中医情志干预联合哀伤疏导对晚期肿瘤陪护家属心理状况的改善效果探究

Exploration of the Improvement Effect of Traditional Chinese Medicine Emotional Intervention Combined with Grief Counseling on the Psychological Status of Family Caregivers of Advanced-Stage Tumor Patients

摘要: 目的：探究从疾病终末期确诊起持续实施中医情志干预联合规范化哀伤疏导对晚期肿瘤主要陪护家属心理状态的改善效果，并观察干预结束后1个月、3个月的远期效应，为基层中医医疗机构构建覆盖疾病终末期至丧亲后的连续性家属心理支持体系提供实践依据。方法：选取2024年1月至2026年1月于本院临终关怀科首次确诊为恶性肿瘤终末期患者的核心陪护家属90例为研究对象，采用随机数字表法分为对照组与观察组，每组45例。对照组实施常规安宁疗护健康指导与一般性心理安抚；观察组在此基础上，同步实施辨证中医情志干预与阶段性哀伤疏导方案，干预自确诊终末期起启动，持续至患者离世，并延伸至丧亲后3个月内的随访支持。分别于干预启动前(确诊时)、患者离世后1个月、3个月，采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、延长哀伤问卷(PG-13)及健康调查简表(SF-36)对两组家属心理状态、哀伤程度及生存质量进行评估。结果：干预启动前，两组SAS、SDS、PG-13及SF-36各维度评分比较，差异无统计学意义(P > 0.05)。患者离世后1个月、3个月，两组SAS、SDS、PG-13评分均较干预前显著下降(P < 0.05)，且观察组各项评分均显著低于同期对照组(P < 0.05)；两组SF-36各维度评分均较干预前显著提升(P < 0.05)，且观察组提升幅度显著优于同期对照组(P < 0.05)；观察组3个月随访时各指标改善程度均优于1个月时(P < 0.05)，而对照组两时点间差异无统计学意义(P > 0.05)。同时，本研究干预实施过程中存在部分非预期问题与干预局限性，包括少数家属对“四道”沟通存在心理抵触、部分中医干预措施适配性不足、长期随访依从性波动等情况。结论：从终末期确诊即启动的中医情志干预联合系统化哀伤疏导，能持续有效地缓解晚期肿瘤陪护家属的焦虑、抑郁及哀伤情绪，并在患者离世后3个月内呈现持续改善趋势。该方案覆盖疾病终末期至丧亲后关键期，为基层中医医院构建连续性、全过程的家属心理支持服务提供了可行路径。

Abstract: Objective: To explore the improvement effect of continuous traditional Chinese medicine emotional intervention combined with standardized grief counseling initiated from the confirmation of end-stage disease on the psychological status of primary family caregivers of patients with advanced tumors, and to observe the long-term effects at 1-month and 3-month follow-ups after intervention, so as to provide practical evidence for grassroots traditional Chinese medicine medical institutions to establish a continuous psychological support system for family members covering the period from end-stage disease to post-bereavement. Methods: A total of 90 core family caregivers of patients newly diagnosed with end-stage malignant tumors in the Department of Hospice Care of our hospital from January 2024 to January 2026 were enrolled as research subjects. They were divided into control group and observation group by the random number table method, with 45 cases in each group. The control group received routine palliative care health guidance and general psychological comfort. On this basis, the observation group was given syndrome-differentiated traditional Chinese medicine emotional intervention and phased grief counseling. The intervention was initiated upon confirmation of end-stage disease, lasted until the patient’s death, and was extended to follow-up support within 3 months after bereavement. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Prolonged Grief-13 Questionnaire (PG-13), and the 36-Item Short-Form Health Survey (SF-36) were adopted to assess the psychological status, grief level and quality of life of family members in both groups before intervention (at diagnosis), 1 month and 3 months after the patient’s death. Results: Before intervention, there were no statistically significant differences in the scores of SAS, SDS, PG-13 and all dimensions of SF-36 between the two groups (P > 0.05). At 1 month and 3 months after the patient’s death, the SAS, SDS and PG-13 scores of both groups decreased significantly compared with baseline (P < 0.05), and the scores in the observation group were significantly lower than those in the control group at the same time points (P < 0.05). All dimension scores of SF-36 in both groups increased significantly compared with baseline (P < 0.05), and the improvement in the observation group was markedly superior to that of the control group (P < 0.05). In the observation group, the improvement of all indicators at the 3-month follow-up was better than that at the 1-month follow-up (P < 0.05), whereas no statistically significant differences were found between the two time points in the control group (P > 0.05). Meanwhile, several unanticipated issues and intervention-related limitations emerged during the implementation of this study, including psychological resistance to the “Four-Step Communication” among a small number of family members, insufficient adaptability of some traditional Chinese medicine interventions, and fluctuating compliance with long-term follow-up. Conclusion: Traditional Chinese medicine emotional intervention combined with systematic grief counseling initiated immediately after the diagnosis of end-stage disease can continuously and effectively relieve anxiety, depression and grief among family caregivers of advanced-tumor patients, with a sustained improving trend within 3 months after the patient’s death. Covering the critical period from end-stage disease to post-bereavement, this protocol offers a feasible approach for grassroots traditional Chinese medicine hospitals to construct continuous whole-process psychological support services for family members.