Abstract: Objective: To explore the mediating effect of cognitive flexibility between the level of mindfulness and fear of disease progression in patients with hematological malignancies. Methods: Convenience sampling method was used and patients with hematologic malignancies in a grade A tertiary hospital were included from May 1, 2021 to August 31, 2022. General information questionnaire, cognitive flexibility questionnaire, five factor mindfulness scale, and fear of disease progression scale were used for investigation. Results: A total of 400 questionnaires were distributed and 373 were collected in the survey, with an effective response rate of 93.25%.The total score of fear of disease progression in patients with hematological malignancies was 35.03±5.50, the total score of cognitive flexibility was 69.98±13.15, and the total score of mindfulness was 112.76±13.15. Fear of disease progression was negatively correlated with cognitive flexibility (r=-0.534, P<0.001), negatively correlated with mindfulness (r=-0.602, P<0.001), and positively correlated with mindfulness and cognitive flexibility (r=0.442, P<0.001). Cognitive flexibility mediated the relationship between mindfulness and fear of disease progression, with a mediating effect size of -0.259, accounting for 41.48% of the total effect. Conclusion: Mindfulness not only directly affects the fear of disease progression in patients with hematological malignancies, but also has an impact on patients′ fear of disease progression through the mediating effect of cognitive flexibility. Caregivers should actively carry out intervention countermeasures based on the pathway that affects the progression of the fear disease, so as to reduce the degree of the progression of the fear disease and improve the mental health of patients.

Key words: Hematologic malignancies, Fear of disease progression, Mindfulness, Cognitive flexibility, Mediating effect

摘要： 目的：探讨认知灵活性在血液肿瘤患者正念水平及恐惧疾病进展间的中介效应。方法：采用便利抽样法，选取 2021 年 5 月 1 日至 2022 年 8 月 31 日在河南省某三级甲等医院住院治疗的血液肿瘤患者为研究对象，以一般资料调查表、认知灵活性问卷、五因素正念量表及恐惧疾病进展量表进行调查。结果：共发放问卷 400 份，回收有效问卷 373 份，有效回收率为 93.25%。血液肿瘤患者恐惧疾病进展总分为（35.03±5.50）分，认知灵活性总分为（69.98±13.15）分，正念水平总分为（112.76±13.15）分。恐惧疾病进展与认知灵活性呈负相关（r=-0.534，P＜0.001），与正念水平呈负相关（r=-0.602，P＜0.001），正念水平和认知灵活性呈正相关（r=0.442， P＜0.001）。认知灵活性在正念水平及恐惧疾病进展间有部分中介作用，中介效应为-0.259，占总效应 41.48%。结论：正念水平不仅直接作用于血液肿瘤患者恐惧疾病进展，还通过认知灵活性的中介作用对患者恐惧疾病进展产生影响。护理人员应积极开展以影响恐惧疾病进展路径为依据的干预措施，降低患者的恐惧疾病进展程度，提高心理健康水平。

关键词: 血液肿瘤, 恐惧疾病进展, 正念水平, 认知灵活性, 中介效应