The Study Of Psycho-social Adaptation And Its Influence Factors In Breast Cancer Patients Undergoing Chemotherapy

ObjectiveTo evaluate the psycho-social adaptation,hope,social support,self-efficacy and coping style in breast cancer patients post-operation undergoing chemotherapy,and analyze the differences of psycho-social adaptation in demographic characteristics and disease related information to identify influence factors.And to explore the correlation between these variables with psycho-social adaptation.To propose and test the structural equation model established on the basis of previous studies and the Stress and Coping Model and to predict psycho-social adaptation as well as identifying the inter-mediation of coping style to clear the acting path of hope,social support,self-efficacy and coping style influencing psycho-social adaptation,so as to provide guidance for clinical staffs on assessing patients’ psycho-social adaptation and making intervention strategies to facilitate psycho-social adaptation.MethodsBreast cancer patients receiving chemotherapy in a Cancer Hospital in Tianjin from November 2015 to July 2016 were investigated.Self-designed general information questionnaire,Herth Hope Index(HHI),Social Support Rating Scale(SSRS),General Self Efficacy Scale(GSES),Medical Coping Modes Questionnaire(MCMQ),and Self-report Psycho-social Adjustment to Illness Scale(PAIS-SR)were used.Data was analyzed using SPSS21.0 for statistical description,one-way analysis of variance or t-test,correlation analysis,multiple step-wise regression analysis,and AMOS21.0 for structural equation model.Results900 questionnaires were given out,while 817 valid questionnaires of 872 questionnaires were retrieved(the valid response rate is 93.69%).The average score of HHI was(40.62±4.87),which was moderately high.The average scores of GSES and SSRS were respectively(26.42±7.34)and(43.29±6.041),both were at a moderate level.Scores of confrontation,avoidance,and resignation were respectively(20.36±3.078),(16.54±2.480)and(11.79±1.490);levels of psycho-social adaptation(46.00±13.784)were moderately high.The results of multiple stepwise regression analysisindicate that self-efficacy,confrontation,social support,the degree of economic difficulties,triple negative breast cancer or not,marital quality,personality optimism,therapeutic regimen,income,resignation and histological grade were risk factors of psycho-social adaptation.Hope(r=-0.443),self-efficacy(r=-0.540),social support(r=-0.403),coping style(ravoidance=0.190,rconfrontation=-0.514,rresignation = 0.292),were all significantly relevant with psycho-social adaptation(P<0.01).Structural equation model showed that confrontation act as an intermediary between self-efficacy,social support and psycho-social adaptation,while confrontation and resignation have mediating effects between hope and psycho-social adaptation,indexes of SEM(c2=4.246,P=0.374,c2/df=1.061,RMSEA =0.009,GFI=0.998,AGFI=0.991)indicate a good fit of theoretical model.ConclusionsPsycho-social adaptation of breast cancer patients receiving chemotherapy were moderately good.Besides,work ability,entertainment and sexual function were slightly worse which require more attention.Clinical staffs should focus on the influence factors of psycho-social adaptation including the degree of economic difficulties,triple negative breast cancer or not,marital quality,personality optimism,therapeutic regimen,income,resignation and so on to identify patients who are more likely to suffer from poor psycho-social adaptation as early as possible.Coping style acts as an intermediary between psycho-social adaptation and hope,self-efficacy,social support.moreover,there are significant positive correlations between hope,self-efficacy,social support and confrontation with psycho-social adaptation,and significant negative correlations between psycho-social adaptation with avoidance and resignation.This study indicates clinical staffs to make personalized nursing intervention targeting risk variables,by providing supportive environment,improving hope,enhancing self-efficacy and guiding the patients to cope positively,so as to promote breast cancer patients’ psycho-social adaptation.