诊断告知/隐瞒对早、中期肝癌患者的焦虑、抑郁及疾病感知的影响

揭彬; 邱琰; 陈耿; 夏锋; 马宽生; 冯正直

doi:10.16016/j.1000-5404.201807074

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诊断告知/隐瞒对早、中期肝癌患者的焦虑、抑郁及疾病感知的影响

医学心理学 | 更新时间：2026-01-09

- 诊断告知/隐瞒对早、中期肝癌患者的焦虑、抑郁及疾病感知的影响
- Impact of disclosure and nondisclosure of diagnosis on anxiety, depression and illness perceptions in patients with hepatocellular carcinoma
- 第三军医大学学报 2018年40卷第24期页码：2284-2290
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)：医学心理系军人发展心理学教研室
  2.400038 重庆，陆军军医大学(第三军医大学)：医学心理系
  3.400038 重庆，陆军军医大学(第三军医大学)：第一附属医院肝胆外科
- 作者简介：
  
  [邱琰, E-mail：psycho_med@sina.com QIU Yan, E-mail: psycho_med@sina.com
- 基金信息：
  
  国家社会科学基金(16BSH096)
- DOI：10.16016/j.1000-5404.201807074
  中图分类号： R395.2; R395.6; R735.7
- 收稿：2018-07-10，
  
  修回：2018-09-11，
  
  纸质出版：2018-12-30
- 稿件说明：
移动端阅览
揭彬, 邱琰, 陈耿, 等. 诊断告知/隐瞒对早、中期肝癌患者的焦虑、抑郁及疾病感知的影响[J]. 第三军医大学学报, 2018,40(24):2284-2290.

Bin JIE, Yan QIU, Geng CHEN, et al. Impact of disclosure and nondisclosure of diagnosis on anxiety, depression and illness perceptions in patients with hepatocellular carcinoma[J]. Journal of Third Military Medical University, 2018, 40(24): 2284-2290.
揭彬, 邱琰, 陈耿, 等. 诊断告知/隐瞒对早、中期肝癌患者的焦虑、抑郁及疾病感知的影响[J]. 第三军医大学学报, 2018,40(24):2284-2290. DOI： 10.16016/j.1000-5404.201807074.

Bin JIE, Yan QIU, Geng CHEN, et al. Impact of disclosure and nondisclosure of diagnosis on anxiety, depression and illness perceptions in patients with hepatocellular carcinoma[J]. Journal of Third Military Medical University, 2018, 40(24): 2284-2290. DOI： 10.16016/j.1000-5404.201807074.

摘要

目的

探讨诊断告知或隐瞒对肝癌患者的焦虑、抑郁及疾病感知的影响。

方法

对住院手术的早、中期肝癌患者，按照出院前是否被告知其肝癌诊断，分为告知组和隐瞒组，以焦虑自评量表、抑郁自评量表、疾病感知问卷进行测评，测评时点为入院时、出院时、出院后1个月时。观察隐瞒组患者在出院后1个月时是否得知了诊断实情以及知情的途径。

结果

285例患者纳入研究，其中150例(52.6%)被告知了肝癌诊断。焦虑症状发生率：在出院时及出院后1个月时，隐瞒组均显著高于告知组(

=0.045、

=0.001)；纵向比较，告知组的焦虑发生率随时间迁移而逐渐下降，而隐瞒组的焦虑发生率逐渐增加。抑郁症状发生率：在出院时告知组显著高于隐瞒组(

=0.043)，但出院后1个月时，告知组的抑郁发生率低于隐瞒组(

=0.039)，纵向比较，告知组的抑郁发生率在出院时最高，出院后1个月时显著下降，而隐瞒组的抑郁发生率在出院时及出院后1个月时均呈现逐渐升高的趋势。疾病感知方面：出院后1个月时，告知组“对疾病的知识了解”以及“自我对疾病的控制力”评分均显著高于隐瞒组(

均＜0.001)，而“情绪受影响程度”评分，告知组显著低于隐瞒组(

=0.001)，多因素分析显示告知诊断与出院后1个月时的“情绪受影响程度”显著负相关(

＜0.001)。隐瞒组在出院后1个月时，84.4%的患者已通过自己的方式得知了诊断实情，查看诊断证明书等病历资料是知情的主要途径。

结论

告知诊断有利于早中期肝癌患者调节情绪以及形成积极的疾病感知。建议对有明确的知情意愿的早中期癌症患者，满足患者的知情意愿。

Abstract

Objective

To investigate how disclosure and nondisclosure of diagnosis affect anxiety

depression and illness perceptions in Chinese patients with hepatocellular carcinoma (HCC).

Methods

Patients with early/intermediate stage HCC admitted for potentially curative operations in

teaching hospital were recruited. According to whether they were informed of the diagnosis before discharge

the patients were divided into disclosure group and nondisclosure group and assessed for anxiety

depression and illness perceptions at admission

at discharge and at one month after discharge. The uninformed patients were interviewed for whether and how they had known the actual diagnosis at one month after discharge.

Results

total of 285 patients were recruited in this study

and 52.6% of them were informed of their cancer diagnosis before discharge (disclosure group). The incidence of anxiety declined gradually with time in the disclosure group and tented to increase in the nondisclosure group during the study period; The in

cidence of anxiety was significantly higher in the nondisclosure group than in the disclosure group both at discharge (

=0.045) and at one month after discharge (

=0.001). The incidence of depression was the highest at discharge and decreased significantly at one month after discharge in the disclosure group

but increased progressively over time in the nondisclosure group; The incidence of depression was significantly higher at discharge (

=0.043) but significantly lower at one month after discharge (

=0.039) in the disclosure group than in the nondisclosure group. The patients in the disclosure group had higher scores for understanding of the illness (

0.001) and personal control (

0.001) but had lower scores for emotional impact (

=0.001) at one month after discharge. Multivariate analysis showed that disclosure of diagnosis was negatively correlated with emotional impact (

0.001). At 1 month after discharge

84.4% of the patients in the nondisclosure group had been in the knowledge of their cancer diagnosis

mainly by reading the medical records.

Conclusion

For patients with early/intermediate stage HCC

disclosure of the diagnosis is beneficial to promote their emotional adjustment and more positive illness perceptions.

关键词

Keywords

references

WANG D C, PENG X, GUO C B, et al . When clinicians telling the truth is de facto discouraged, what is the family's attitude towards disclosing to a relative their cancer diagnosis[J ] . Support Care Cancer, 2013, 21(4): 1089-1095. DOI: 10.1007/s00520-012-1629-y.

WANG D C, GUO C B, PENG X, et al . Is therapeutic non-disclosure still possible?A study on the awareness of cance r diagnosis in China[J ] . Support Care Cancer, 2011, 19(8): 1191-1195. DOI: 10.1007/s00520-010-0937-3.

JIANG Y, LIU C, LI J Y, et al . Different attitudes of Chinese patients and their families toward truth telling of different stages of cancer[J ] . Psychooncology, 2007, 16(10): 928-936. DOI: 10.1002/pon.1156.

JIE B, FENG Z Z, QIU Y, et al . Association between socio-demographic factors, coping style, illness perceptions and preference for disclosure/nondisclosure of diagnosis in Chinese patients with hepatocellular carcinoma[J ] . J Health Psychol, 2017: 1359105317707258. DOI: 10.1177/1359105317707258.

谭晓骏, 宁翠霞, 王萍.知情状况对肺癌患者心理状态的影响及相关因素分析[J].上海护理, 2013, 13(5): 25-28.

TAN X J, NING C X, WANG P. Psychological impact of informed consent status in lung cancer patients and related factor[J]. Shanghai Nursing, 2013, 13(5): 25-28.

李芳昕, 孙春燕, 黄悦.初诊卵巢癌住院患者知情前后心身症状表现调查[J].中国误诊学杂志, 2011, 11(3): 739.

LI F X, SUN C Y, HUANG Y. Psychosomatic symptoms before and after diagnostic disclosure in patients with ovarian cancer[J]. Chin J Misdiag, 2011, 11(3): 739.

马鑫.癌症患者的知情程度对身心健康的影响及护理干预[J].锦州医科大学学报, 2017(5): 102-103.

MA X. The efiect of information awareness of cancer patients on their physical and mental health and nursing intervention[J]. J Jinzhou Med Univ, 2017(5): 102-103.

JIE B, QIU Y, FENG Z Z, et al . Impact of disclosure of diagnosis and patient autonomy on quality of life and illness perceptions in Chinese patients with liver cancer[J ] . Psychooncology, 2016, 25(8): 927-932. DOI: 10.1002/pon.4036.

HAGGER M S, ORBELL S. A eeta-analytic review of the common-sense model of illness representations[J]. Psychol Health, 2003, 18(2): 141-184. DOI: 10.1080/08870440 3100081321.

FAN S Y, EISER C, HO M C, et al . Health-related quality of life in patients with hepatocellular carcinoma: the mediation effects of illness perceptions and coping[J ] . Psychooncology, 2013, 22(6): 1353-1360. DOI: 10.1002/pon.3146.

WALY RAPHAEL S, YANGDE Z, YUXIANG C. Hepatocellular carcinoma: focus on different aspects of management[J]. ISRN Oncol, 2012, 2012: 421673. DOI: 10.5402/2012/421673.

张作记.行为医学量表手册[M].北京:中华医学电子音像出版社, 2005.

ZHANG Z J. Behavioral Medicine Scale Manual[M]. Beijing: Chinese Medical Multimedia Press, 2005.

SMITH R P, DEVINE P, JONES H, et al . Internet use by patients with prostate cancer undergoing radiotherapy[J ] . Urology, 2003, 62(2): 273-277. DOI: 10.1016/s0090-4295(03)00251-6.

KANGAS M, HENRY J L, BRYANT R A. The course of psychological disorders in the 1st year after cancer diagnosis[J]. J Consult Clin Psychol, 2005, 73(4): 763-768. DOI: 10.1037/0022-006X.73.4.763.

ADELLUND HOLT K, JENSEN P T, Gils Hansen D, et al . Rehabilitation of women with gynaecological cancer: the association between adult attachment, post-traumatic stress disorder and depression[J ] . Psychooncology, 2016, 25(6): 691-698.

崔雅静, 宁军.病情知情程度对晚期肿瘤患者及其家属心理状况的影响[J].广西医学, 2018, 40(8): 973-975.

CUI Y J, NING J. Influence of disease informing on psychological state of advanced cancer patients and their family members[J]. Guangxi Med, 2018, 40(8): 973-975.

SHAND L K, COWLISHAW S, BROOKER J E, et al . Correlates of post-traumatic stress symptoms and growth in cancer patients: a systematic review and meta-analysis[J ] . Psychooncology, 2015, 24(6): 624-634. DOI: 10.1002/pon.3719.

唐棠, 缪毅, 彭李, 等.癌症患者创伤后成长与情绪调节、应对方式和自我效能的相关性研究[J].第三军医大学学报, 2012, 34(19): 2016-2018.

TANG T, MIAO Y, PENG L, et al . Correlation of posttraumatic growth with emotion regulation, coping style and self-efficacy in cancer patients[J ] . J Third Mil Med Univ, 2012, 34(19): 2016-2018.

STANTON A L, DANOFF-BURG S, CAMERON C L, et al . Emotionally expressive coping predicts psychological and physical adjustment to breast cancer[J ] . J Consult Clin Psychol, 2000, 68(5): 875-882. DOI: 10.1037//0022-006x.68.5.875.

Hong S J, You K H. The Effects of Experienced Uncertainty and Patients' Assessments of Cancer-Related Information-Seeking Experiences on Fatalistic Beliefs and Trust in Physicians[J]. Health Commun, 2016, 31(12): 1495-1505. DOI: 10.1080/10410236.2015.1089399.

LUDGATE M W, SABEL M S, FULLEN D R, et al . Internet use and anxiety in people with melanoma and nonmelanoma skin cancer[J ] . Dermatol Surg, 2011, 37(9): 1252-1259. DOI: 10.1111/j.1524-4725.2011.02124.x.

CHITTEM M, NORMAN P, HARRIS P R. Relationships between perceived diagnostic disclosure, patient characteristics, psychological distress and illness perceptions in Indian cancer patients[J]. Psychooncology, 2013, 22(6): 1375-1380. DOI: 10.1002/pon.3149.

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