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Article(id=1322924497560543927, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.17.025, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1762876800000, receivedDateStr=2025-11-12, revisedDate=1784131200000, revisedDateStr=2026-07-16, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339378967, onlineDateStr=2026-10-30, pubDate=1788969600000, pubDateStr=2026-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339378967, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339378966, creator=13701087609, updateTime=1793339378966, updator=13701087609, issue=Issue{id=1322924415817757501, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='17', pageStart='2961', pageEnd='3152', issueExtLink='null', onlineDate='null', pubDate='1788969600000', pubDateStr='2026-09-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793339359478, creator='13701087609', updateTime=1793343089343, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940060072542250, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940060072542251, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3121, endPage=3127, ext={EN=ArticleExt(id=1322924497795424952, articleId=1322924497560543927, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Dynamic multidimensional evolutionary and intervention for health-related behaviors in breast cancer patients based on integration theory, columnId=1220689488284668633, journalTitle=Chinese Nursing Research, columnName=Comprehensive Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To integrate the Chronic Illness Trajectory Model and Self-Determination Theory to explore the dynamic evolutionary mechanisms of health-related behaviors in breast cancer patients and to propose a phased theoretical intervention framework.

Methods

A purposive sampling method was used to conduct longitudinal semi-structured interviews with 65 breast cancer patients.Data were organized and analyzed using grounded theory and narrative analysis combined with Nvivo 12 Plus software.

Results

Patients' health-related behaviors exhibited a three-stage dynamic model:"external drive phase-motivation internalization phase-autonomous integration phase",which was dynamically influenced by the interaction of four dimensions:"cultural beliefs, family dynamics, medical interactions,and individual traits".Based on these findings,a three-tier intervention framework of "mindfulness-narrative-community" was proposed.

Conclusions

Health-related behaviors in breast cancer patients follow a nonlinear three-stage evolution of "external drive phase-motivation internalization phase-autonomous integration phase",dynamically influenced by four dimensions including cultural beliefs and family dynamics.The "mindfulness-narrative-community" three-tier intervention framework provides a scientific basis for developing individualized nursing strategies in clinical practice.

, authors=Yongqi WANG, Fu'na YANG, Xuelu ZHENG, Chunhui LIU, Jianli WANG, Xin ZHAO, authorsList=Yongqi WANG, Fu'na YANG, Xuelu ZHENG, Chunhui LIU, Jianli WANG, Xin ZHAO, authorCompany=null, correspAuthors=Yongqi WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322924498336490171, articleId=1322924497560543927, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=基于整合理论的乳腺癌病人健康相关行为多维动态演变及干预, columnId=1220689488938980091, journalTitle=护理研究, columnName=综合研究, runingTitle=null, highlight=null, articleAbstract=
目的

整合慢性疾病轨迹模式与自我决定理论，探讨乳腺癌病人健康相关行为的动态演变机制，提出分阶段干预理论框架。

方法

采用目的抽样法对65例乳腺癌病人进行纵向半结构化访谈，运用扎根理论及叙事分析法结合NVivo 12 Plus软件进行资料整理与分析。

结果

病人健康相关行为呈现“外部驱动期-动机内化期-自主整合期”三阶段动态模型，受“文化信念-家庭动力-医疗互动-个体特质”4个维度动态交互影响，基于此提出“正念-叙事-社群”3级干预框架。

结论

乳腺癌病人健康相关行为呈“外部驱动-动机内化-自主整合”3阶段非线性演变，受文化信念、家庭动力等4个维度动态影响，“正念-叙事-社群”3级干预框架可为临床制定个体化护理策略提供科学依据。

, authors=王永琦, 杨福娜, 郑雪露, 刘春慧, 王建丽, 赵欣, authorsList=王永琦, 杨福娜, 郑雪露, 刘春慧, 王建丽, 赵欣, authorCompany=null, correspAuthors=王永琦, authorNote=null, correspAuthorsNote=
WANG Yongqi, E-mail:
王永琦，主管护师，硕士研究生，E-mail：
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tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924497560543927, doi=null, pmid=null, pmcid=null, year=2023, volume=39, issue=4, pageStart=151469, pageEnd=null, url=null, language=null, rfNumber=24, rfOrder=23, authorNames=Sözerioztürk E, Canbolat Ö, Polat Ù, journalName=Semin Oncol Nurs, refType=null, unstructuredReference=Sözerioztürk E,Canbolat Ö,Polat Ù.Internet use,eHealth literacy,and influencing factors in turkish cancer patients:a descriptive and correlational study[J].Semin Oncol Nurs,2023,39(4):151469., articleTitle=Internet use,eHealth literacy,and influencing factors in turkish cancer patients:a descriptive and correlational study, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322924498579759804, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924497560543927, xref=1, ext=[AuthorCompanyExt(id=1322924498588148413, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924497560543927, companyId=1322924498579759804, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan 450000 China), AuthorCompanyExt(id=1322924498596537022, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924497560543927, companyId=1322924498579759804, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1郑州大学附属肿瘤医院 河南省肿瘤医院，河南 450000)])], figs=[ArticleFig(id=1322924502702760681, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924497560543927, language=EN, label=Figure 1, caption=“Stage-dimension” interactive dynamic evolution model of health-related behaviors in breast cancer patients, figureFileSmall=OmgoYPUXHEmIfBDBXq3oDQ==, figureFileBig=bYVVb8toK3XShvULL+w7yw==, tableContent=null), ArticleFig(id=1322924502782452458, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924497560543927, language=CN, label=图1, caption=乳腺癌病人健康相关行为“阶段-维度”交互式动态演变模型, figureFileSmall=OmgoYPUXHEmIfBDBXq3oDQ==, figureFileBig=bYVVb8toK3XShvULL+w7yw==, tableContent=null), ArticleFig(id=1322924502971196139, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924497560543927, language=EN, label=Table 1, caption=

General information of the respondents（n=65）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目类别例数构成比（%）
疾病阶段诊断期1523.08
首次治疗1726.15
治疗中期1726.15
治疗末期1624.62
年龄18~40岁1015.38
>40~50岁2538.46
>50~60岁2030.77
>60岁1015.38
文化程度小学及以下1421.54
初中1726.15
高中/中专2030.77
专科及以上1421.54
职业职工1827.69
无业2030.77
退休1624.62
农民1116.92
疾病分期Ⅰ期2030.77
Ⅱ期2640.00
Ⅲ期1929.23
), ArticleFig(id=1322924504627946220, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924497560543927, language=CN, label=表1, caption=

受访者一般资料（n=65）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目类别例数构成比（%）
疾病阶段诊断期1523.08
首次治疗1726.15
治疗中期1726.15
治疗末期1624.62
年龄18~40岁1015.38
>40~50岁2538.46
>50~60岁2030.77
>60岁1015.38
文化程度小学及以下1421.54
初中1726.15
高中/中专2030.77
专科及以上1421.54
职业职工1827.69
无业2030.77
退休1624.62
农民1116.92
疾病分期Ⅰ期2030.77
Ⅱ期2640.00
Ⅲ期1929.23
), ArticleFig(id=1322924504724415213, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924497560543927, language=EN, label=Table 2, caption=

Typical examples

, figureFileSmall=null, figureFileBig=null, tableContent=
原始语录初始概念
确诊那天我懵了，医生说什么我就做什么（A12）被动依赖
我种了一辈子地，不该得这病，拖累孩子了（A5）责任内疚
一开始天天哭，现在慢慢能接受了（B11）情绪韧性
医生说化疗副作用会掉头发，我就提前买了假发（B10）预防顺应
每天按医生说的吃药复查，但也会坚持喝点中药汤（B7）双轨行为
我现在每天六点起床去公园快走1 h（C15）主动康复行为
别人说癌症是绝症，我就觉得活不长了（D8）疾病宿命论
丈夫说要陪着我一起去医院，我才敢去（D4）家庭依附
护士教我深呼吸，我试着缓解恶心，觉得有用（A11）技能学习
病友群里大家互相鼓励，我慢慢有信心了（B6）社群支持
以前觉得运动没用，现在坚持锻炼发现身体好多了（D9）观念转变
), ArticleFig(id=1322924504812495598, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924497560543927, language=CN, label=表2, caption=

典型示例

, figureFileSmall=null, figureFileBig=null, tableContent=
原始语录初始概念
确诊那天我懵了，医生说什么我就做什么（A12）被动依赖
我种了一辈子地，不该得这病，拖累孩子了（A5）责任内疚
一开始天天哭，现在慢慢能接受了（B11）情绪韧性
医生说化疗副作用会掉头发，我就提前买了假发（B10）预防顺应
每天按医生说的吃药复查，但也会坚持喝点中药汤（B7）双轨行为
我现在每天六点起床去公园快走1 h（C15）主动康复行为
别人说癌症是绝症，我就觉得活不长了（D8）疾病宿命论
丈夫说要陪着我一起去医院，我才敢去（D4）家庭依附
护士教我深呼吸，我试着缓解恶心，觉得有用（A11）技能学习
病友群里大家互相鼓励，我慢慢有信心了（B6）社群支持
以前觉得运动没用，现在坚持锻炼发现身体好多了（D9）观念转变
), ArticleFig(id=1322924504883798767, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924497560543927, language=EN, label=Table 3, caption=

Representative categories and typical concepts of each dimension

, figureFileSmall=null, figureFileBig=null, tableContent=
核心维度代表性范畴典型概念举例
文化信念疾病宿命论别人说癌症就是判死刑，我就觉得活不长了（D8）
命里注定的病，没办法（B3）
传统调理观每天按医生说的吃药复查，但也会坚持喝点中药汤（B7）；平时多做艾灸，感觉舒服一些（A12）
观念转变以前觉得运动没用，现在坚持锻炼发现身体好多了（D9）；医生说可以长期管理，我就觉得还有希望（A14）
家庭动力责任伦理我种了一辈子地，不该得这病，拖累孩子了（A5）；为了家人，我得坚持活下去（C7）
家庭支持模式孩子说要陪我一起去医院，我才敢去（D4）
丈夫接送我化疗，给我很大力量（B2）
角色冲突以前都是我照顾家人，现在反而需要别人照顾（B9）
我不能再像以前一样干活，心里别扭（C12）
医疗互动遵医行为确诊那天我懵了，医生说什么我就做什么（A12）
医生让我化疗，我不敢不听（C10）
医患信任护士教我深呼吸，我试着缓解恶心，觉得有用（A11）；医生的话让我安心（D6）
信息依赖听说有人吃保健品有效，我也想试（D5）；不懂就问医生，自己不敢乱来（C4）
个体特质自我效能我现在每天六点起床去公园快走一小时（C15）；我自己记录副作用，调整饮食（C9）
情绪韧性一开始天天哭，现在慢慢能接受了（B11）
病友群里大家互相鼓励，我有了信心（B6）
主动探索我上网查康复方法，还去听讲座（B16）
我试着练太极，发现很适合自己（A3）
), ArticleFig(id=1322924504976073456, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924497560543927, language=CN, label=表3, caption=

各维度的代表性范畴与典型概念

, figureFileSmall=null, figureFileBig=null, tableContent=
核心维度代表性范畴典型概念举例
文化信念疾病宿命论别人说癌症就是判死刑，我就觉得活不长了（D8）
命里注定的病，没办法（B3）
传统调理观每天按医生说的吃药复查，但也会坚持喝点中药汤（B7）；平时多做艾灸，感觉舒服一些（A12）
观念转变以前觉得运动没用，现在坚持锻炼发现身体好多了（D9）；医生说可以长期管理，我就觉得还有希望（A14）
家庭动力责任伦理我种了一辈子地，不该得这病，拖累孩子了（A5）；为了家人，我得坚持活下去（C7）
家庭支持模式孩子说要陪我一起去医院，我才敢去（D4）
丈夫接送我化疗，给我很大力量（B2）
角色冲突以前都是我照顾家人，现在反而需要别人照顾（B9）
我不能再像以前一样干活，心里别扭（C12）
医疗互动遵医行为确诊那天我懵了，医生说什么我就做什么（A12）
医生让我化疗，我不敢不听（C10）
医患信任护士教我深呼吸，我试着缓解恶心，觉得有用（A11）；医生的话让我安心（D6）
信息依赖听说有人吃保健品有效，我也想试（D5）；不懂就问医生，自己不敢乱来（C4）
个体特质自我效能我现在每天六点起床去公园快走一小时（C15）；我自己记录副作用，调整饮食（C9）
情绪韧性一开始天天哭，现在慢慢能接受了（B11）
病友群里大家互相鼓励，我有了信心（B6）
主动探索我上网查康复方法，还去听讲座（B16）
我试着练太极，发现很适合自己（A3）
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基于整合理论的乳腺癌病人健康相关行为多维动态演变及干预
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王永琦 , 杨福娜 , 郑雪露 , 刘春慧 , 王建丽 , 赵欣
护理研究 | 综合研究 2026,40(17): 3121-3127
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护理研究 |综合研究 2026 , 40 (17) : 3121 -3127
基于整合理论的乳腺癌病人健康相关行为多维动态演变及干预
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王永琦 , 杨福娜, 郑雪露, 刘春慧, 王建丽, 赵欣
作者信息
  • 1郑州大学附属肿瘤医院 河南省肿瘤医院，河南 450000
通讯作者:
WANG Yongqi, E-mail:
王永琦，主管护师，硕士研究生，E-mail：
Dynamic multidimensional evolutionary and intervention for health-related behaviors in breast cancer patients based on integration theory
Yongqi WANG , Fu'na YANG, Xuelu ZHENG, Chunhui LIU, Jianli WANG, Xin ZHAO
Affiliations
  • 1The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan 450000 China
出版时间: 2026-09-10 doi: 10.12102/j.issn.1009-6493.2026.17.025
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摘要
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目的

整合慢性疾病轨迹模式与自我决定理论，探讨乳腺癌病人健康相关行为的动态演变机制，提出分阶段干预理论框架。

方法

采用目的抽样法对65例乳腺癌病人进行纵向半结构化访谈，运用扎根理论及叙事分析法结合NVivo 12 Plus软件进行资料整理与分析。

结果

病人健康相关行为呈现“外部驱动期-动机内化期-自主整合期”三阶段动态模型，受“文化信念-家庭动力-医疗互动-个体特质”4个维度动态交互影响，基于此提出“正念-叙事-社群”3级干预框架。

结论

乳腺癌病人健康相关行为呈“外部驱动-动机内化-自主整合”3阶段非线性演变，受文化信念、家庭动力等4个维度动态影响，“正念-叙事-社群”3级干预框架可为临床制定个体化护理策略提供科学依据。

乳腺癌  /  自我决定理论  /  慢性病  /  轨迹模式  /  质性研究  /  护理
Objective

To integrate the Chronic Illness Trajectory Model and Self-Determination Theory to explore the dynamic evolutionary mechanisms of health-related behaviors in breast cancer patients and to propose a phased theoretical intervention framework.

Methods

A purposive sampling method was used to conduct longitudinal semi-structured interviews with 65 breast cancer patients.Data were organized and analyzed using grounded theory and narrative analysis combined with Nvivo 12 Plus software.

Results

Patients' health-related behaviors exhibited a three-stage dynamic model:"external drive phase-motivation internalization phase-autonomous integration phase",which was dynamically influenced by the interaction of four dimensions:"cultural beliefs, family dynamics, medical interactions,and individual traits".Based on these findings,a three-tier intervention framework of "mindfulness-narrative-community" was proposed.

Conclusions

Health-related behaviors in breast cancer patients follow a nonlinear three-stage evolution of "external drive phase-motivation internalization phase-autonomous integration phase",dynamically influenced by four dimensions including cultural beliefs and family dynamics.The "mindfulness-narrative-community" three-tier intervention framework provides a scientific basis for developing individualized nursing strategies in clinical practice.

breast cancer  /  self-determination theory  /  chronic illness  /  trajectory model  /  qualitative research  /  nursing
王永琦, 杨福娜, 郑雪露, 刘春慧, 王建丽, 赵欣. 基于整合理论的乳腺癌病人健康相关行为多维动态演变及干预. 护理研究, 2026 , 40 (17) : 3121 -3127 . DOI: 10.12102/j.issn.1009-6493.2026.17.025
Yongqi WANG, Fu'na YANG, Xuelu ZHENG, Chunhui LIU, Jianli WANG, Xin ZHAO. Dynamic multidimensional evolutionary and intervention for health-related behaviors in breast cancer patients based on integration theory[J]. Chinese Nursing Research, 2026 , 40 (17) : 3121 -3127 . DOI: 10.12102/j.issn.1009-6493.2026.17.025
正文
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乳腺癌是全球女性发病率最高的恶性肿瘤之一，其长期治疗伴随的生理功能损伤、心理应激及社会角色适应问题，已成为影响病人生存质量的核心挑战[1]。随着综合治疗技术的进步，乳腺癌病人5年生存率提升至83%[2]，但治疗相关并发症及复发风险仍导致病人长期处于慢性病管理状态。在此背景下，健康相关行为作为慢性病管理的核心要素[3]，其动态演变机制与促进策略研究具有重要临床价值。有证据表明，系统化健康行为可降低化疗并发症发生率，并提升病人治疗依从性[4]。慢性疾病轨迹模式（chronic illness trajectory model,CITM）为解析病人疾病体验的动态性提供了重要理论框架，但其传统应用多聚焦症状演变与情绪反应的阶段特征描述[5]，未能深入了解构健康相关行为的内在驱动机制。值得关注的是，乳腺癌病人的健康行为呈现异质性：部分病人处于被动依赖状态，而另一些病人逐步发展为自主决策者[6]。这种差异提示单一病程阶段理论难以解释行为转化的心理动因，亟需整合动机理论以深化机制研究。自我决定理论（self-determination theory,SDT）通过自主性-胜任感-归属感3维动机模型，为破解上述理论困境提供了新视角。该理论强调，病人行为从外部控制到内在驱动的转化过程，本质是基本心理需求满足的递进[7]。最新研究证实，将自我决定理论应用于肝癌管理可使病人自我效能提升[8]，但其在乳腺癌领域的研究较少。然而，现有研究在整合慢性疾病轨迹模式与自我决定理论时，多聚焦于行为阶段与动机类型的静态对应，缺乏对演变过程中关键调节因素的动态分析。尤其在中国文化语境下，家庭角色的核心作用、“孝道”与“责任”伦理对动机内化的驱动、传统医疗观念与现代循证医学的碰撞以及医患关系模式，构成了影响行为演变的独特且关键的系统性因素[9]。这些因素不仅作用于特定阶段，更在阶段间形成动态交互网络，共同塑造病人的行为轨迹。忽视这些维度的交互作用，将导致行为演变模型的解释力不足，进而限制干预策略的精准性和文化适配性。因此，本研究旨在整合慢性疾病轨迹模式的阶段观、自我决定理论的动机内核，并嵌入文化心理学视角与社会系统观，构建一个多维度、交互式的动态演变模型，以更全面地阐释中国乳腺癌病人健康相关行为的复杂演变机制。
1　对象与方法
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1.1　访谈对象
选取2024年3月—11月河南省某三级甲等肿瘤医院的65例乳腺癌病人进行访谈。纳入标准：首次诊治为单侧乳腺癌的Ⅰ~Ⅲ期病人；年龄18~65岁；有良好的沟通表达能力；知情同意且自愿参加。排除标准：复发、转移乳腺癌病人，伴有其他严重疾病；有视听障碍、精神障碍性疾病。本研究首先采用目的性抽样招募覆盖不同年龄、疾病分期、文化程度和城乡背景的病人，以保证初始资料的异质性；随后，在编码分析过程中基于扎根理论的理论抽样原则对样本进行补充：当开放编码或主轴编码提示某一范畴信息不足，团队即有针对性地从住院名单中招募符合该特征的受访者以丰富范畴的厚度，直至理论饱和[10]。本研究经河南省肿瘤医院伦理委员会审查批准（审批号：2024-247-001）。受访者一般资料见表1。
1.2　资料分析方法
本研究基于慢性疾病轨迹模式及自我决定理论，围绕健康相关行为，结合研究目的及相关文献，制定访谈提纲初稿，对5例受访者进行预访谈，修订访谈提纲并与专业学者讨论后，最终确定的访谈提纲包括：1）从确诊到现在的治疗过程中，您对乳腺癌的理解经历了哪些关键变化？这种变化如何影响您的健康相关行为？2）在制定治疗方案或日常管理时，您是否遇到过“医生建议”与“传统观念”不一致的情况？您最终如何权衡并做出选择？3）在您的健康管理经历中，是否存在某个时刻让您改变想法？如果有，是什么事件或原因促使了这种转变？4）在整个治疗过程中，每个阶段最困扰您的问题是什么？这些困难如何影响您的自我管理策略？5）您是否感受到外界对“抗癌者”的某种期待？这种期待如何影响您真实的情感表达？6）在长期管理中，哪些健康相关行为您能坚持下来？哪些很难持续？在确诊期、首次治疗、治疗中期、治疗末期4个阶段对病人进行访谈。
1.3　资料收集
采用面对面半结构式深入访谈。在确诊期、首次治疗、治疗中期、治疗末期4个阶段分别招募独立受访者，以捕捉各阶段典型的行为特征与动机状态。4个阶段的操作定义：1）确诊期，为确诊至首次治疗前/确诊后2周内；2）首次治疗期，即术后1~6周；3）治疗中期：正在接受多周期化疗阶段（术后3~6个月）；4）治疗末期/康复期，为完成主要抗癌治疗≥6个月，进入康复/随访阶段。受访者阶段归类基于其就诊记录与主治医生的时间点确认。正式访谈前，研究者向受访者介绍本研究的目的、方法、内容、所需时间、保密原则，征得其同意后全程录音。访谈时间在治疗结束、晚饭后，地点选在安静的病房或病区示教室进行。访谈过程中根据回答逐步缩小内容范围，鼓励受访者全面、深入地表达自己的感受，同时记录受访者的面部表情和举止变化。
1.4　质量控制
受访者在年龄、文化程度、疾病分期等特征上具有代表性；研究者经过质性研究的专业培训，熟练掌握其理论知识及研究方法；访谈前，研究者掌握制定访谈提纲、调节访谈氛围、积极阐述的方法，引导病人对有关其健康相关行为进行陈述；研究者与病人建立信任关系，减轻其顾虑情绪；访谈过程中研究者做到摒弃个人偏见；对资料分析后再对访谈录音进行回听，确保资料的可信性，并保存完整原始资料及分析过程。
1.5　资料分析
本研究采用Strauss & Corbin的扎根理论流程作为编码框架，步骤包括开放式编码、主轴编码与选择性编码，以便系统构建阶段-范畴模型。鉴于研究重视受访者叙事的建构性意义，在分析过程中还融合了构建主义视角，通过叙事分析补充质性解释层次，使得理论既具有结构性也兼具解释深度。首先，通过开放式编码识别出与病人健康相关行为相关的概念；然后，进行主轴编码，将概念归类为若干范畴，并探索其内在关联；最后，在选择性编码阶段确立健康相关行为的动态演变为核心范畴，并构建理论模型。同时，为增强文化敏感性与解释力，辅以叙事分析方法，具体步骤：1）辨识叙事单元，从逐字稿中识别叙事段落、关键转折点与“关键事件”；2）结构性分析，分析叙事的时间顺序、因果链与情感走向；3）意义/隐喻分析，归纳其中反复出现的文化隐喻（如“孝”“命运”）与陈述框架；4）三角校验，将叙事主题与扎根编码得到的范畴进行对照，检验是否提供补充或修正，必要时进行理论抽样以验证解释的普遍性。叙事分析过程同样由2名研究者独立完成并讨论达成共识，关键示例性语段在结果中以引用原话呈现以保障透明性。
数据分析过程中借助NVivo 12 Plus软件进行编码管理，建立主题节点体系，并通过频次统计与范畴关联分析提升资料的可追溯性和逻辑一致性，确保资料分析的科学性和结论的可信度。
2　结果
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2.1　扎根理论编码过程
本研究访谈到65例乳腺癌病人时，资料达到饱和时无新主题出现，停止收集。为保证理论模型的科学性与可追溯性，研究团队严格遵循开放式编码-主轴编码-选择性编码的分析路径。
2.1.1　开放式编码
研究者逐句分析65份访谈文本，初步提炼出134个初始概念，涵盖疾病认知、文化观念、家庭角色、医患互动、自我管理行为等方面。典型示例见表2。
2.1.2　主轴编码
经比对整合形成14个范畴，进一步归纳为4个核心维度。各维度的代表性范畴与典型概念见表3。
2.1.3　选择性编码
在主轴编码的基础上，进一步整合出核心范畴，即乳腺癌病人健康相关行为的动态演变。该核心范畴表现为“外部驱动期-动机内化期-自主整合期”的非线性演变过程，其形成机制由文化信念、家庭动力、医疗互动、个体特质4个维度动态交互驱动，最终凝练为阶段-维度交互式动态演变模型。具体见图1。
2.2　外部驱动期：多维压力下的被动依赖
该阶段主要涵盖乳腺癌确诊初期至首次治疗前后，是病人心理与行为反应的急性应激窗口期，也是其健康行为最具被动性和依赖性的时期。访谈显示，大多数病人在接收到乳腺癌诊断结果后经历明显的认知失调与情绪崩溃，典型反应包括惊恐、否认、羞耻、无助等，常伴随“脑中一片空白”“不知道该怎么办”等表达，行为上表现为对外部力量的高度依附。A12：“确诊那天我懵了，医生说什么我就做什么。”此阶段个体尚未形成系统化的疾病认知与健康行为规划，其健康相关行为主要由医生安排或家庭成员主导，呈现出明显的“遵医行为”模式[11]。部分病人还表现出明显的角色冲突感，既要面对“被照护者”的身份转变，又对家庭负担深感内疚。A5：“我种了一辈子地，不该得这病，拖累孩子了。”在文化层面，受访者中普遍存在宿命化与疾病污名化观念，例如“命里注定得这个病”“患癌等于判死刑”。在中老年女性、低教育水平或农村地区病人中尤为普遍[12]。这些观念不仅削弱了个体积极寻求治疗的动机，还可能造成治疗延迟、依从性差、康复信心低等不良后果[13]。D8：“别人说癌症是绝症，我就觉得活不长了。”部分病人因“怕别人知道”“不想让家里人担心”而推迟就医，表现为“外控驱动但内在抗拒”的矛盾状态。外部驱动期病人健康相关行为主要受诊断冲击和家庭/医嘱的外部力量影响，普遍呈现被动依赖和消极情绪，应对方式有限。
2.3　动机内化期：文化双轨性驱动的行为整合
随着乳腺癌治疗进入中期，病人逐渐从初期的急性情绪反应中恢复，认知水平与行为能力得到提升，健康行为逐步向主动性转化。本阶段病人表现出初步的自主性，开始主动获取信息、尝试调节不适并形成个体化的管理策略。C9：“我自己记录副作用，调整饮食。”B16：“我上网查康复方法，还去听讲座。”部分病人在症状管理上尝试新的方法，如呼吸训练、穴位按摩等。在文化层面，多数病人呈现“文化双轨性”倾向：一方面继续采用传统中医调理方法以获取心理安慰，如艾灸、食疗、太极；另一方面也积极遵循现代医学方案，遵医复查、规范用药。B7：“每天按医生说的吃药复查，但也会坚持喝点中药汤，觉得结合使用更安心。”家庭支持在本阶段的作用从单向推动逐渐转为陪伴和共同参与。B2：“丈夫接送我化疗，给我很大力量。”动机内化期病人逐渐展现自主探索与双轨整合的特征，既保留传统调理方式，又积极接受现代医学指导，行为逐渐稳定。
2.4　自主整合期：价值重构下的生命意义再生
进入治疗末期或康复阶段，病人逐步完成从“疾病应对者”向“健康主导者”的角色转化，健康行为趋于自主化和稳定化[14]。访谈显示，多数病人会主动制定锻炼和饮食计划，并融入日常生活。C15：“我现在每天06:00起床去公园快走1 h，身体状态好多了，人也更精神。”病人的健康行为不再限于对症处理，而逐渐成为生活习惯，表现为规律化与日常化。症状管理能力出现泛化趋势，即将治疗期的应对经验迁移至生活的其他方面，如饮食优化、睡眠管理和压力调节。部分病人提到，病友群和社群活动增强了坚持行为的动力。B6：“病友群里大家互相鼓励，我有信心了。”文化层面上，病人常把康复和家庭责任、生命意义相联系，将健康管理纳入生活目标。B6：“我觉得我的病让我重新认识了自己，也让我更懂得生活的意义。”自主整合期病人的健康相关行为已基本生活化与价值化，表现为高度自主、稳定持续，并逐步融入社会与家庭角色。
3　讨论
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本研究基于慢性疾病轨迹模式与自我决定理论，深入解析了乳腺癌病人健康相关行为的阶段性演变路径，并提出具有文化敏感性与技术适应性的干预建议，访谈显示病人以“遵医-依附-角色内疚”为主，对应自我决定理论的外部/服从调节与归属感待满足；此时，慢性疾病轨迹模式对急性应激窗口的阶段刻画与开放式编码高度契合，提示护理需以替代性控制+情绪安抚+家庭介入建立安全依附。进入动机内化期，病人在“文化双轨性”中实现行为整合，胜任感与关联感上升，动机由内摄到认同/整合调节过渡；这既延展了慢性疾病轨迹模式的阶段框架，又以自我决定理论揭示了从外控到内化的心理机制，支持在该期采用叙事重构、目标设定与技能赋能的干预取向。到自主整合期，个体将健康行为纳入自我认同，呈现整合/内在调节与生活方式化；慢性疾病轨迹模式的康复阶段与自我决定理论的高级动机阶段在本研究中实现对接，并由数字化支持-社群激励等机制维系，据此提出“正念-叙事-社群”3级干预框架作为“阶段-维度”干预矩阵的操作化路径。总之，本研究并非简单将“阶段”与“动机类型”静态对应，而是以编码证实文化信念、家庭动力、医疗互动、个体特质四维跨阶段动态交互对动机转化的调节作用，从而弥补既往整合研究忽视调节/中介链的不足，明确了不同阶段的作用靶点与干预抓手。
3.1　自我决定理论有效揭示行为演化机制，分阶段提供匹配支持
自我决定理论的核心假设是个体行为的持续性和稳定性依赖于自主性、胜任感与归属感三大基本心理需求的满足[15]。本研究验证了这一理论在乳腺癌病人自我管理中的适用性，进一步揭示了行为演化的动态机制[7]。在确诊初期，病人的心理应激反应强烈，健康行为主要受外部控制和他人驱动，表现为依赖医嘱与家属支持。此时，临床护理的重点应放在替代性控制与情绪支持上，以帮助病人减轻焦虑、恐惧等情绪负担，建立稳定的医患关系，并通过家庭成员的积极参与为病人提供情感支持。这一阶段，护理干预应更加关注病人的心理需求，尤其是在归属感与依附需求方面。进入动机内化期后，病人的健康行为逐渐从外部控制转向内在驱动，病人开始有意识地参与到健康行为的计划和调整中。此时，护理干预应从单纯的外部支持转向个体化的行为调节，尤其是通过设定健康目标、促进病友间的交流和互助等方式，增强病人的胜任感和自我效能感。个体化护理应充分考虑病人的疾病认知、心理状态及其文化背景，通过叙事疗法、行为激励等方式，引导病人形成更为积极的健康行为管理观念和策略[16-17]。在自主整合期，病人已经在治疗过程中实现了自我角色的重构，并主动寻求更多的信息、支持和资源。此时，护理干预应转向赋能模式，通过数字化健康管理工具、远程随访等技术手段，为病人提供持续的、个性化的护理服务[18]。这一阶段，病人的健康相关行为趋于稳定，护理工作可以更加专注于如何帮助病人保持和强化自我调节能力，并通过技术平台提供长期的支持和指导。
3.2　文化因素深刻影响行为选择，注重护理干预的本土化与文化敏感性
乳腺癌病人的健康相关行为不仅受个人健康信念的影响，还深受文化背景的制约。在中国，传统的文化信念（如宿命论、家庭责任、集体主义等）深刻影响病人对疾病的认知与行为选择[9]。本研究发现，在外部驱动期，宿命论的文化倾向可能使病人对疾病的主动应对产生抗拒，导致治疗延误和自我管理的缺失。例如，许多病人在确诊初期表现出对疾病的否认或逃避情绪，这与社会文化中对疾病的“污名化”及其对病人心理的压迫有直接关系[19]。然而，在动机内化期，家庭责任感和集体主义文化反而能成为促进病人健康相关行为的重要驱动力。通常由于病人对家庭的责任感，逐步从消极情绪中走出，开始积极参与健康管理。因此，护理干预必须充分考虑文化背景，设计具有文化适应性的干预策略。具体来说，护理人员应在病人的健康教育中融入“家人共治”理念，鼓励病人与家庭成员共同参与疾病管理，并通过家庭为单位建立健康责任网络。同时，护理干预应利用文化认同感，引导病人将“孝”“责任”与康复目标结合，将这些文化价值转化为积极的健康管理动力。在这一过程中，叙事疗法可以作为一个有效的文化整合手段，帮助病人通过讲述个人的疾病经历，将疾病视为一种成长和自我修复的契机[20]。例如，通过引导病人将乳腺癌的治疗过程视为“涅槃重生”，不仅可以帮助病人缓解负面情绪，还能促进其健康行为的内化和持续。
3.3　数字化工具拓展管理边界，推动护理服务与技术平台深度融合
随着技术的进步，数字化工具在乳腺癌病人长期健康管理中的应用潜力逐渐显现。本研究表明，在自主整合期，病人对信息获取、社群支持以及行为提醒有强烈需求，且已具备接受数字化干预的基础。随着病人生活质量的提升，数字化技术的应用将不再仅仅是治疗过程中的补充工具，而是成为病人健康管理的核心组成部分。数字化健康管理平台、远程监控系统和智能化应用不仅能有效提升护理工作的效率，还能增强病人的自主性和长期行为的持续性[21]。具体来说，护理服务可以依托数字化平台（如APP、小程序等）将治疗日程、康复计划、症状监测等信息整合为一个全面的健康管理系统。病人可以通过该平台实时查看自己的健康数据、康复进展，获取个性化的健康建议[22-23]。此外，社群互助、病友交流等功能也可以增强病人的归属感与社交支持，进一步促进其健康行为的积极性和稳定性。然而，尽管数字化技术为乳腺癌病人的长期健康管理提供了方向，技术的普及应用仍面临一些挑战。部分病人，尤其是年长病人或文化背景较为传统的病人，可能对数字化平台的接受度较低[24]，如何通过易用性设计和培训提升病人的技术适应性，成为数字化护理干预普及的关键。此外，技术平台的隐私保护、数据安全等问题也需要在实施过程中予以高度重视。
4　小结
收起
本研究基于自我决定理论与慢性疾病轨迹模式，构建了乳腺癌病人健康相关行为的“外部驱动-动机内化-自主整合”3阶段动态模型，系统揭示了病人在确诊、治疗中期及康复阶段的行为演化机制。结果表明，病人在外部驱动期受医患关系与家庭支持影响较大，需通过结构化信息传递与情绪疏导建立初步依附；在动机内化期，胜任感与归属感的增强是行为转向主动的关键，适宜通过叙事疗法与个体化目标设定促进动机内生；在自主整合期，内在动机已成为持续自我管理的主导力量，数字化赋能与社群支持能够有效巩固健康行为。在理论层面，本研究丰富了肿瘤护理行为理论，通过跨理论整合与文化敏感性分析，深化了对乳腺癌病人行为动机演变的理解；在实践层面，提出了“正念-叙事-社群”三级干预框架，并结合数字化平台建设与家庭共治模式，为分阶段精准护理提供了可操作的路径。尤其在中国文化背景下，将“孝”“责任”“集体主义”等价值观融入干预，有助于提升病人的内生动机与行为持续性。
尽管本研究采用纵向质性访谈并辅以Nvivo编码，有效捕捉了病人行为演变过程，但仍存在样本区域集中、量化验证不足等局限。未来研究应在多中心、大样本基础上引入行为量表及生存质量评估，开展混合方法研究；同时，应加强跨学科合作，探索人工智能与数字化健康管理工具在乳腺癌长期自我管理中的应用效果，以期为提升病人生存质量与护理服务水平提供更为坚实的证据支持。

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doi: 10.12102/j.issn.1009-6493.2026.17.025
  • 接收时间：2025-11-12
  • 首发时间：2026-10-30
  • 出版时间：2026-09-10
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  • 收稿日期：2025-11-12
  • 修回日期：2026-07-16
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    1郑州大学附属肿瘤医院 河南省肿瘤医院，河南 450000

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王永琦，主管护师，硕士研究生，E-mail：
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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