| Summary: | 碩士 === 國立臺北護理健康大學 === 護理研究所 === 106 === Background:
Surgical incisions are the primary treatments for oral cancer. After the surgeries, patient often face facial appearance changes, dysphagia, and verbal communication difficulties, which may negatively affect their psychological adjustment. The purpose of the study is to explore the changing trend of postoperative psychosocial adjustment and its related factors in oral cancer patients.
Methods
The study was based on a prospective longitudinal study design. Oral cancer patients admitted for reconstructive surgeries were recruited from two medical centers. Data were collected at preoperative (T1), one month (T2), three months (T3), and five months after discharge (T4). The instruments include the Facial disfigurement scale, the EORTC QLQ-H＆N35, the Psychosocial Adjustment to Illness Scale (PAIS) , and the Social Support Scale. Data were analyzed by using SPSS software. Mean, standard deviation, frequency, percentage were used to describe study variables. A generalized estimating equation (GEE) was used to analyze the general trend of psychosocial adjustment over time. The effects of each hypothesized independent variable on the changing trend of psychosocial adjustment were analyzed by using univariate analysis of GEE. All the significant independent variables found in the univariate analyses were then entered into the final model of GEE as a multivariate analysis to explore significant predictors of the changing trend of psychosocial adjustment.
Results:
The average scores of psychosocial adjustment were 43.42 (SD = 18.59), 49.79 (SD = 22.46), 51.20 (SD = 21.44), and 48.93 (SD = 21.81) measured at T1, T2, T3, and T4, respectively. Result of GEE showed a significant time effect on psychosocial adjustment. Result of multivariate GEE showed that economic status, pain, speech, social contact, and family social support were significant predictors of the changing trend of psychosocial adjustment. However, the patients’ occupational status, diagnosis, cancer staging, perceived disease severity, patient-rated facial disfigurement, and observer-rated facial disfigurement were not significantly related to the psychosocial adjustment trend over time.
Conclusions:
In general, oral cancer patients reported poor postoperative psychosocial adjustment and it deteriorated gradually over time. Therefore, it is important to assess oral cancer patients’ postoperative psychosocial adjustment regularly and provide guidance for using proper coping strategies according. Patients with poor financial status, lacking family social support, having pain, speech difficulties, and social contact difficulties were at the greatest risk for psychosocial maladjustment. Welfare referring, family social support strengthening, pain management, language therapy, and social contact may help patients to adapt their postoperative life.
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