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VAI TRO CUA YEU TO CHAP NHAN DOI VOI KIEU Q N G PHO BENH NHAN UNG THU PGS.TS Nguyen Thi Minh Hang Ngo Thi Thuy Linh Tran Thj Nhung • Ti-irdiig Dai hgc Khoa hoc Ki hgi vli Nhan mn Dgi hgc Qudc giu Ha Ngi TOM A T dung ndng luc chdp nhdn trgng tdm ly tr Nghien cuu dua tren md hinhTung lieu cua S.C Hayes vdi ten ggi la Tri lieu chdp nhdn vd cam ket (acceptance and commitment therapy - ACT), dugc tiin hanh tren 120 benh nhdn ung thu Nghien ciru nhim xdc dinh mdi lien he gida ndng luc chdp nhdn vd kiiu ung phd vdt benh a benh nhdn ung thu Cde cong cu nghien cim la 1) Thang Chip nhdn (the acceptance subscale of the Philadelphia mindfulness scale - PHLMS) cua Cardaclotto, Herber Forman, Moitra vd Farrow (2008); 2) Thang Ifng phd (COPE scale) eia (Carve Scheier vd Weintraub (1989) Kit qud nghien ciru cho thdy, benh nhdn nam chip nhdn cao han benh nhdn na, tuii ddi lan han thi chap nhdn eag han Khdng cd moi tuang quan giUa chip nhan vd irng phd tap trung vdo vdn de, ngugc lai, ed tucmg quan nghich giUa chip nhdn vd ung phd tap trung vdo edm xuc vd img phd ne trdnh ling ne trdnh ciing la yeu td cd khd ndng du bdo manh nhdt ndng luc chdp nhdn cua benh nhdn ung thu Tren ca sd cua ket qud nghien cuu ndy, cdc khuyen nghi ve viee d dung yeu td chdp nhdn chdm sdc gidm nhe vd tdm ly tri Heu cho benh nhd ung thu cung nhu nhirng ggi md cho cdc nghien cuu tuang lai da dugc thdo ludn Tir khoa: Chdp nhdn; Ling pho; Ung phd vdi benh; Benh nhdn ung thu Ngdy nhdn bdi: 7/3/2019; Ngdy duyet ddng bdi: 25/3/2019 Dat van de Ung thu la nguyen nhan hang dau gay tu vong tren toan thi gidi, ude tinh khoang 9,6 trieu ca tit vong vao nam 2018 (WHO, 2018) Nhttng nghien ciru ve benh nhan ung thu da chu trgng den nhung vin di lien ouan den nhimg thay ddi sinh ly, xa hdi va dac biet la tiim Iy Ngoai nhung thav ddi sinh ly nhanh ehdng va cd the la dot ngpt thi cac vin di xa hdi ciins oSv nhieu kho khan va bat Igi, cd the lam giam su tuan thii diiu tri, tu dd ' h 46 TAP CHi TAM LY HOC, S6 (241), 2019 hudng Idn din sue khde eua bpnh nhan Cae vin di xa hdi ma benh nhan ung thu phai ddi mat bag gdm: thilu thdng tin hoac ky nang ein thilt di ung phd vdi benh tat; gian doan edng viee, hpc tap, eude sdng gia dinh dao Idn; eang thing tai chinh (Adler, Page, 2008) Dae biet, eac vin dl tam ly cua benh nhan ung thu rit da dang, phttt; tap va thudng biiu Men d mtte trim trpng Cae nghien ettu tam ly eho thay, hau het benh nhan ung thu diu roi vao trang thai dau khd (distress) (Sehlen va cdng sy, 2003) Trong dd, 23,4% sd benh nhan ung thu tidu hda va 40,9% sd benh nhan ung thu vu d trang thai rit dau kho (Hersehbach va edng sy, 2004) Cd 28% sd benh nhan ung thu duge chin doan mac rdi loan tam than, dd cd 26% sd benh nhan ed dilm sd eao vl trim eain va lo au (Keller va cdng su, 2004) Trong nhilu nghien euu khae, lo au va tram cam ciing la hai loai rdi loan tam than biin nhit d benh nhan ung thu (Nikbakhsb va edng sy, 2014; Kbalil va cdng sy, 2016) Nhu vay, khdng chi chju dyng dau ddn tbi ehit ma nhttng benh nhan ung thu edn phai chiu dyng ndi dau tam Iy, tinh than rat Idn Thye trang dat nhieu thaeh thuc eho y hge va ea tam ly hoc viee hd trp benh nhan ung thu vugt qua benh tat va rdi loan tam ly benh tat gay Trong nhttng nam gan day, bien phap eham sde giam nhe da phd bien tren the gidi va dan din duge biet den d Viet Nam Cham sde giam nhe (palliative care) tap trang vao lam giam trieu ehiing va eae bien ehung dieu tri gay ra, tang cudng chat lugng sdng va hd trg eho benh nhan eung nhu gia dinh cda hg, bao gdm ca hd trg tam ly Mdt nhung ngi dung cham sdc giam nhe cho benh nhan ung thu la giup benh nhan tang cudng tinh linh boat tam ly (psychological flexibility) va chanh niem (mindfulness) di chap nhan eae trai nghiem tieu cue rapt each nhe nhang hon Nhieu nghien euu cho thay, yeu td chap nhan da lam giam stress, lo au, tram cam va eae rdi loan tam ly khae (Carver va edng su, 1993; Campbell-Sillsa va edng sy, 2006) Trong thdi gian theo ddi tu din thang sau dieu tri, ed din 78% sd benh nhan rdi loan lo au da khdng edn dap img eae tieu ehuin chin doan sau duge diiu tri bang lieu phap dya tren sy chip nhan va 77% sd benh nhan dat dugc eae chuc nang sdng d mtte cao (Roemer va cdng sy, 2008) Ruiz (2010) da phan tieh ban 30 nghien ettu va di din nhan djnh ring, ed mdi lien be giua sy chip nhan vdi eac trieu ehung benh ly va eae eiu true tam ly khae Chip nhan noi dau ed the giai thich duge sy thoai mai, di chiu vl tbi ehit va tam thin (Wicksell, Renofalt, Olsson, Bond, Melin, 2008), lam giam dau, giam sg van ddng, giam trim cam, tang mtte hai long vdi eude sdng va tinh linh boat tam ly d nhttng benh nhan dau man tinh (Wicksell, Ahlqvist, Bring, Melin, Olsson, 2008) Cae nghien ettu cung eho thiy, su chip nhan la biin sd ed the dy bao duge hieu qua dng phd vdi benh tat va rdi loan ehue nang tdt ban so vdi eae chiin luge ung phd khae (MeCracken va Eecleston, 2006; Campbell-Sillsa va cdng su, 2006) Ddi vdi benh nhan, dae TAPCHiTAM LY HOC, Sd4 (241), 4-2019 47 biet la benh nhan ung thu, chip nhan tinh trang benh va nhung cam xue euc phat sinh cd anh hudng tich euc din dilu tri (Kratz, Davis va ^aui , 2007) Chip nhan eung la biln sd giai thich dugc tinh trang boat Wng en nang va sy phyc bdi chttc nang eua benh nhan (Esteve va cdng su, im , MeCracken va Vowles, 2007; MeCracken va Zhao-O'Brien, 2011.) Ttt nhiiu bing Chung nghien euu, tri lieu chip nhan va cam ket (aceptance and commitment therapy - ACT) dugc thiet ke tap trang vao vige hudng din benh nhan din din chip nhan cac cam JiiSe va cam xiic tieu eye eua ban than eung nhu tao sy cam kit diiu trj Tri lieu chap iihan va earn kit duge danh gia la tiip can tri lieu rit cd hieu qua ddi vdi nhieu rdi loan ehue nang eung nhu roi loan tam ly va thudng xuyen dugc ap dung cho benh nhan, dd cd benh nhan ung thu dang giai doan dieu tri (Branstetter va edng sy, 2004; Ruiz, 2010; Feros va cdng su, 2013) va ca giai doan tai boa nhap (din theo Landy, Schneider, Arch, 2015) Nhu vay, nhiiu bing chung nghien euu eho thiy, chip nhan cd vai trd quan trgng viec giiip mgi ngudi ndi chung va benh nhan ung thu ndi rieng duong diu vdi nhung khd khan, eang thing cupc sdng Tidp can tri lieu dya tren ly thuyit chip nhan cung dugc ehung minh la cd hieu qua ddi vdi eac rdi loan tam ly ndi chung va nhttng van de tam ly d benh nhan tmg thu ndi rieng Tuy vay, g Viet Nam, viec dng dung yeu td chap nhan ndi chung va tri lieu chap nhan va cam ket ndi rieng cdn rat mdi me va hau nhu chua duge nghien euu Vdi mue di'ch tim nhiing bang chung cu the ve mdi lien he gitta chap nhan va ung phd vdi benh cung nhu stress benh giiy di eung cip eg sd khoa hpc eho cham sdc giam nhe cung nhu trj lieu chap nhan va earn kit ddi vdi nhttng ngudi cd vin lie tam ly ndi ehung va benh nhan ung thu ndi rieng d Viet Nam, chung tdi da tien hanh nghien ciiu Cau hoi nghien cu'u Cac cau hdi nghien cim ma chiing tdi k^ vpng sg tim eau tra loi bao gdm: Benh nhan ung thu chap nhan hay khdng chip nhan tinh trang benh tat cila hp? Neu cd, hg chip nhan d mue dp nao? Su chap nhan hay khdng chip nhan cd anh hudng nhu thi nao din each ttng phd vdi benh tat d benh nhan ung thu? Khai niem 3.1 Chap nhan Cac tiep can tri Heu nhan thtte va banh vi trayin thdng thudng duoc van hanh theo nguyen tic ehung la "ehdng lai hoae ne tranh" ("fight or flight'"! nghia la than chu dugc hudng din each thue kiim soat cac y nghi va cam ' 48 TAP CHi TAM LY HOC, SS (241), 4-2019 tieu eye eua ban than Khae vdi nguyen tie dd, vao nhung nam 80 eila tbi ky XX, S.C Hayes da di xuit mgt each tilp can tri lieu mdi ma triit ly nln tang la su chip nhan va earn kit hanh dgng di thay ddi Theg dd, khai niem chdp nhdn (acceptance) dugc hieu la su col ma vd sdn sdng trdi nghiem tdt ed cde hien tugng tdm ly ben trong, bao gim y nghi, cdm xic vd cdm gide md khong thay sii, ne trdnh hay kiim soat chung (Hayes, 1987; Hayes, Wilson, Gifford, FoUette va Strosahl, 1996) Chip nhan ehinh la each ling phd edi md va ty do, thuan theo ty nhien nhit, eho phep ehung ta ddi xu tdt vdi ehinh minh, Kr bi vdi ban than sy hien dien eua sy khd chju hay noi dau di chung di qua Nguge lai, neu ehiing ta ne tranh hay ed kiem soat ehung tbi sy khd cMu va ndi dau chi hi hi hoan va tieh tu lai ma thdi, dd, sy kiim soat ed thi lam eho ehung ta kiet sue va den mdt luc nao dd ehiing ta se bi "danh gue" bdi sy khd chiu nhieu hem va ndi dau Idn hon Trong tri lieu chap nhan va cam kit, sy chip nhan duge bpc hdi thdng qua viee tang cucmg tinh linh boat tam ly vdn la "nang lyc tiip xuc vdi giay phut hien tai mdt each trpn ven va cd y thirc di thay ddi hay tri hanh vi nham dat den mpt mue dich cd gia tri (Hayes, Luoma, Bond, Masuda va Lillis, 2006, trang 7) De biet each chap nhan, chap nhan benh tat ndi rieng va chap nhan nhttng trai nghiem tieu eye ndi ehung, de chap nhan khdng ddng nghTa vdi buong bd hay budng xudi, ea nhan phai cd sy bilu biet va thich ttng linh boat Ddi vdi benh nhan ung thu, viee hilu vi tien trinh benh, kha nang khach quan cila viee ehua tri cung nhu qua trinh lao hda tat yeu cua co the de ed sy thich ling phu hgp la vd edng quan trpng Thich irng d day la khdng trdn tranh ma ddi mat dl giai quylt vin di Yiu td chip nhan giup benh nhan ung phd tot vdi cac y nghl phi ehue nang, cam xue tieu eye va cam giac khd chju de quyet tam thue Men nghiem tue phae dd diiu tri cung nhu tuong tac tdt vdi bae si dieu tri, nhan vien y te va ngudi than cua minh Nhu vay, nghien cim nay, khai niem chap nhan khdng ddng nghTa la su bit luc budng xudi ma la nang lyc nhan dien van de, cdi md va linh boat vdi cacfrainghiem tieu cue, thieh iing tdt vdi tinh ttang benh va qua ttinh digu tti 3.2 Ung Trong Tam ly hpc, ed mdt sd each tiip can nghien cira irng phd cua ea nhan, nhien each tilp can phd biln nhit eoi ttng phd la sy nang ddng cua chu thi ddi vdi hoan eanh thugc vl Lazarus va Folkman (1984) Thei) hai tac gia nay, itng Id su thay ddt nhdn thuc vd nd luc eia ed nhdn nhdm phdn img Igl vdt hodn ednh co nhirng thdeh thiic md cd nhdn ddnh gid Id vuat qud ngudn lue eia hg (Lazarus va Folkman, 1984) Theo dd, cd hai each ung phd CO ban la: I) ung phd tap trang vao vin di, 2) ung phd tap trang vao cam xue Sau dd khdng lau, mdt sd tac gia khae di xuit them ung phd ne tranh, ed nghia TAP CHi TAM LY HOC, Sd (241), - 2019 49 la lang tranh vin dl, lam nhang su ehu y cua ban than (_Ro"i , ;.„ 1986; Anshel, 1996) Tilp nhan quan diem cua cae tac S'^,**"' '™ S-j nhan cuu nay, chung tdi hiiu ttng phd eua benh nhan ung thu la sy may ^^ thiic, cam xuc va banh vi eua ca nhan nham ung phd lai vgi tinh trang oe va nhttng cang thing benh tat gay Phu-ong phap nghien ciiu 4.1 Mdu nghien cdu vd edeh thde thu thgp so lieu ^ Nghien euu duoc tiln hanh vdi cho phep ciia Benh " ? " »?'[j^f ^ Ndi va Benh vien K Ha Ndi, ngudi nha benh nhan va benh nhan Ph>euJchao sat duoc phat cho benh nhan tai cae khoa ma benh nhan dang dieu tti Da sd benh nhan tu tra Idi philu, sd it benh nhan dugc ngudi khao sat dpe, gm thieh, sau dd benh nhan W diln vao phuong an tra Idi ma hg lya ehgn^So lugng benh nhan tham gia vao nghien ciiu la 120 ngudi Dudi day la cae bien sd nhan kbiu va biin sd vi benh cua miu nghien ettu Bdng 1: Cde dde diim nhdn khdu xd hpi vd dgc diem benh eia benh nhdn (N = 120) Bien so (%) (%) Nam 35,0 Co kho khan 71,7 NQ' 65,0 Khong kho khan 28,3 So dat dieu tri hoa chdt Tudi (DTB = 47,63 DLC = 11.21) TCr 18-38 tuoi 21,7 dot 12,5 Tir 39 - 59 tu6i 62,5 - dot 19,2 Tir 60 luoi tro len 15,8 - dot 12,5 Hon dgt 55,8 Que qudn Nong thon 59,2 Loai benh Thiinli thi 29,2 Vu 31,6 Mien niii 11,7 Da day 17,5 Phoi 17,5 Thdi gian mac benh 50 Tyle Kho khdn ve kinh le Gidi linh Bien so Tyle Dirai thann 35,8 Dai true trang 10,0 6-12 Ihang 32,5 Buong triing 8,3 TAP CHi TAM LY HOC, So' (241), - 2019 - nam 12,5 Hach Hem nam 19,2 Co tir cung Thirc quan 2,5 1,7 Thdi gian dieu tri 4,2 Dir6i thang 48,3 Luai 6- 12 thang 28,3 Xir ong 1.7 - nam 8,3 Tuyen 0,8 Hon nam 15,1 * Bgo dire nghien ciru: Nha nghien cuu gidi thieu vdi benh nhan va nguoi nha eua hg ve mye di'eh nghien cuu, ndi dung ea ban eua phieu dieu tra, quyen tu ehdi tra Idi phieu dieu tra Viec dieu tra bang phieu khao sat eung nhu phdng van sau ehi duge thye hien benh nhan hoan loan ty nguyen va hoan loan thoai mai, khde manh di dam bao khdng anh budng den sue khde cua hg cung nhu xac thye eua thdng tin thu duge Trong qua trinh thu thap sd lieu, can bd khao sat da hd trg tam ly cho mgt sd benh nhiin bang each hdi tham, trd chuyen di hg cam thay vui ve, de chiu hem Mdt sd benh nhan (theo nhu eau ciia hg) dugc gidi thieu eae dia ehi tham kham tam ly ed uy tin d Ha Ndi de hg CO the tilp can can 4.2 Cong eu lu&ng 4.2.1 Thang Chdp nhdn Nghien ciia da su dyng tiiu thang Chap nhdn (the acceptance subscale of the Philadelphia mindfulness scale - PHLMS) Cardaclotto, Herbert, Forman, Moitra va Farrow dl xuit nam 2008 Thang gdc PHLMS dugc thilt kl gdm 20 eau ehia lam tilu thang la tilu thang Chap nhan (10 eau) va tiiu thang Nhan thue (10 eau) Cdng eu duge thiet ke theo thang Likert mue dp Tilu thang Nhan thue va tilu thang Chap nhan la hai nhan td dde lap nen ed thi nghien cuu tiSch rieng (Cardaclotto va edng sy, 2008) Do vay, nghien euu nay, ehung tdi khdng su dung tieu thang Nhan thuc (awareness) ma ehi su dung 10 cau tiiu thang Chap nhan de mue dp chip nhan cua benh nhan Vi du vi mdt so cau thang Chap nhan la: 2- Cd nhirng diiu vi bdn thdn minh md tot khong muon nghi den; 7- To/ tif nhi rdng tot khong nen cdm thdy budn; 10- Khi^ cd mpt ky ire xdu, tdi ed gdng ldm nhang bdn thdn di quen nd di Diim sd eua thang duge tinh bang ting diem eac eau ma khach thi lua ehpn (cd 10 eau tit ca, mdi cau b?ic) Tiiu thang Chip nhan nguyen goe duge quy diim ngupe, nghia la diem cang cap thi mue dp chip nhan eang thip, vi vay, nhap sd lieu chung tdi da TAP CHi TAM LY HOC, Sd (241), - 2019 51 dao diim lai Do vay, dilm trang binh eang Idn tbi mue dp chip nhan b?nh eua benh nhan ung thu cang cao Kiem dinh dp tin cay bang be so Alpha Cronbaeh a = 0,87 cho thay thang cd dp tin eay eao 4.2.2 Thang ifng phd Dl ludng each thuc ung phd cua benh nhan ung thu, ehiing tdi da xay dmig thang tren eo sd tham khao thang l/ng phd (COPE scale) eua Carver Scheier va Weintraub (1989) Thang gde COPE ed 14 tieu thang (5 tiiu thang thudc ung phd tap trung vao giai quyet van de; tieu thang ung plio tap ttung vao cam xuc va tilu thang ung phd ne tranh) Mdi tieu thang co cau vdi mue do: 1- khdng bao gid, 2- hiim khi, 3- thinh thoang, 4- thudng xuyen va 5- ludn ludn Chung tdi da bd tilu thang Chap nhan (thudc kieu ung tap trang vao cam xue), ebon cau d mdi tilu thang edn lai va sua ddi eho phu hgp vdi nghien eim ttng phd cua benh nhan ung thu Nhit vay, thang mdi gdm 26 cau Vi du vi mdt so cau: 1- Tot nd lue tudn thi diiu tri; 14- Toi chu dpng tim kiim thong tin vi benh vd cdeh diiu tri; 20- Toi tiii ring benh tdt la thir thach de tot mgnh me, truang thdnh han; 21- Tot cau khan vd ldm nhirng viec tam linh md toi tin tuang Do tin cay cua tiiu thang LTng phd tap trung vao van de la 0,698; tieu thang LTng phd tap trang vao cam xue ed a = 0,650; tieu thang iTng phd ne tranh cd a = 0,603 Bang hdi cac biin sd nhan khiu - xa hdi va bien sd ve benh bao gdm: gidi tinh, tudi, dia ban sinh song trude mac benh, khd khan ve tai ehinh, thdi gian mac benh, thai gian dieu tri, sd dgt dieu tri hda ehat, loai benh Ket qua nghien ciru 5.7 Mire dp chdp nhgn & benh nhdn ung thu Ket quii phan tich du lieu cho thay, loan bd nhdm benh nhan dupe nghien cuu cd diem trung binh chap nhan la 3,14 (DLC = 0,83), gia tri nhd nhat la 18 va gia tri Idn nhat la 49 Nhu vay, mtte dp chap nhan eua nhdm bdnh nhan ung thu d khoang trang binh So sanh cac nhdm benh nhan khae theo biin sd nhan khiu va bien sd benh cho thay, khdng cd su khae biet giua cae nhdm benh nhan xet theo dia ban sinh sdng trudc mic benh, thdi gian mic benh, thdi gian dilu tri, sd dgt dieu tri hda chat ya khd khan tai chinh (p > 0,05) (bang 2) Dg cd loai ung thu chi cd mdt ho^c hai benh nhan mic phai nen chiing tdi khdna so sanh chap nhan theo bien sd 52 TAP CHiTAM LY HOC, sa (241).4-2019 Bang 2: So sdnh mirc dp chap nhdn a cde nhom benh nhdn theo bien so nhdn khdu vd biin sd benh (N = 120) Cac bien so nhSn khau N BTB DLC Nam 42 3,35 0,81 Nii 78 3,03 0,82 Tirl8-38tu8i 26 2,55 6,01 Tir 39 - 59 tu6i 75 3,28 8,10 Tir 60 tuoi trd len 19 3,42 8,29 Nong thon 71 3,21 0,84 Thanh thi 35 3,16 0,84 Giii tinh Tuoi Dia ban sinh song Th6i gian mac benh Th6i gian dieu tri Kho khan t^i chinh Mien nui 14 2,77 0,65 Dual thang 43 3,20 0,79 - thang 39 3,02 0,79 1-2 nam 15 3,22 0,91 Hon nam 23 3,18 0,92 Dudi thang 58 3,14 0,79 - 12 thang 34 3,07 0,80 1-2 nam 10 3,01 0,94 Hem nam 18 3,36 0,94 Co 86 3,09 0,79 Khong 34 3,28 0,91 t/F 37,737 < 0,001 10,011 0,001 1,691 0,189 0,397 0,755 0,566 0,639 -1,145 0,255 Trong dd, ed sy khae biet giua nam va ntt ve rnuc dp chap nhan (t = 37,737; p < 0,001), eu thi, benh nhan nam ed mue dp chip nhan cao hon so vdi benh nhan nu Tuong tu, ed sy khae biet gitta eae nhdm mdi theo xu hudng ngudi eang Idn mdi tM miic chip nhan benh cang cao F(2,117) = 10,011; p < 0,001 5.2 ifng phd cda benh nhan ung thu Dilm trang binh ung phd tap trung vko vin di eao nhat (DTB = 3,48; DLC = 0,52), tilp din la ttng phd tap trung vao e t o xue (DTB = 3,38; DLC = 0,60) va thip nhit la ttng phd ne tranli (DTB = 2,02; DLC = 0,47) Nhu vay, benh nhan ung thu thudng ed xu hudng tim eae giai phap eho vin de dang gap TAPCHiTAM LYHOC, Sd'4 (241), - 2019 53 phai hon la chi tap trang vao cam xuc ciia ban than Hg eung It ne tranh van de hay khd khan eua ban than Bdng 3: Ifng phd tap trung vdo idn di a benh nhdn ung thu (N - 120) Tan suat (%) iTng tap trung vao van de No luc tuan thii dieu tri BTB DLC 56,7 4,52 0,59 13,3 2,79 1,47 TT TX LL 0,0 5,0 28,3 KBG HK 0,0 Dal thu- tir uu lien cho timg viec phai lam 31,7 11,7 15,8 27.5 Tap n-ung, khong de viec nao khae anh 0,0 3,3 15,0 42,5 39,2 4,17 0,86 Kilm che ban than dl khong lam bSt cu dieu gi thieu kiem soat 6,7 7.5 31,6 42,5 11,7 3,45 1,02 Xin loi khuyen til' chuyen gia, bac sT, y ta 6,7 15,8 31,7 37,5 8,3 3,25 1,03 Chil dong liin kiem tliong tin ve benh va each dieu tri 11,7 9.2 28,3 48,3 2,5 3,21 1,05 Len ke hoaeh hanh dpng ciia rieng minh thoi gian dieu iri 31,7 25,8 23,4 18,3 0,8 2,31 1,12 De ban than khong bi phan tam boi suy nghT va hanh dgng khae dieu tri 17 4,1 24,2 50,0 20,0 3,83 0,85 Khong de cho vin dl toi le hon hanh dong qua voi vang 2,5 3,3 26,7 43,3 24,2 3,83 0,92 Hoi kinh nghiem cac benh nhan khae 5,0 6,7 31,7 44,1 12,5 3,53 0,97 Ghi chii: KBG: khong bao gia; HK: hiim khi, TT: thinh thoang TX- thu&ng xuyen; LL: luon luon Tieu thang LTng phd tap trung vao vin di bilu bien d viee ehu dpng ung phd, len ke hoaeh giai quyit vin di, tap ttung giai quylt vin dl, kiim ehi phan ung, flm kiem hd trg xa hdi vi vat ehit Trong eac each dd, benh nhan ung thu sir dung nhieu nhat la tap trung giai quyit vin dl va kiim ehi phan ung Cu the, eac each dugc benh nhan thudng xuyen va ludn ludn sit dung la- nd lue tuan thu dieu tri (85%), tap trung vao diiu tri va khdng di viec gi khae anh hudng den dieu tri (81,7%), giu cho ban than khdng bi phan tam bdi eac suv nghl va hanh ddng khae dieu tti (70%), khdng dl cho vin di tdi td hon hanh dgng qua vdi vang (67,5%) Tuy nhien, chu ddng itng phd ieh' dgng len ke hoaeh, tim kiem thdng tin vl benh, trao ddi/xin Idi khuye t" 54 TAP CHITAM LY HOC, Sd (241), 4•2019 chuyen gia, bac si, y ta) la eaeh ung phd rit hieu qua dieu tri benh ndi chung va dac biSt quan trong dilu tti ung thu thi chua duge benh nhan thuc hien nhieu (bang 3) Bdng 4: (fngpho tap trung vdo cdm xie a benh nhdn ung thu (N = 120) iTiig tap trung vao cam xuc Tan suat t"io) DTB DLC 10,8 3,55 0,96 49,2 15 3,67 0,91 11,7 37,5 43,3 4,15 0,95 28,3 28,3 7,5 2,86 1,25 19,2 25 12,5 2,80 1,40 22,5 38,3 7,5 3,04 1,23 50 15,8 3,61 1,02 KBG HK TT TX LL Chia se cam xuc ciia minh vai nguoi khae 1,7 12,5 25,8 49,2 Tim su h6 trg tinh thiin tir nguai than va ban be 2,5 7,5 25,8 L?c quan rang minh se duac chiia khoi benh 1,7 5,8 21,7 14,2 Tim su an ui ton giao 26,6 16,7 CSu khan va lam nhflng viec tam linh 17,5 14,2 Hanh dong nhu the benh tat khong anh hudng gi toi minh 3,3 14,2 16,7 Tin rang benh tat la thir thach de minh manh me han, truang han Ghi chu KBG: khong bao gid; HK: hiim khi; TT thinh thoang; TX: thucmg xuyen; LL: luon luon LTng phd tap trang vao cam xuc ed nhdm eo ban, la tim kiem hd tro xa hgi ve tinh cam, diln giai tieh eye, tim den tdn giao Bang cho thay, ung phd tap trang vao cam xue d benh nhan ung thu the hien nhieu nhat d su dien giai tich eye va tim kiim sy hd trg xa hdi Diln hinh nhit la benh nhan thudng xuyen va ludn ludn lae quan ring minh se duge ehua khdi benh (80,8%) Nhung each ttng phd bing cam xue khae cung dupe sii dung nhieu, la chia se cam xic eua minh vdi ngudi khae (60%), tim sy hd trg tinh thin tu ngudi than va ban be (64,2%), hanh ddng nhu thi benh tat khdng anh hudng gi tdi minh (65,8%) Tiiu thang LTng phd ne tranh gdm nhdm hanh vi: trut bd cam xue, budng xudi hanh vi va budng xudi tinh thin Trong ba nhdm treii, benh nhan ung thu su dung nhiiu nhit la budng xudi tinh thin, diin hinh nhat la "Khi cd nhung cam xue, suy nghl tieu eye thi tim viee khae de lam" (67,5% sd benh nhan thudng xuyen va ludn ludn lam nhu vay, DTB = 3,64; DLC = 0,90) hay TAPCHiTAM LYHOC, Sd'4 (241), - 2019 55 "Mo mong vi nhttng thu khae" (36,7%; DTB = 2,96; DLC = 1,20) ^^f^^^ ttng phd ne tranh khae mang tinh tieu eye ban nhu budng xuoi hanh vi (m dung viec diiu tti bay su dung thudc la, rugu, bia) thi benh nhan ung tnu ehpn su dung Bdng 5: Ung phd ne trdnh a benh nhdn ung thu (N - 120) ran suat (%1 DTB BLC 4,2 2,55 1,25 7,5 0,0 1,94 0,98 10,8 2,5 0,0 1,41 0,78 13,3 21,7 5,0 0,0 1,72 0,97 4,2 5,8 22,5 56,7 10,8 3,64 0,90 Mo mong ve nhieu thir khao 18,3 14,2 30,8 30,0 6,7 2,93 1,20 Sir dung thuoc la hoac ruon, bia 95,8 2,5 1,7 0,0 0,0 1,06 0,29 Sir dung thuoc an than 84,1 7,5 6,7 1,7 0,0 1,26 0,65 65,9 9,2 13,3 8,3 3,3 1,74 1,17 iTng ne tranh KBG HK TT TX LL Thi hien nhirng cam xuc bu6n rat nhilu 25,8 24,2 23,3 22,5 Thi hien cam xiic tieu cue 43,3 26,7 22,5 Muln dung viec dieu tri benh 75,0 11,7 Thira nhan minh khong the doi 60,0 Khi CO cam xiic, suy nghT tieu cue thi tim viec khae de lam Tu noi rang "Day khong phai la sir that" Ghi chit: KBG: khong bao gid: HK: hiem khi; TT: thinh thoang; TX: thudng xuyen; LL: luon luon Ket qua kiem dinh T-test cho thiy, khdng cd sy khae biet ed y nghia ttong ttng phd tap trang vao van de gitta nam benh nhan va ntt benh nhan (p > 0,05), nhung ed sy khae biet cd y nghia ung phd tap trung vao cam xue (1(118) = -3,968; p < 0,01) va ung phd ne tranh (t(I18) = -2,421; p < 0,05) Theo dd, benh nhan ntt cd mue dp ung phd tap trang vao cam xue (DTB = 32DLC = 0,57) cao hon benh nhan nam (DTB = 2,89; DLC = 0,56) va miie' dd ung phd ne tranh d ntt (DTB = 2,13; DLC = 0,42) eung cao hon so vdi nam gidi (DTB = 1,92; DLC = 0,52) Tdm lai, benh nhan ung thu nghien ettu thudng ttng phd vdi benh bing each tap trang vao diiu tri, kilm chi phan ttng di nhttng khd khan cua minh khdng phuc tap them, nhin nhan benh tat mgt each tich cue va f 56 TAP CHiTAM LY HOC, Sd (241), 2019 kilm sy hd trg xa hdi Ben canh dd, benh nhan eung kha thudng xuyen su dung each ling phd ne tranh nhu tap trung vao mgt ddi tugng khae di tam thdi quen di benh tat va nhttng khd khan eua minh Hg eung it su dung cae each ung phd tieu cue nhu sd dung chit kich thieh Tuy nhien, nhttng each ttng phd tieh eye hon nhu chu ddng tim kilm thdng tin hay trao dc^i, xin Idi khuyen eua bae si va nhan vien y te ehua duge benh nhan thye hien nhilu Phan tieh tuong quan Pearson eho thiy, ttng phd tap trung vao vin dl ed tuong quan thuan vdi ling phd tap trung vao cam xuc (r = 0,296; p < 0,01) va tuong quan nghich vdi ung phd ne tranh (r = -0,184; p < 0,05), dd, ling phd tap trang vao earn xuc khdng cd mdi tuong quan vdi ung phd ne ttanh (r = -0,133; p > 0,05) Dieu ehung td ring, eang ung phd tap trung vao vin di thi benh nhan ung thu eang ed xu hudng ung phd tap trung vao cam xuc hoac ngugc lai Ben canh dd, eQng ed thi nhan dinh ring, eang ttng phd tap trung vao vin de va tap trang vao cam xiie tbi benh nhan eang it ung phd ne ttanh bang nhttng each thue tieu eye Anh htrdug ciia sir chap nhan den trng vdi benh tat d benh nhan ung thtr Bdng 6: Khd ndng du bdo da yeu to chdp nhgn doi vol kieu irng phd a benh nhdn ung thu Bien so R= R'A He so chua ehuan hoa He so ehuan hoa B SE P t P ling tap trung vao van de 0,034 0,026 0,116 0,057 0,184 2,037 0,044 Ung tap trung vao cam xuc 0,115 0,108 -0,247 0,063 -0,340 -3,921 < 0,001 Ung ne tranh 0,285 0,279 -0,305 0,044 -0,534 -6,860 < 0,001 Phan tieh dtt lieu bing ttrcmg quan Pearson cho thay, chap nhan benh va ling phd tap ttung vao vin dl ed tuong quan thuan vdi (r = 0,184; p < 0,05), chap nhan tuong quan nghich vdi ung phd tap trung vao earn xue (r = -0,340; p < 0,01) va ling phd ne ttanh (r = -0,534; p < 0,01) Dilu cd nghia la eang chip nhan benh tat bao nhieu thi benh nhan ung thu cang tim each giai quyet van di cua minh biy nhieu va eang it tim kiim su hd trg vl cam xue, it trut bd cam TAP CHi TAM LY HOC, Sd (241), - 2019 57 xuc, it tim din sy hd trg cda tam linh va it budng xudi ve tinh than cung nhu hanh vi hoac ngugc lai Kit qua phan tich hdi quy tuyin tinh dan biin vdi biln sd dgc lap la chip nhan va tung biin sd phu thupe la ung phd tap trung vao vin de, ttng tap trung vao cam xdc va ung phd ne tranh duge the hien d bang Sy chip nhan benh cd thi dy bao dugc 3,44% ttng phd tap unng vag vin di theo hudng tang kha nang ung phd (R^ = 0,034; p = 0,184; p < 0,05) Ngugc lai, chip nhan cd thi dy bao duge 11,5% iing phd tap trung^vao cam xuc (R^ = 0,115; p = -0,340; p < 0,001) va 28,5% ttng phd ne tranh (R = 0,285; P = -0,534; p < 0,001) d benh nhan ung thu theo hudng giam hai kilu ung phd Ban luan Kit qua nghien ettu cho thiy, nam gidi ed mue chap nhan cao hgn so vdi ntt gidi Cac bing cbttng da ehi ring, ddi mat vdi can benh de dga din tinh mang benh nhan ung thu thudng xem xet lai each song cua bg va nhilu ngudi chgn mdt sd mue tieu uu tien va tap trung vao eae van de hien sinh nhu suy nghiem ve y nghia euge sdng, tang trucmg tam linh ca nhan va sdng ed chanh niem (Brennan, 2001), nhien, sy khae liiet ve gidi chanh niem khdng duge tim thay (Brown va Ryan, 2003; Catak, 2012; De Petrillo va edng su, 2009; Feldman va edng sy, 2007; MaeKillop va Anderson, 2007; Malcoun, 2008) Mac du vay, xet ve tung yeu td eua chanh niem, nghien ettu eua Sabina Alispabie, Enedina Hasanbegovic-Anie (2017) eho thay, cd su khae biet gidi d tung yeu td phan theo Bang bdi yeu td chanh niem (Five factor mindfulness questionnaire): Nu gidi cd diim sd cao d tilu thang Quan sat (observing), dd, nam gidi cd diim sd eao d tiiu thang Hanh ddng tinh thuc (acting with awareness) Diiu phu hgp vdi kit qua nghien euu vi sy khae biet gidi tinh cudng cam xuc va each thue ttng phd Theo dd, phu ntt dugc cho la cd cudng phan ung cam xue eao hon va chu y vao cae trai nghiem cam xiic (ca cam xuc tieu eye va cam xuc tieh eye) eung nhu tap trung nhiiu vao sy kiim soat cam xuc (Diener, Sandvik va Larsen, 1985), dd, nam gidi lai thudng sit dung chiin luge ttng phd tap ttung vac) nhan thtte va hanh ddng ttng phd nhilu ban la cac trai nghiem cam xue tieu eye Ket qua phan tich T-test vi sy khae biet ba kiiu ung phd giua benh nhan nam va benh nhan nQ cung hoan loan phu hop vdi cac nhan dinh (nu ed diem sd ung phd tap trung vao cam xuc va img phd ne ttanh eao hon nam) Ket qua nghien cuu cua chiing tdi eung eho thiy, nhdm ngudi ed mdi ddi eao hon cd diem sd chap nhan cao hon nhdm it tudi Xet vi dp ttidi ed 62 5»/ benh nhan tii 39 - 59 tudi va 15,8% benh nhan tu 60 tuoi trd len nghia la d~ t ^° 58 TAP CHI TAM LYHOC, Sfi4 (241), 4-2019 cua benh nhan tuang ddi eao (tudi trung binh la 47,63) Mdt sd nghien ettu khae cung tim thiy mdi lien he giua dp mdi vdi mtte chip nhan, chanh niem va sy tap trang vao thdi diem hien tai (Sabina Alispabie, Enedina Hasanbegovic-Anie, 2017; Mogilner, Kamvar va Aaker, 2011; Smrgess, 2012) Mat khae, thdi giati mic benh ciing la yiu td giai thieh eho sy khae biet vi dp tudi chip nhan Khoang hai phin ba (64,2%) benh nhan da biit minh mic benh ttt thang ttd len, dd, hp da ed mpt khpang thdi gian hrong ddi dai dl thich ung vdi benh cua minh Cae nghien cira khae da chi rang, eac biin so nhu thdi gian ki ttt chin doan (Velikova va edng su, 2001) va eac trieu cbttng lien quan din ung thu (Nordin, Berglund, Glimelius va Sjoden, 2001) ed tbi tae ddng din ttang thai tam ly cua ngudi benh Elisabeth Kubler-Ross (1969, 2011) da dua nam giai doan ddi mat vdi eai chet ma sau duge nhiiu tac gia khae danh gia la phu hpp vdi ea phan irng ve dau budn va benh tat Giai doan diu tien dac trang bdi phan iing sde (shock) vi nhSn duge chin dgan, benh nhan thutmg phu nhan (denial) hien thue ("Dieu khdng tbi xay vdi tdi") hoac nghi ngd ("Cd thi day la mdt ehan doan sai") Giai doan thtt hai la Gian dtt (Anger), benh nhan thudng dat eau hdi: "Tai lai la tdi?", "Dieu that khdng edng bUngi", "Tdi da lam gi sai?" Ngudi benh ed the dd Idi cho ban than hoac Idi cho ngudi khae Giai doan thtt ba la Mae ea (Bargaining), d day ngudi benh tim each ne ttanh benh tat bang each mac ca vdi ban than va vdi ngudi khae, tham ehi vdi ea nhttng nang lyc sieu binh ("Neu khdi benh tdi se ") i) giai doan eiing thudng sinh mac cam tgi 16i ("Gia ma tdi ") Giai doan tiep theo la Trim cam (Depression) sy xuat hien thudng xuyen eua cac y nghl va cam xuc tieu cue Ngudi benh ed the bd thude hoae bd diiu tri Giai doan eudi eiing la Chap nhan (Acceptance), benh nhan bit diu hilu ring ed the khdng ed each nao lam mit can benh eiia minh nhung minh ed tbi thieh nghi vdi nd Cam giac lo ling va khd chju cd thi thinh tbgang vin quiy riy benh nhan nhung hp da biet each ttng phd vdi chung Nghien euu eua ehung tdi da xae dinh sy anh hudng cua chap nhan den ba kiiu ttng phd cy thi Kit qua nghien euu cho thay, chip nhan it cd kha nang dy bao ttng phd tap trang vao vin di nhttng lai ed kha nang du bao tuong ddi tit ddi vdi ttng phd tap trung vao cam xuc va dac biet, cd kha nang dy bao rat lit ung phd ne tranh iTng phd ne tranh dupe eoi la kilu ung phd khdng hieii qua bdi chung ta khdng thi ne tranh hoan loan viee giai quyet nhung vin de vdn la nguon gde gay eang thing Da ed khdng it nghien euu dua bang chung vi viee anh hudng tieu cue eua ne tranh a benh nhan ndi ehung, cd benh nhan ung thu LTng phd ne tranh cd mdi tuong quan thuan vdi stress va tuong quan nghjeh vdi tinh thin lac quan d benh nhan ung thu (Friedman va cong sy, 1992) LTng phd ne ttanh la ylu td trung gian gitta hanh vi khdng hd trg etia ngudi than va stress cd hai d benh nhan ung thu vu (Manne va cdng TAP CHi TAM LY HOC, Sd (241), - 2019 59 sy, 2005) Mdt nghien ettu khae theo ddi va danh gia mdi lien he giua ung phd ne tranh va eae ttieu chung trim cam tren 1.211 ngudi d dp tudi trung nien vdng 10 nam cho thiy, cd mdi lien quan chat ehe gitta cac sy kien gay eang thing, each ttng phd ne tranh va trieu chung tram cam (Holahan va edng su, 2005) Niu nhu utig phd tap trang vao su loai bd hay kiem soat y nghl va cam xuc thi chip nhan lai dtm gian la nhan biet rd su bien dien eua cam xue tieu eye va di cho chung qua di ma khdng can de nen, kiem soat hay ed loai bd cbttng Chap nhan eung ddng nghia vdi sy khdng ne tranh ma la bao dung va ttt bi vdi cam giac khd chju va nhttng trang thai cam xuc tieu eye cua ban than Do dd, chap nhan khdng lam cho benh nhan eang thang, met mdi vi tieii bag nhieu nang lugng tinh than Nhttng bang chung da trinh bay d phan dat van de eho thay, chap nhan cd tac dung giam dau, giam stress, lo au va tram earn, day nhanh su phue hdi chttc nang Nhung dieu ggi y chg viec bd trg tam ly eho benh nhan ung thu bang each danh gia mtte dp chap nhan d benh nhan, hudng dan benh nhan loai bd dan thdi quen "chien dau" ehdng lai cae cam xue tieu cue Thay vao dd, hudng dan benh nhan cac ky thuat theo ddi va nhan biet cam xiie tieu cue, tang mtte dp chanh niem de giam sy ne tranh, khoan dung va tu bi ban vdi cac cam xue tieu eye de chung qua di mot each ty nhien Nhu vay, tong hgp ket qua eua eae nghien ettu tren the gidi da trinh bay d phan dau vdi kit qua nghien cuu eua ehiing tdi cd thi dua hai nhan djnh nhu sau: I) Chap nhan la yeu td ed thi lam giam trieu cbttng benh eung nhu giam cac cam xiic tieu cue benh tat gay ra, tang sy thoai mai va ed tac dgng tich cue din su pbiic hdi chttc nang thdng qua eo chi giam ttng phd ne tranh; 2) Ung phd ne ttanh lam giam hieu qua diiu ttj d benh nhan Tir hai nhan dinh tten cd the dua gia dinh quan trgng, la: chip nhan ed thi la yiu to lam tang hieu qua dieu ttj d benh nhan, dd ed benh nhan ung thu Day eiing chinh la ggi y eho cac nghien cuu tugng iai tap trung vao viee kiim cbttng mdi quan he gitta chap nhan benh va cae cam xuc tieu cue di kem vdi hieu qua dieu trj d benh nhan Cac nghien euu ttong tuong lai cung cin kham pha eac biln sd cd vai trd dieu net mdi quan he giua chap nhan va ung phd vdi benh d benh nhan una thu Lieu cac yeu td dd cd phai la dac diem tam ly ea nhan etia benh nhan ftinh hudng ndi/hudng ngoai, tinh lae quan/bi quan, ) hay eac ylu td tam Iv xS hdi (sy ho trp xa bdi, giao tiep gitta bac si va benh nhan, su cung cip diy du thd ' tin vee benh dieu trj benh, ) hay L o r.,? va each , , ^.-;'-••••••:;) hay su sy kit kit ban bop eiOa giua cac cae vl„ ylu ,A tddd? Davit nhunj buong eo the nghien euu tiep tue ve anh hudng cua chip nhan din t~ t nhung nhan ung thu nhan nno thir ^^ Oenn 60 TAPCHiTAMLYHOC, S64(241), -2019 Kit luan vk ap dung Nghien ciiti tten 120 benh nhan ung thu da eho thiy mdi lien he rd rang gitta nang lye chip nhan va ung phd tap trang vao cam xtte va ttng phd ne ttanh Kit qua nghien eu:u la ea sd khoa hge bude diu dl ed tbi ap dung yiu td chap nhin vao ndi dung eua cham sde giam nhe cho benh nhan ung thu d Viet Nam nhim giam iiguy ea mie them eae rdi loan tam ly qua trinh dilu tti benh thye the Ddi vdi nhttng benh nhan ung thu ed kem theo rdi loan lo au va tram cam can duge ap dung tiep e|in tri lieu chip nhan va cam kit can thiep tam ly song song vdi eae can thiep y khoa, giup benh nhan ttng phd tdt vdi benh tat di ed ehat lugng sdng tdt hem Tuy nhien, cin thye hien them nhiiu nghien ettu khae nua de thu thap them eae bing ehttng khga hpe vi CO che anh hudng eua nang lyc chip nhan den ttng phd, nang lue chip nhan va anh hudng eiia nd len hieu qua dieu tti benh d eac giai doan benh khae tten nhieu nhdm benh nhan khae vdi nhieu the benh da dang hon Tai lieu tham khao Adler N.E., Page A.E (2008) Cancer care for the whole patient- Meeting psychosocial health needs Washington (DC) National Academies Press (US) Anshel M.H (1996) Coping styles among adolescent competitive athletes The Journal of Social Psychology 136 311 - 323 Blalock J.A., Joiner Jr T.E (2000) Interaction of Cognitive Avoidance Coping and Stress in Predicting Depression/Anxiety Cognitive Therapy and Research Vol 24 Issue 47-65 Branstetter A.D., Wilson K.G., tfildebrandt M and Mutch D (2004) Improving psychological adjustment among cancer patients: ACT and CBT The Meeting of the Association for Advancement of Behavior Therapy New Orleans Google Scholar Brennan J (2001) Adjustment to cancer: Coping or personal transition PsychoOncology Vol 10 P - 18 Brown K.W & Ryan R.M (2003) The benefits of being present- Mindfulness and its role in psychological well-being Joumal of Personality and Social Psychology 84 (4) 822 - 848 Doi: 10.1037/0022-3514.84.4.822 Campbell-Sillsa L., Barlowb D.H., Brownb T.A., Hofmann S.T (2006) Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders Behaviour Research and Therapy 44 (2006) 1.251 - 1.263 Cardaclotto L.A., Herbert J.D., Forman E.M., Moitta E & Farrow V (2008) The assessment of present-moment awareness and acceptance The Philadelphia Mindfuln Scale Assessment Vol 15 No P 204-223 Doi: 10.1177/1073191107311467 TAPCHiTAM LYHOC, Sd4 (241), - 2019 61 Carver C.S Pozo C , Harris S.D., Noriega V., Scheier M.F., Robinson D.S., Ketcham A.S., Moffat F.L & Clark K.C (1993) How coping mediates the effect oj optimism on distress: A study of women with early stage breast cancer Journal o Personality and Social Psychology Vol 65 P 375 - 390 10 Carver C.S., Scheier M.F & Weintraub J K (1989) Assessing coping strategies, A theoretically based approach Joumal of Personality and Social Psychology Vol 56 P - 11 Catak P.D (2012) The Turkish version of the cognitive and affective mindfulness scale-revised Europe's Journal of Psychology (4) 603 - 619 Doi: 10.5964/ejop.v8i4.436 12 De Petrillo L.A., Kau&nan K.A., Glass C.R & AmkoffD.B (2009) Mindfulness for long-distance runners- An open trial using mindful sport performance enhancement (MSPE) Joumal of Clinical Sport Psychology (4) 357 - 376 Doi: 10.1123/jcsp.3.4.357 13 Diener E., Sandvik E & Larsen R.J (1985) Age and sex effects for emotional (n/e
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