结直肠癌肠造口患者健康促进行为的研究进展
1. 延边大学, 护理学院, 吉林延边 133002
2. 山东大学齐鲁医院德州医院, 山东德州 253000
3. 延边大学附属医院 (延边医院), 吉林延边 133099
| 摘 要： | 目的：结直肠癌为中国常见消化道恶性肿瘤，肠造口术是重要治疗手段，但术后生理改变、并发症高发与心理负担显著影响患者康复。方法：本文系统梳理结直肠癌肠造口患者健康促进行为研究进展，明确其概念、测量工具、现状特点与影响因素，总结干预模式，为临床康复护理与后续研究提供依据。以文献综述法为主，从概念界定、评估工具、影响因素、干预措施四个维度进行归纳、整合与分析。结果：健康促进行为主要涵盖造口自我护理、健康饮食、规律运动、心理适应与社会支持等维度；常用评估工具以普适性量表为主，专用量表仍待完善；患者健康促进行为整体处于中等水平，运动与健康责任维度偏低；受社会人口学、疾病特征、疾病感知、自我效能、心理状态及环境支持等多因素影响；基于达标理论、转变理论的理论干预及数字化延续护理可有效提升健康行为水平、降低并发症、改善生活质量。结论：结直肠癌肠造口患者健康促进行为水平有待提升，影响因素复杂多样，理论驱动与延续性护理干预效果明确。未来应研发本土化专用评估工具，开展多中心、个性化干预研究，完善系统化健康促进体系，以优化护理实践、改善患者远期预后与生活质量。 |
| 关 键 词： | 肠造口; 结直肠癌; 健康促进行为; 影响因素 |
| DOI： | 10.57237/j.nhres.2026.01.001 |
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收稿日期: 2026-04-11
接受日期: 2026-05-07
在线出版日期: 2026-05-13
Research Progress on Health Promotion Behaviors of Colorectal Cancer Patients with Enterostomy
1. School of Nursing, Yanbian University, Yanbian 133002, China
2. Qilu Hospital of Shandong University Dezhou Hospital, Dezhou 253000, China
3. Yanbian University Affiliated Hospital (Yanbian Hospital), Yanbian 133099, China
| Abstract: | Objective: Colorectal cancer is a common gastrointestinal malignancy in China, and enterostomy is an important treatment. However, postoperative physiological changes, high complication rates and psychological burden significantly affect patients’ rehabilitation. This paper systematically reviews the research progress of health promotion behaviors in patients with colorectal cancer and enterostomy, clarifies the concept, measurement tools, current status and influencing factors, summarizes intervention models, and provides evidence for clinical rehabilitation nursing and future research. Methods: A literature review was conducted. Domestic and foreign studies were retrieved and systematically analyzed from four aspects: concept definition, assessment tools, influencing factors and intervention measures. Results: Health promotion behaviors mainly include stoma self-care, healthy diet, regular exercise, psychological adaptation and social support. Most commonly used assessment tools are universal scales, while specialized scales still need to be improved. The overall level of health promotion behaviors in patients is moderate, with low scores in exercise and health responsibility. It is affected by multiple factors including sociodemographic characteristics, disease-related factors, illness perception, self-efficacy, psychological status and environmental support. Theory-based interventions and digital transitional care can effectively improve health promotion behaviors, reduce complications and enhance quality of life. Conclusion: The level of health promotion behaviors in colorectal cancer patients with enterostomy needs to be improved, and the influencing factors are complex. Theory-driven and transitional care interventions show significant effects. Future research should develop localized specialized assessment tools, carry out multi-center and personalized intervention studies, and improve the systematic health promotion system to optimize nursing practice and improve long-term prognosis and quality of life. |
| Keywords: | Enterostomy; Colorectal Cancer; Health Promotion Behaviors; Influencing Factors |
参考文献
| [1] | Taylor C. Commentary: Jordanian ostomates' health problems and self-care ability to manage their intestinal ostomy: a cross-sectional study. J Res Nurs. 2020 Dec; 25(8): 697-698. https://doi.org/10.1177/1744987120941949IF:2.0Q2 |
| [2] | Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin. 2022 Jan; 72(1): 7-33. https://doi.org/10.3322/caac.21708 |
| [3] | Yang Y, Wang HY, Chen YK, et al. Current status of surgical treatment of rectal cancer in China. Chin Med J (Engl). 2020 Nov 20; 133(22): 2703-2711. https://doi.org/10.1097/cm9.0000000000001076 |
| [4] | Li S, Zhong L, Zhou D, et al. Predictors of Psychological Distress among Patients with Colorectal Cancer-Related Enterostomy: A Cross-sectional Study. Adv Skin Wound Care. 2023 Feb 1; 36(2): 85-92. https://doi.org/10.1097/01.ASW.0000911012.63191.4c |
| [5] | Tang WSW, Chiang LLC, Kwang KW, et al. Prevalence of depression and its potential contributing factors in patients with enterostomy: A meta-analytical review. Front Psychiatry. 2022 Nov 30; 13: 1001232. https://doi.org/10.3389/fpsyt.2022.1001232 |
| [6] | 周静茹, 赵莉, 王海潮等. 214名结直肠癌患者一级亲属健康促进生活方式现状及影响因素分析 [J]. 护理学报, 2023, 30(13): 53-58. |
| [7] | Kasl SV, Cobb S. Health behavior, illness behavior, and sick role behavior. I. Health and illness behavior. Arch Environ Health. 1966 Feb; 12(2): 246-66. https://doi.org/10.1080/00039896.1966.10664365 |
| [8] | Pender NJ, Walker SN, Sechrist KR, et al. Predicting health-promoting lifestyles in the workplace. Nurs Res. 1990 Nov-Dec; 39(6): 326-32. PMID: 2092305. https://psycnet.apa.org/doi/10.1097/00006199-199011000-00002 |
| [9] | Yang SY, Wang JD, Chang JH. Occupational therapy to improve quality of life for colorectal cancer survivors: a randomized clinical trial. Support Care Cancer. 2020 Mar; 28(3): 1503-1511. https://doi.org/10.1007/s00520-019-04971-2 |
| [10] | 赵桂娟. 健康行为及影响因素的研究进展 [J]. 右江医学, 2014, 42(02): 237-239. https://doi.org/10.3969/j.issn.1003-1383.2014.02.032 |
| [11] | Walker SN, Sechrist KR. The Health-Promoting Lifestyle Profile: development and psychometric characteristics [J]. Nord J Nurs Res, 1987, 36(2): 76-81. https://doi.org/10.1097/00006199-198703000-00002 |
| [12] | 万丽红, 熊小妮, 潘俊豪 等. 脑卒中患者健康行为量表的编制及信效度检验 [J]. 护理学杂志, 2017, 32(01): 25-29. https://doi.org/10.3870/j.issn.1001-4152.2017.01.025 |
| [13] | 韩雪娜, 王淑云, 郑学风 等. 个人掌控感对肠造口患者健康促进行为影响的研究 [J]. 护理管理杂志, 2021, 21(08): 538-542. https://doi.org/10.3969/j.issn.1671-315x.2021.08.002 |
| [14] | 陈旭. 永久性肠造口病人自我感受负担及健康相关行为与生活质量的关系研究 [J]. 全科护理, 2021, 19(06): 823-826. https://doi.org/10.12104/j.issn.1674-4748.2021.06.032 |
| [15] | Ping W, Cao W, Tan H, et al. Health protective behavior scale: Development and psychometric evaluation. PLoS One. 2018 Jan 8; 13(1): e0190390. https://doi.org/10.1371/journal.pone.0190390 |
| [16] | 裴祺, 张宁宁, 李涛. 新疆地区肠造口患者自我护理能力的相关影响因素及对策探讨 [J]. 新疆医科大学学报, 2020, 43(03): 365-368. https://doi.org/10.3969/j.issn.1009-5551.2020.03.029 |
| [17] | Ramezanzade Tabriz E, Ramezani M, Heydari A, et al. Development and psychometric properties of Health-Promoting Lifestyle Scale in Colorectal Cancer Survivors (HPLS-CRCS): a mixed-method study. BMC Cancer. 2023 Oct 3; 23(1): 931. https://doi.org/10.1186/s12885-023-11436-7 |
| [18] | 韩雪娜, 杨富国, 王淑云 等. 肠造口患者健康促进行为动机问卷的编制及信度效度检验 [J]. 中国护理管理, 2022, 22(01): 28-32. https://doi.org/10.3969/j.issn.1672-1756.2022.01.007 |
| [19] | 韩雪娜, 高俊茹, 杨富国 等. 肠造口患者健康促进行为意向问卷的编制及信效度检验 [J]. 中华现代护理杂志, 2022, 28(14). https://doi.org/10.3760/cma.j.cn115682-20210803-03432 |
| [20] | Mendes-Santos C, Quinta-Gomes AL, Pereira R, et al. A Smartphone-Delivered Program (Anathema) to Promote the Sexual Health of Older Adults, Colorectal Cancer Survivors, and Stroke Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial. JMIR Res Protoc. 2023 Jun 27; 12: e46734. https://doi.org/10.2196/46734 |
| [21] | Szpilewska K, Juzwiszyn J, Bolanowska Z, et al. Acceptance of disease and the quality of life in patients with enteric stoma. Pol Przegl Chir. 2018 Feb 28; 90(1): 13-17. https://doi.org/10.5604/01.3001.0011.5954 |
| [22] | 陈依琳, 张美芬, 覃惠美 等. 结直肠癌患者口服化疗药依从性与健康信念相关性的研究 [J]. 中国护理管理, 2017, 17(09): 1282-1286. https://doi.org/10.3969/j.issn.1672-1756.2017.09.029 |
| [23] | Shah V, Geller G, Xu D, et al. Evaluating the potential impact of lifestyle-based behavior change interventions delivered at the time of colorectal cancer screening. Cancer Causes Control. 2023 Nov 5. https://doi.org/10.1007/s10552-023-01773-0 |
| [24] | Kanehara R, Katagiri R, Goto A, et al. Sugar intake and colorectal cancer risk: A prospective Japanese cohort study. Cancer Sci. 2023 Jun; 114(6): 2584-2595. https://doi.org/10.1111/cas.15766 |
| [25] | Carr PR, Jansen L, Walter V, et al. Associations of red and processed meat with survival after colorectal cancer and differences according to timing of dietary assessment. Am J Clin Nutr. 2016 Jan; 103(1): 192-200. https://doi.org/10.3945/ajcn.115.121145 |
| [26] | Taylor C, Munro J, Goodman W, et al. Hernia Active Living Trial (HALT): an exercise intervention in people with a parastomal hernia or bulge. Br J Nurs. 2023 Dec 7; 32(22): S4-S11. https://doi.org/10.12968/bjon.2023.32.22.s4 |
| [27] | Brown JC, Damjanov N, Courneya KS, et al. A randomized dose-response trial of aerobic exercise and health-related quality of life in colon cancer survivors. Psychooncology. 2018 Apr; 27(4): 1221-1228. https://doi.org/10.1002/pon.4655 |
| [28] | Kim JY, Lee MK, Lee DH, et al. Effects of a 12-week home-based exercise program on quality of life, psychological health, and the level of physical activity in colorectal cancer survivors: a randomized controlled trial. Support Care Cancer. 2019 Aug; 27(8): 2933-2940. https://doi.org/10.1007/s00520-018-4588-0 |
| [29] | Yan Q, Li Y. Micro video incentive nursing intervention improves the psychological state and quality of life in patients with rectal cancer after enterostomy. Am J Transl Res. 2023 Mar 15; 15(3): 2040-2048. https://doi.org/10.62347/XYEO1786 |
| [30] | Van Blarigan EL, Fuchs CS, Niedzwiecki D, et al. Association of Survival With Adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors After Colon Cancer Diagnosis: The CALGB 89803/Alliance Trial. JAMA Oncol. 2018 Jun 1; 4(6): 783-790. https://doi.org/10.1001/jamaoncol.2018.0126 |
| [31] | Bours MJ, Beijer S, Winkels RM, et al. Dietary changes and dietary supplement use, and underlying motives for these habits reported by colorectal cancer survivors of the Patient Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship (PROFILES) registry. Br J Nutr. 2015 Jul; 114(2): 286-96. https://doi.org/10.1017/S0007114515001798 |
| [32] | Eyl RE, Xie K, Koch-Gallenkamp L, et al. Quality of life and physical activity in long-term (≥5 years post-diagnosis) colorectal cancer survivors - systematic review. Health Qual Life Outcomes. 2018 Jun 1; 16(1): 112. https://doi.org/10.1186/s12955-018-0934-7 |
| [33] | Eyl RE, Thong MSY, Carr PR, et al. Physical activity and long-term fatigue among colorectal cancer survivors - a population-based prospective study. BMC Cancer. 2020 May 18; 20(1): 438. https://doi.org/10.1186/s12885-020-06918-x |
| [34] | 韩雪娜. 基于健康行为理论整合模型肠造口患者健康促进行为及影响因素研究 [D]. 青岛大学, 2023. https://doi.org/10.27262/d.cnki.gqdau.2022.000245 |
| [35] | 杨昕宇. 结直肠癌幸存者健康促进生活方式与自我接纳、家庭亲密度和适应性的关系研究 [D]. 山东中医药大学, 2022. https://doi.org/10.27282/d.cnki.gsdzu.2021.000310 |
| [36] | 万珊珊, 杨长永, 卫莉. 新辅助化疗直肠癌造口患者健康行为现状及影响因素分析 [J]. 中国实用护理杂志, 2019, 35(1): 60-64. https://doi.org/10.3760/cma.j.issn.1672-7088.2019.01.013 |
| [37] | 贾莉莉. 结直肠癌肠造口患者疾病感知、应对方式与健康行为的相关性研究 [D]. 河南大学, 2023. https://doi.org/10.27114/d.cnki.ghnau.2021.000340 |
| [38] | Kim AS, Jang MH, Park KH, et al. Effects of Self-Efficacy, Depression, and Anger on Health-Promoting Behaviors of Korean Elderly Women with Hypertension. Int J Environ Res Public Health. 2020 Aug 29; 17(17): 6296. https://doi.org/10.3390/ijerph17176296 |
| [39] | Pitt E, Cashion C, Rumble S, et al. Associations between Health Behaviors, Health Self-Efficacy, and Long-Term Outcomes in Survivors of Childhood Cancer: A Cross-Sectional Study. Semin Oncol Nurs. 2023 Aug; 39(4): 151434. https://doi.org/10.1016/j.soncn.2023.151434 |
| [40] | 陈单, 傅桂芬, 林枚光 等. 大肠癌患者造口初期健康行为自我效能及其相关因素研究 [J]. 中国实用医药, 2015, 10(36): 271-272. https://link.cnki.net/doi/10.14163/j.cnki.11-5547/r.2015.36.200 |
| [41] | van Roekel EH, Duchâteau J, Bours MJL, et al. Longitudinal associations of light-intensity physical activity with quality of life, functioning and fatigue after colorectal cancer. Qual Life Res. 2020 Nov; 29(11): 2987-2998. https://link.springer.com/article/10.1007/s11136-020-02566-7 |
| [42] | Fisher A, Wardle J, Beeken RJ, et al. Perceived barriers and benefits to physical activity in colorectal cancer patients. Support Care Cancer. 2016 Feb; 24(2): 903-910. https://link.springer.com/article/10.1007/s00520-015-2860-0 |
| [43] | Devin JL, Sax AT, Hughes GI, et al. The influence of high-intensity compared with moderate-intensity exercise training on cardiorespiratory fitness and body composition in colorectal cancer survivors: a randomised controlled trial. J Cancer Surviv. 2016 Jun; 10(3): 467-79. https://doi.org/10.1007/s11764-015-0490-7 |
| [44] | Hardcastle SJ, Maxwell-Smith C, Hagger MS, et al. Exploration of information and support needs in relation to health concerns, diet and physical activity in colorectal cancer survivors. Eur J Cancer Care (Engl). 2018 Jan; 27(1). https://doi.org/10.1111/ecc.12679 |
| [45] | 陈霞, 越丽霞, 王志霞 等. 基于达标理论的老年肠造口患者出院准备计划的构建及应用 [J]. 中华护理教育, 2022, 19(11): 1027-1032. https://doi.org/10.3761/j.issn.1672-9234.2022.11.014 |
| [46] | 徐燕华. 基于转变理论的肠造口患者术后转变支持方案的构建及应用 [D]. 江苏大学, 2023. https://doi.org/10.27170/d.cnki.gjsuu.2022.001873 |
| [47] | Hao J, Xu Y, Li H. The Value of Applying a Continuous Nursing Model Based on Virtual Platforms for Patients with Colostomy or Ileostomy. Adv Skin Wound Care. 2023 Apr 1; 36(4): 206-212. https://doi.org/10.1097/01.ASW.0000919960.94295.53 |
| [48] | Huang Q, Zhuang Y, Ye X, et al. The effect of online training-based continuous nursing care for rectal cancer-patients undergoing permanent colostomy. Am J Transl Res. 2021 Apr 15; 13(4): 3084-3092. https://pubmed.ncbi.nlm.nih.gov/34017476/ |
