肺癌患者失志综合征的评估及相关因素研究进展

Research Progress on the Assessment and Associated Factors of Demoralization Syndrome in Patients with Lung Cancer

摘要: 肺癌患者在确诊、治疗及康复过程中常面临较重的症状负担、预后不确定性和心理社会压力，部分患者可出现以无助、无望、意义丧失及主观应对无能为主要表现的失志综合征，并与较低的治疗信心、疾病适应不良及生活质量下降相关。本文围绕肺癌患者失志综合征的概念、常用评估工具、发生现状及相关因素进行综述，重点梳理人口社会学特征、疾病与治疗因素、症状负担、心理认知资源、家庭功能、社会支持及应对方式等与失志水平的关系，并总结潜在类别及多因素关联路径的研究进展。现有研究仍存在评估工具与分界值不统一、横断面研究占比较高、肺癌特异性证据不足以及动态变化研究缺乏等局限。未来应开展多中心、纵向研究，完善肺癌患者失志的动态评估和高危人群识别，为临床护理人员实施针对性心理支持和分层护理提供依据。

Abstract: Patients with lung cancer often experience substantial symptom burden, prognostic uncertainty, and psychosocial distress throughout diagnosis, treatment, and rehabilitation. Some patients may develop demoralization syndrome, characterized primarily by helplessness, hopelessness, loss of meaning, and a perceived inability to cope, which is associated with lower treatment confidence, poorer adjustment to illness, and reduced quality of life. This review summarizes the concept, commonly used assessment instruments, current status, and associated factors of demoralization syndrome in patients with lung cancer. Particular attention is given to the relationships of sociodemographic characteristics, disease- and treatment-related factors, symptom burden, psychological and cognitive resources, family functioning, social support, and coping styles with demoralization. Recent advances in latent class analyses and multivariable association pathways are also reviewed. Current evidence is limited by inconsistent assessment instruments and cutoff values, the predominance of cross-sectional designs, insufficient lung cancer-specific evidence, and a lack of longitudinal research. Future studies should adopt multicenter and longitudinal designs to improve dynamic assessment and the identification of high-risk patients, thereby providing evidence for targeted psychological support and stratified nursing care.