食管癌术后患者的心理体验与食物回避行为：一项质性研究。

文献信息

中文摘要

背景： 营养康复对食管切除术后的恢复至关重要。然而，食物回避行为很常见，并可能损害营养摄入、生活质量和术后恢复。本研究旨在探讨食管切除术后影响食物回避行为的因素以及此类行为背后的心理和情境过程，以期为有针对性的心理社会和行为干预以及个体化饮食管理提供信息。
方法： 采用描述性质性设计。以Roy适应模式（RAM）为指导，制定了半结构化访谈提纲。从中国中部一家三级肿瘤医院目的性招募了16例接受过食管切除术的患者。进行了定向内容分析，并使用NVivo 14.0促进数据整理和编码。RAM指导了编码框架和类别开发。
结果： 确定了四个主要类别和十个亚类别：生理功能因素（味觉改变和吞咽不适；反复出现的症状）、自我概念因素（营养知识缺乏；对疾病复发的恐惧；疾病的创伤性经历）、角色功能因素（患者角色限制社会功能；社会角色优先于饮食管理）、相互依赖因素（依赖关系中的被动饮食限制；出院后随访缺乏；经济负担）。
结论： 食管切除术后的食物回避行为反映了生理症状、疾病相关信念和经历、角色相关挑战、照护者影响以及出院后支持不足之间的相互作用。以RAM为指导的照护应整合个体化营养支持、心理咨询、行为指导、照护者教育和持续随访，以减少不必要的食物回避并促进营养和心理适应。

英文摘要

BACKGROUND: Nutritional rehabilitation is essential for recovery after esophagectomy. However, food avoidance behavior is common and may compromise nutritional intake, quality of life, and postoperative recovery. This study aimed to explore the factors influencing food avoidance behavior and the psychological and contextual processes underlying such behavior after esophagectomy, with the aim of informing targeted psychosocial and behavioral interventions and individualized dietary management.
METHODS: A descriptive qualitative design was used. Guided by the Roy Adaptation Model (RAM), a semi-structured interview guide was developed. Sixteen patients who had undergone esophagectomy were purposively recruited from a tertiary cancer hospital in central China. Directed content analysis was conducted, with NVivo 14.0 used to facilitate data organization and coding. The RAM guided the coding framework and category development.
RESULTS: Four main categories and ten subcategories were identified: physiological function factors (taste changes and swallowing discomfort; recurrent symptoms), self-concept factors (lack of nutritional knowledge; fear of disease recurrence; traumatic experiences of illness), role function factors (the patient role limiting social functioning; social role priorities overriding dietary management), and interdependence factors (passive dietary restriction in dependent relationships; lack of post-discharge follow-up; economic burden).
CONCLUSIONS: Food avoidance behavior after esophagectomy reflects the interaction of physiological symptoms, illness-related beliefs and experiences, role-related challenges, caregiver influences, and limitations in post-discharge support. RAM-informed care should integrate individualized nutritional support, psychological counseling, behavioral guidance, caregiver education, and continuous follow-up to reduce unnecessary food avoidance and promote nutritional and psychological adaptation.