Psihološke reakcije dece i adolescenata na malignu bolest i lečenje - procena i podrška

Abstract

Cilj istraživanja za potrebe doktorskog rada bio je da se na uzorku dece i adolescenata koji su oboleli od različitih malignih bolesti i njihovih roditelja (N=120) ispitaju različite psihološke reakcije tokom aktivnog kombinovanog onkološkog lečenja. Psihološke reakcije koje su ispitane kod dece uzrasta (7 – 12 god.) (N=30) i adolescenata (13-19 god.) (N=30) su anksioznost (izmerena RCMAS skalom – The Revised Children`s Manifest Anxiety Scale), depresivnost (izmerena CDI upitnikom– The Children`s Depression Inventory), osećanje umora (ispitano FACIT - F scale – The Pediatric Functional Assesment of Chronic Illness Therapy – Fatigue scale), uz procenu doživljaja kvaliteta života (ispitano PCQOL – 32 instrumentom – The Pediatric Cancer Quality of Life Inventory) i mehanizama prevladavanja (ispitano instrumentom - KIDCOPE scale, dve verzije, jedna verzija za mlađu i jedna verzija za stariju grupu).Kod roditelja koji sa decom borave na odeljenju tokom kombinovanog onkološkog lečenja procenjeni su doživljaj kvaliteta života (ispitano Peds Q1-Upitnik za procenu kvaliteta života roditelja i procena detetovog kvaliteta života od strane roditelja PCQOL – 32 Parent Proxy Report Form) , umor (ispitano PFS instrumentom - Parent Fatigue Scale), mehanizmi prevladavanja (ispitano Brief Cope Parents Inventory – BCPI) i roditeljski stres (izmeren PSI/SF indeksom – Parenting Stress Index – short form). Porodična kohezija i porodična fleksibilnost (sa aspekta roditelja koji je uz dete tokom lečenja) ispitane su FACES IV paketom. Dobijeni rezultati: Statistički značajna razlika se pokazala na skali anksioznosti i to na subskalama: Fiziološka anksioznost (adolescenti imaju niži skor) (t=2.258, df=58, p=,028) (p<0,05) i Socijalna anksioznost (adolescenti imaju niži skor) (r=-.228, t=.0,40 (p<0,05).T testom za nezavisne uzorke testirane su razlike dece i adolescenata na ska-lama anksioznosti, depresivnosti, doživljaju umora, percepciji kvaliteta života i u načinu prevladavanja. Statistički značajne razlike su dobijene na skali depresivnosti i to na sledećim subskalama: anhedonia (deca iz mlađe grupe imaju viši skor) (t=2.274, df=58, p=.027) (p<0,05); nisko sampoštovanje (deca iz mlađe grupe imaju viši skor) (t=2.325, df=58, p=.024 (p<0,05); total skor na skali depresivnosti (deca iz mlađe grupe imaju viši skor) (t=2.125, df=58, p=.038 (p<0,05). Analiza je pokazala da statistički značajna razlika postoji na subskali fizičko funkcionisanje PCQL – 32 Patient Self Report skali kvaliteta života (dečaci imaju viši skor od devojčica (t=2.006, df=58, p=,049 (p<0,05). T testom za nezavisne uzorke testi-rane su razlike između dva pola dece preko skala za roditelje.Analiza je pokazala da statistički značajna razlika postoji samo na skali PCQL-32. Parent Proxy Report Form i to na subskali socijalno funkcionisanje (dečaci imaju viši skor) (t=2.00, df=58, t=.049 (p<0,05) (roditelji procenjuju da deca i adolescenti muškog pola lošije socijalno funkcionišu nego što oni sami sebe procenjuju)...

Using a sample of (N total=120), 60 children and adolescents who are affected by various malignant diseases and who are treated for different malignant diseases (ages 7 – 12) (N=30) and (ages 13 – 19) (N=30) and their parents (N=60), this study aimed to investigate different psychological reactions during the oncological treatment.The subject of the research - can psychological reactions such as: anxiety, depression and fatigue during the treatment be properly estimated and how they affect the quality of life and efficiency of the prevalence in children and adolescents aged 7 to 19 who are treated for different malignant diseases with existing instruments and with the objective to construct a model for providing adequate psychological and psycho-social support. Anxiety measured by following instrument RCMAS – The Revised Children`s Manifest Anxiety Scale; Depression measured by following instrument CDI – The Children`s Depression Inventory; Quality of life tested by following instrument PCQOL – 32 – The Pediatric Cancer Quality of Life Inventory; Fatique tested by following instrument FACIT - F scale – The Pediatric Functional Assesment of Chronic Illness Therapy – Fatigue scale; Coping measured by following instrument KIDCOPE scale- two different forms for younger and older group of children.Parents psychological reactions such as quality of life , fatique , coping mechanisms and parental stress, measured by following instruments : QOL (measured by PCQOL – 32 Parent Proxy Report Form and PCQOL – 32 Parent Proxy Report Form for parents assesment of children QOL), fatique (measured by PFS - Parent Fatigue Scale), coping mechanisms (measured by BCPI -Brief Cope Parents Inventory) and parental stress measured by PSI/SF – Parenting Stress Index – short form.Cohesion and stability of the family (from the aspect of a parent present during the tratment of the child) tested with FACES IV. Results: Statistically significant difference was also demonstrated on the anxiety scale (The Revised Children’s Manifest Anxiety Scale – RCMAS) and on subscales: Physiological anxiety (lower score in adolescents) (t=2.258, DF=58, p= 0,028) (p<0,05) and Social anxiety (lower score in adolescents) (r= -.228, t= 0,40 (p<0,05).We applied T tests for independent samples for testing the difference between pediatric and adolescent population (the first group of children age 7 to 12, and the other group of adolescents age 13 to 19) at the scale for anxiety, depression, fatigue experience, quality of life and way of coping. Analysis demonstrated statistically significant differencies at the depression scale (CDI - The Children Depression Inventory) on the following subscales: anhedonia (higher score in children) (t=2.274, df=58, p=.027) (p<0,05); low self-respect (higher score in children) (t=2.325, df=58, p=.024 (p<0,05); total depression score (higher score in children) (t=2.125, df=58, p=.038 (p<0,05)...