肠造口患者经济毒性的潜在剖面分析及影响因素

Latent profile analysis of financial toxicity and its influencing factors in patients with enterostomy

摘要

目的 基于潜在剖面分析探索肠造口患者经济毒性的潜在类别,分析其影响因素,为制订针对性干预策略提供依据。 方法 采用便利抽样法,于2023年4月—9月选取天津市某三级甲等医院肠造口门诊的512例患者为研究对象。采用一般资料调查表、家庭关怀度指数量表、癌症患者报告结局的经济毒性量表和慢性病治疗功能评估-灵性健康量表进行调查。采用Mplus 8.3进行潜在剖面分析,采用SPSS 21.0进行多项logistic回归分析影响因素。 结果 肠造口患者经济毒性可分为3个潜在剖面:无经济毒性组(17.19%)、轻度经济毒性组(47.27%)和中度经济毒性组(35.54%)。多项logistic回归分析显示,家庭关怀度较低、灵性健康水平较低、文化程度较低、医疗费用支付方式为城镇居民医保或农村合作医疗,以及家庭人均月收入处于1 001~3 000元区间,是患者归入更高经济毒性组的独立影响因素(P<0.05)。 结论 肠造口患者经济毒性存在明显的群体异质性,受客观经济条件与主观心理社会资源的共同影响。医护人员应依据不同剖面的特征实施分层管理,构建整合医疗、心理与家庭支持的综合干预模式,以精准缓解患者的经济毒性。

Abstract

Objective To explore the potential categories of financial toxicity in patients with enterostomy using latent profile analysis(LPA)and to analyze their influencing factors, aiming to provide a basis for developing targeted intervention strategies. Methods From April to September 2023, a total of 512 patients from the enterostomy clinic of a Grade A tertiary hospital in Tianjin were selected by convenience sampling. Data were collected using a general information questionnaire, the Family APGAR index, the Comprehensive score for Financial toxicity-functional assessment of chronic illness therapy, and the Functional assessment of chronic illness therapy-spiritual well-being scale. Latent profile analysis was performed using Mplus 8.3, and multivariate logistic regression analysis was conducted using SPSS 21.0 to identify influencing factors. Results The financial toxicity of enterostomy patients could be classified into three latent profiles: the non-financial toxicity group(17.19%), the mild financial toxicity group(47.27%), and the moderate financial toxicity group(35.54%). Multivariate logistic regression analysis revealed that lower family care, lower spiritual well-being, lower educational level, medical payment methods of urban resident medical insurance or new rural cooperative medical care, and a per capita monthly household income in the range of 1,001-3,000 yuan were independent factors influencing patients’ classification into higher financial toxicity profiles(P<0.05). Conclusion There is significant heterogeneity in financial toxicity among enterostomy patients, influenced by both objective economic conditions and subjective psychosocial resources. Healthcare professionals should implement stratified management based on the characteristics of different profiles and construct a comprehensive intervention model integrating medical, psychological, and family support to precisely alleviate patients’ financial toxicity.

关键词

结直肠癌 / 造口 / 经济毒性 / 家庭关怀度 / 灵性健康 / 潜在剖面分析

Key words

Colorectal cancer / Enterostomy / Financial toxicity / Family care / Spiritual health / Latent profile analysis

参考文献

[1] Han BF, Zheng RS, Zeng HM, et al. Cancer incidence and mortality in China, 2022[J]. J Natl Cancer Cent, 2024, 4(1): 47-53.

[2] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.

[3] 赵改丽, 赵婷婷, 应晓燕, 等. 3D打印旁疝固定片在永久性结肠造口患者护理中的应用[J]. 护理学杂志, 2022, 37(19): 33-35.

[4] ZHAO Gaili, ZHAO Tingting, YING Xiaoyan, et al. Application of 3D printed mesh to prevent parastomal hernia in patients undergoing permanent colostomy[J]. Journal of Nursing Science, 2022, 37(19): 33-35.

[5] Kristensen HØ, Thyø A, Emmertsen KJ, et al. Surviving rectal cancer at the cost of a colostomy: global survey of long-term health-related quality of life in 10 countries[J]. BJS Open, 2022, 6(6): zrac085. doi:10.1093/bjsopen/zrac085

[6] Halpern MT, Thamm C, Knowles R, et al. Cancer survivors’ experience of care and financial toxicity: results from a national survey[J]. JCO Oncol Pract, 2025, 21(2): 226-234.

[7] Boman SE, Hed Myrberg I, Bruze G, et al. Earnings and work loss after colon and rectal cancer: a Swedish nationwide matched cohort study[J]. E Clinical Medicine, 2024, 75: 102770. doi:10.1016/j.eclinm.2024.102770

[8] 陈小芳, 薛小玲. 有益健康模型的研究进展[J]. 护理研究, 2010, 24(34): 3103-3105.

[9] CHEN Xiaofang, XUE Xiaoling. Research progress on helpful health model[J]. Chinese Nursing Research, 2010, 24(34): 3103-3105.

[10] 张锐, 冯绘绘, 勾阳阳, 等. 家庭关怀度与服药信念在老年缺血性卒中患者药物素养和服药依从性之间的中介作用[J]. 护理学杂志, 2024, 39(8): 20-24.

[11] ZHANG Rui, FENG Huihui, GOU Yangyang, et al. The mediating role of family function and medication belief in relationship between drug literacy and medication adhe-rence in elderly patients with ischemic stroke[J]. Journal of Nursing Science, 2024, 39(8): 20-24.

[12] Albusoul RM, Hasanien AA, Abdalrahim MS, et al. The effect of spiritual well-being on symptom experience in patients with cancer[J]. Support Care Cancer, 2022, 30(8): 6767-6774.

[13] Tirgari B, Khaksari M, Soltani Z, et al. Spiritual well-being in patients with chronic diseases: a systematic review and meta-analysis[J]. J Relig Health, 2022, 61(5): 3969-3987.

[14] 尹奎, 彭坚, 张君. 潜在剖面分析在组织行为领域中的应用[J]. 心理科学进展, 2020, 28(7): 1056-1070.

[15] YIN Kui, PENG Jian, ZHANG Jun. The application of latent profile analysis in organizational behavior research[J]. Advances in Psychological Science, 2020, 28(7): 1056-1070.

[16] 国家卫生健康委员会医政司,中华医学会肿瘤学分会. 中国结直肠癌诊疗规范(2023版)[J]. 协和医学杂志, 2023, 14(4): 706-733.

[17] Kendall MG. A course in multivariate analysis[M]. London: Charles Griffin & Company, 1957: 185.

[18] de Souza JA, Yap BJ, Hlubocky FJ, et al. The development of a financial toxicity patient-reported outcome in cancer: the COST measure[J]. Cancer, 2014, 120(20): 3245-3253.

[19] 于慧会, 毕雪, 刘运泳. 中文版癌症患者报告结局的经济毒性量表信度和效度研究[J]. 中华流行病学杂志, 2017, 38(8): 1118-1120.

[20] YU Huihui, BI Xue, LIU Yunyong. Reliability and validity of the Chinese version on Comprehensive Scores for Financial Toxicity based on the patient-reported outcome measures[J]. Chinese Journal of Epidemiology, 2017, 38(8): 1118-1120.

[21] Smilkstein G. The physician and family function assessment[J]. Fam Syst Med, 1984, 2(3): 263-278.

[22] 吕繁, 顾湲. 家庭APGAR问卷及其临床应用[J]. 国外医学(医院管理分册), 1995(2): 56-59.

[23] Brady MJ, Peterman AH, Fitchett G, et al. A case for including spirituality in quality of life measurement in oncology[J]. Psychooncology, 1999, 8(5): 417-428.

[24] 刘翔宇, 韦迪, 谌永毅, 等. 中文版慢性疾病治疗功能评估-灵性量表在癌症患者中的信效度评定[J]. 中华护理杂志, 2016, 51(9): 1085-1090.

[25] LIU Xiangyu, WEI Di, CHEN Yongyi, et al. Reliability and validity of the Chinese version of the functional assessment of chronic illness therapy-spiritual well-being in cancer patients[J]. Chinese Journal of Nursing, 2016, 51(9): 1085-1090.

[26] 王柯鑫, 何欣宇, 李瑞莲, 等. 泸州市肺癌患者经济毒性潜在剖面分析及其影响因素研究[J]. 现代预防医学, 2024, 51(21): 4008-4014.

[27] WANG Kexin, HE Xinyu, LI Ruilian, et al. Analysis of the economic toxicity profile and influencing factors in lung cancer patients in Luzhou city[J]. Modern Preventive Medicine, 2024, 51(21): 4008-4014.

[28] Shao MW, Yao LQ, Zhang MH, et al. Post-surgery financial toxicity and its influencing factors in colorectal cancer care: a cross-sectional study[J]. Eur J Oncol Nurs, 2024, 68: 102518. doi:10.1016/j.ejon.2024.102518

[29] 姚远. 结直肠癌患者家庭关怀度、睡眠障碍与癌因性疲乏的相关性研究[D]. 延吉: 延边大学, 2022.

[30] 何彪, 黄小丽, 李方怡, 等. 结直肠癌化疗患者经济毒性的潜在剖面分析及影响因素研究[C] // 第六届上海国际护理大会论文汇编(下). 上海, 2024: 617.

[31] 王利敏, 方继红, 杨侠, 等. 癌症患儿主要照顾者经济毒性体验及应对策略的质性研究[J]. 军事护理, 2025, 42(3): 48-52.

[32] WANG Limin, FANG Jihong, YANG Xia, et al. Qualitative study on economic toxicity experience and coping strategies of main caregivers of children with cancer[J]. Military Nursing, 2025, 42(3): 48-52.

[33] 杨洁, 黄定凤, 冯丽娟, 等. 中晚期低位直肠癌造口患者自我厌恶现状及影响因素分析[J]. 护理学杂志, 2024, 39(17): 40-44.

[34] YANG Jie, HUANG Dingfeng, FENG Lijuan, et al. Level and factors associated with self-disgust in clinical stage Ⅱ or Ⅲ low-rectal cancer patients with a stoma[J]. Journal of Nursing Science, 2024, 39(17): 40-44.

[35] 惠蓉. 胃癌患者经济毒性、自我效能、灵性健康与生命质量的关系研究[D]. 延安: 延安大学, 2024.

[36] 吴隆燕, 邱丽燕, 陈璧学, 等. 肝动脉插管化疗栓塞术患者的经济毒性现状及其影响因素分析[J]. 广西医学, 2024, 46(6): 882-888.

[37] WU Longyan, QIU Liyan, CHEN Bixue, et al. Current statues of economic toxicity in patients with transcatheter arterial chemoembolization and its influencing factors: an analytic study[J]. Guangxi Medical Journal, 2024, 46(6): 882-888.

[38] 程珂, 曹希, 黎燕红, 等. 结直肠癌患者经济毒性的危险因素分析[J]. 中华肿瘤防治杂志, 2023, 30(16): 984-989.

[39] CHENG Ke, CAO Xi, LI Yanhong, et al. Risk factors analysis of economic toxicity in colorectal cancer patients[J]. Chinese Journal of Cancer Prevention and Treatment, 2023, 30(16): 984-989.

[40] Mo MH, Jia PP, Zhu K, et al. Financial toxicity following surgical treatment for colorectal cancer: a cross-sectional study[J]. Support Care Cancer, 2023, 31(2): 110. doi:10.1007/s00520-022-07572-8

基金资助

国家自然科学基金面上项目(82371312)