健康与遗传心理学研究室知识库

对疾病进展的恐惧是妇科肿瘤患者最常表达的心理痛苦，给患者的心身健康和生活质量造成严重影响。临床医护人员对于如何理解和支持患者的疾病进展恐惧还不是十分清楚。国内外研究发现，躯体症状是引起患者疾病进展恐惧的主要内部刺激因素，但躯体症状如何影响疾病进展恐惧尚不清楚。既往理论模型集中强调了元担忧对疾病进展恐惧的重要作用，患者躯体症状、元担忧和疾病进展恐惧的关系有待探讨。医患共情是临床医护人员为患者提供心理支持的主要方式，医患共情与患者疾病进展恐惧的关系的研究尚属于起步阶段，而且医患共情对患者元担忧的作用尚不明确。基于此，开展本研究，以期为临床医护人员理解患者的疾病进展恐惧提供新的思路，从而在临床工作中为患者提供良好的心理支持。

研究I检验元担忧在患者躯体症状与疾病进展恐惧之间的中介效应。采用人口统计学及疾病资料调查表、躯体症状量表、元认知问卷(包括对担忧的积极信念、对担忧的消极信念、认知自信、认知自我意识和控制想法的需要5个维度)和恐惧疾病进展问卷对208名妇科肿瘤患者进行问卷调查，使用SPSS软件25.0版本以及PROCESS插件进行数据分析。结果显示:妇科肿瘤患者躯体症状、疾病进展恐惧和元担忧呈显著正相关;躯体症状、对担忧的积极信念、对担忧的消极信念、认知自我意识、职业状态与疾病了解程度是妇科肿瘤患者疾病进展恐惧的预测因素;元担忧在躯体症状和疾病进展恐惧之间起部分中介作用。

研究II从医患沟通的角度探究患者感知医患共情在躯体症状、元担忧及疾病进展恐惧之间关系中的调节作用。对241名妇科肿瘤患者进行问卷调查，研究工具在研究一的基础上增加了诊疗关系共情量表。结果表明，感知医患共情与躯体症状、疾病进展恐惧呈显著负相关;感知医患共情可以负向预测疾病进展恐惧;感知医患共情在躯体症状、元担忧和疾病进展恐惧之间关系中的调节作用均不显著。

根据研究II的结果，研究III使用质性研究的方法了解患者对医患共情的看法，探索影响医患共情对患者疾病进展恐惧、元担忧的作用的因素。共访谈12名妇科肿瘤患者，对访谈录音转录后进行人工编码，采用主题分析法进行分析，归纳三个主题:C1)患者感知医患共情包括认知共情、情感共情、实际的帮助和持续的关注;C2)影响医患共情对患者疾病进展恐惧的作用的因素有医患关系、治疗满意度、医患沟通满意度、疾病感知和社会支持;(3)影响感知医患共情对患者元担忧的作用的因素有个人特质、疾病感知、治疗满意度和对医患沟通的看法。

结论:躯体症状不仅可以直接影响患者疾病进展恐惧，还可以通过元担忧的中介作用间接影响疾病进展恐惧。感知医患共情对患者疾病进展恐惧有显著的保护作用，但对元担忧的保护作用不显著。感知医患共情不能调节躯体症状、元担忧和疾病进展恐惧之间的关系。临床医护人员还需提高医患沟通的技能，主动减少患者对医患沟通的顾虑，增强对患者负性情绪和担忧想法的识别，将医学治疗与心理支持相结合更能使患者受益。

The fear of disease progression is commonly expressed in gynecological tumor patients as a psychological pain. It greatly impacts the mental and physical health and quality of life of the tumor patients. Clinical professionals are not very clear about how to understand and support patients to handle their fear of disease progression. Chinese and foreign showed that somatic symptoms are the main internal stimuli that lead to fear of disease progression for the patient. However, it is still unclear how somatic symptoms affect the fear of disease progression. Previous theoretical models have been focused on the important role of meta-worry in the fear of disease progression, and the relationship between somatic symptoms, meta-worry, and fear of disease progression needs to be explored. Doctor-patient empathy is the main solution to provide psychological support for patients. Research on the association between doctor-patient empathy and patients' fear of disease progression is still at early stage, and the role of doctor-patient empathy in patients' meta-worry has not been determined yet. Based on this, the study aims to provide new insights for clinical healthcare professionals to understand patients' fear of disease progression, and provide solid psychological support for patients in clinical work.

Study I tested the mediating effect of meta-worry between somatic symptoms and fear of disease progression. A total of 208 patients with gynecological tumors were surveyed, using the demographic and disease data questionnaire, Somatic Symptom Scale, Metacognition Questionnaire(including positive beliefs about worry, negative beliefs about worry, cognitive confidence, cognitive self-consciousness and the need to control thoughts)and Fear of Disease Progression Questionnaire. SPSS software 25.0 and PROCESS were used to data analysis. The results showed that there was a significant positive correlation between somatic symptoms, fear of disease progression, and meta-worry in gynecological tumor patients. Somatic symptoms, positive beliefs about worry, negative beliefs about worry, cognitive self-awareness, occupational status and understanding of the disease were predictive factors of fear of disease progression in gynecological tumor patients. Meta-worry partially mediated somatic symptoms and fear of disease progression.

Study II explored the moderating role of perceived doctor-patient empathy in the relationship between somatic symptoms, meta-worry, and fear of disease progression from the perspective of doctor-patient communication. A questionnaire survey was conducted on 241 gynecological tumor patients, and the research tool added Consultation and Relational Empathy Measure on the basis of Study I.The results showed perceived doctor-patient empathy was significant negatively correlated with somatic symptoms and fear of disease progression. Perceived doctor-patient empathy could negatively predict the fear of disease progression. The moderating effects of perceived doctor-patient empathy on somatic symptoms, meta-worry and fear of disease progression were not significant.

Based on the results of Study II, StudyIII explored the content of perceived doctor-patient empathy through qualitative research，and explored the factors that affect the relationship between perceived doctor-patient empathy，patients' fear of disease progression and meta-worry. A total of 12 gynecological tumor patients were interviewed, and the interview recordings were transcribed and manually encoded. Theme analysis was used to analyze and summarize the following three themes:(1) Patients' perceived doctor-patient empathy includes cognitive empathy，emotional empathy，practical assistance, and continuous attention. (2) The factors that affect the relationship between doctor-patient empathy and patient fear of disease progression include doctor-patient relationship, treatment satisfaction, doctor-patient communication satisfaction, disease perception, and social support. (3) The factors that affect the relationship between doctor-patient empathy and patient's meta-worry include personal traits, disease perception, treatment satisfaction, and perceptions of doctor-patient communication.

Conclusions: Somatic symptoms not only directly affect the fear of diseases progression, but also indirectly affect the fear of disease progression through the mediation of meta-worry. Perceived doctor-patient empathy has a significant protective effect on patients' fear of disease progression, but its protective effect on meta-worry is not significant. Perceived doctor-patient empathy does not moderate the association between somatic symptoms, meta-worry, and fear of disease progression. Physicians and nurses need to improve their communication skills with patients, and reduce patients' concerns during communication, enhance recognition of negative emotions and worry, and better benefit patients through combined medical treatment and psychological support.