| 【Objective】To investigate the status of demoralization、social support and quality of life in patients with lung cancer undergoing chemotherapy,to explore the status of demoralization and its influencing factors.Additionally,to analyze the correlation among demoralization,social support and quality of life,to explore whether social support plays a moderator role between demoralization and quality of life.It provides evidences for identifying demoralization,relieving it from the perspective of social psychology,alerting to the occurrence of suicidal ideation or suicidal behavior and improving the quality of life of patients.【Methods】In this study,a cross-sectional survey method was used,and a total of300 inpatients with primary bronchogenic carcinoma who were undergoing chemotherapy from April to November 2019 in three first-class hospitals in Jinan was investigated.The Demoralization Scale Mandarin Version(DS-MV)、Social Support Rating Scale(SSRS)、The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core·30(EORTC QLQ·c30)and Quality of Life Questionnaire Lung Cancer·13(QLQ—LCl3)were used to assess demoralization、social support and quality of life(QOL),respectively.SPSS 21.0 and Process plug-in were used to analyze the data,including statistical descriptive analysis,Chi-square test,independent sample t-test,one-way ANOVA,correlation analysis,multiple linear stepwise regression analysis and moderating effect analysis.【Results】1.The current condition of demoralization in patients with lung cancer undergoing chemotherapyThe average score of the total score of demoralization in 259 patients with lung cancer undergoing chemotherapy was(35.42±12.70),and the average score of for each item was(1.48±0.53).The scores of the five dimensions from high to low were dysphoria(1.92±0.77),disheartenment(1.60±0.63),helplessness(1.46±0.79),sense of failure(1.41±0.47)and loss of meaning and purpose(1.03 ± 0.74).86.1% of lung cancer patients undergoing chemotherapy with moderate or severe demoralization.2.Factors interfering the demoralization in patients with lung cancer undergoing chemotherapyIndependent sample t-test and one-way ANOVA indicated that there were significant differences in education level,place of residence,marital status,occupation,work status,family income per capita,inform status of disease,payment system in health care,duration of initial diagnosis,disease stages,time to first chemotherapy,transfer and pain(p<0.05).3.Multiple linear stepwise regression analysis of demoralization in patients with lung cancer undergoing chemotherapyThe multiple linear stepwise regression analysis of demoralization in patients with lung cancer undergoing chemotherapy showed that inform status of disease,marital status(divorce),education level,duration of initial diagnosis,work status(unemployed)and place of residence(countryside)were the influencing factors of demoralization,which explained 34.1%of the valiances.4.The current status of social support and QOL in patients with lung cancer undergoing chemotherapyThe average score of total social support of lung cancer chemotherapy patients was(38.48 ± 8.69),and the average score of for each item was(3.85±0.87).The score of the three dimensions from high to low were subjective support(22.92±5.11),objective support(9.26±3.33)and support using degree(6.29±2.02).The social support level of lung cancer chemotherapy patients mainly concentrated in the middle level,accounting for 68.3%.The overall quality of life of lung cancer chemotherapy patients scored(57.34±20.38);in the functional area,the cognitive function score was the highest(65.51 ± 27.74),and the social function score was the lowest(58.30± 23.59);in the three symptom areas,pain score was the highest(49.74 ±25.42);in the six separate items,economic difficulty score was the highest(53.02± 23.96),insomnia score was the second(50.97±30.11),diarrhea score was the lowest(17.50 ± 22.98).In lung cancer specific module,the highest score was cough(37.58±36.11),and the lowest score was hemoptysis(9.40±19.73).5.Correlation analysis of social support、QOL and demoralization in patients with lung cancer undergoing chemotherapyThe correlation analysis showed that total score of demoralization and each dimension were negatively correlated with total score of social support(r=-0.310 ～-0.480,P<0.01),objective support(r=-0.160 ～-0.290,P<0.01),subjective support(r=-0.315 ～-0.480,P<0.01)and support using degree(r=-0.250～-0.375,P<0.01).The correlation analysis showed that total score of social support and each dimension were positively correlated with overall quality of life(r=0.590～0.895,P<0.01);and which were positively correlated with physical function(r=0.510～0.775,P<0.01),role function(r=0.525～0.750,P<0.01),emotional function(r=0.565～0.810,P<0.01),cognitive function(r=0.500～0.785,P<0.01)and social function(r=0.525～0.825,P<0.01).In the three symptom areas,the correlation coefficients of social support total score and each dimension with fatigue(r=-0.335～-0.405)and pain(r=-0.230～-0.410)were relatively high,which were significantly negative correlation(P<0.01);in the six separate items,which with dyspnea(r=-0.235～-0.400),loss of appetite(r=-0.220～-0.340),insomnia(r=-0.225～-0.330)and economic difficulty(r=-0.325～-0.435)were relatively high,which were significantly negative correlation(P<0.01);and which were negatively correlated with lung cancer specific module(r=-0.225～-0.350,P<0.01).The correlation analysis showed that total score of demoralization and each dimension were negatively correlated with overall quality of life(r=-0.365～-0.550,P<0.01);and which were negatively correlated with physical function(r=-0.290～-0.455,P<0.01),role function(r=-0.250～-0.405,P<0.01),emotional function(r=-0.305 ～-0.470,P<0.01),cognitive function(r=-0.340～-0.495,P<0.01)and social function(r=-0.340～-0.490,P<0.01);in the three symptom areas,the correlation coefficients of demoralization and each dimension with pain(r=0.545～0.755)was the largest,which was significant positive correlation(P<0.01);in the six separate items,which with insomnia was the largest(r=0.510～0.705)and significant positive correlation(P <0.01);and which were positively correlated with lung cancer specific module(r=0.130～0.260,P<0.01).6.The moderating effect of social support between demoralization and QOL in patients with lung cancer undergoing chemotherapyHierarchical regression analysis results showed that the association between demoralization and QOL was moderated by social support(b=0.134,P< 0.01),when the level of social support was high,the impact of demoralization on the quality of life was weaker.【Conclusion】1.The degree of demoralization in patients with lung cancer undergoing chemotherapy was more serious,86.1% of them were moderate or severe.2.Demoralization of patients with lung cancer undergoing chemotherapy was affected by marital status,education level,place of residence,occupation,work status,family income per capita,inform status of disease,payment system in health care,duration of initial diagnosis,disease stages,time to first chemotherapy,transfer and pain.3.Multiple linear regression analysis showed that marital status(divorce)and education level could negatively predict demoralization,duration of initial diagnosis,work status(unemployed)and place of residence(countryside)could positively predict demoralization,which were important influencing factor for the occurrence of demoralization in patients with lung cancer undergoing chemotherapy.4.The social support level of demoralization in patients with lung cancer undergoing chemotherapy was medium,which indicated that the social support level of patients with lung cancer chemotherapy was better.The quality of life of patients with lung cancer chemotherapy was in the middle level,which was most affected on cognitive function,insomnia,pain and fatigue are the most serious symptoms.5.There was a significant negative correlation between demoralization and social support,the overall quality of life in patients with lung cancer chemotherapy,and a significant positive correlation between social support and the overall quality of life in patients with lung cancer chemotherapy.6.The association between demoralization and QOL was moderated by social support,and improving the level of social support can weaken the influence of demoralization on the quality of life. |
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