基于双过程模型的头颈癌患者吞咽练习依从性：一项质性研究

文献信息

中文摘要

目的： 运用双过程模型探讨影响头颈癌（HNC）患者吞咽练习依从性的自动与反思性因素。
设计： 采用质性内容分析法的描述性质性研究。
方法： 于2024年5月至9月在中国湖北肿瘤医院护理康复门诊目的性招募18例有吞咽练习经历的头颈癌患者。对半结构化访谈采用演绎与归纳相结合的内容分析法进行分析。数据收集持续至编码饱和与意义饱和均达成。20%转录文本的编码者间一致性为高度一致（Cohen's kappa = 0.79）。
结果： 共识别出七个主题。练习体验、习惯性练习线索与常规以及情感支持主要反映系统1过程；对吞咽困难的反思性评估、对医疗服务资源的考量、对获益与风险的权衡以及期望与效果之间的差距主要反映系统2过程。跨系统交互显示，即时的身体与情绪反应不断被反思性评估、情境资源和感知进展所重塑。
结论： 吞咽练习依从性是自动与反思过程相互作用的动态产物，而非纯粹的理性决策。干预应将习惯支持性线索和情感支持与教育、期望管理、可及的随访以及个体化目标设定相结合。
临床实践相关性： 临床工作者应将练习锚定于稳定的日常线索，让家庭成员作为近端习惯教练参与，对在职患者采用灵活或简化的方案，并提供动机性访谈和远程康复支持以减少不确定性并维持依从性。
报告方法： 本研究按照COREQ清单进行报告；已完成的清单作为补充文件提交。
患者或公众贡献： 无患者代表参与访谈提纲的设计。

英文摘要

AIM: To explore automatic and reflective factors influencing swallowing exercise adherence in patients with head and neck cancer (HNC) using the dual-process model.
DESIGN: A descriptive qualitative study using qualitative content analysis.
METHODS: Eighteen patients with HNC who had experience of swallowing exercises were purposively recruited from a nursing rehabilitation clinic of Hubei Cancer Hospital in China between May and September 2024. Semistructured interviews were analyzed through combined deductive and inductive content analysis. Data collection continued until both code and meaning saturation were achieved. Intercoder agreement for 20% of transcripts was substantial (Cohen's kappa = 0.79).
RESULTS: Seven themes were identified. Exercise experience, habitual exercise cues and routines, and emotional support predominantly reflected system 1 processes; reflective appraisal of dysphagia, consideration of medical service resources, weighing benefits and risks, and the gap between expectations and effects predominantly reflected system 2 processes. Cross-system interactions showed that immediate bodily and emotional responses were continually reshaped by reflective appraisal, contextual resources, and perceived progress.
CONCLUSION: Swallowing exercise adherence is a dynamic product of interacting automatic and reflective processes rather than a purely rational decision. Interventions should combine habit-supportive cues and affective support with education, expectation management, accessible follow-up, and individualized goal setting.
RELEVANCE TO CLINICAL PRACTICE: Clinicians should anchor exercises to stable daily cues, involve family members as proximal habit coaches, use flexible or abbreviated protocols for working patients, and provide motivational interviewing and tele-rehabilitation support to reduce uncertainty and sustain adherence.
REPORTING METHOD: The study was reported according to the COREQ checklist; the completed checklist is submitted as a supplementary file.
PATIENT OR PUBLIC CONTRIBUTION: No patient representatives were involved in the design of the interview guide.