺癌术后化疗患者心理痛苦发生率，可以改善其不良情绪，降低其自杀风险，提高其生存质量。

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