Path Analysis From Symptom Burden To Demoralization In Elderly Cancer Patients Undergoing Chemotherapy

AimsTo identify the factors influencing the demoralization syndrome in cancer patients.To analyze the relationship between demoralization syndrome and symptom burden,coping style,social support,and cognitive evaluation in elderly cancer chemotherapy patients.To explore the pathway of the role of symptom burden on demoralization syndrome in elderly cancer chemotherapy patients,with the aim of providing a reference for improving the mental health of elderly cancer chemotherapy patients.MethodsSystematic literature review was conducted to identify the main factors influencing the demoralization syndrome in cancer patients.Based on Qianjin Jiang’s theoretical model of psychological stress process,the pathway model of symptom burden acting on demoralization syndrome in elderly cancer chemotherapy patients was constructed by combining the results of literature studies.A cross-sectional study was conducted with 316 elderly patients undergoing chemotherapy for cancer in a tertiary care general hospital.And the General Information Questionnaire,Anderson Symptom Inventory,Social Support Rate Scale,Medical Coping Modes Questionnaire,Brief Illness Perception Questionnaire and Demoralization Scale Mandarin Version were used as research tools to validate the pathway model of symptom burden acting on demoralization syndrome in elderly cancer chemotherapy patients.SPSS 26.0 and AMOS 24.0 software were used for statistical analysis,and the statistical methods mainly included descriptive statistical analysis,independent t-test,one-way ANOVA,Pearson correlation analysis,multiple linear regression analysis,and mediation effect analysis.Results(1)A systematic review of the literature was conducted by searching nine electronic databases: Pub Med(Ovid),EMBASE(Ovid),Web of Science(Ovid),CINAHL(EBSCO),SCOPUS,China Knowledge Network,Wan-fang database,vip database,and China Biomedical Database.Among the 30 factors extracted from the text,the influencing factors with a high number of reports were literacy,social support,resignation medical coping method,monthly income,cancer stage,symptom burden,depression,presence of stoma,postoperative length,and work status,etc.The influencing factors of general information and the demoralization syndrome in cancer patients with controversies were excluded.Therefore,factors influencing the demoralization syndrome in cancer patients with a high level of evidence and a high number of reports were finally identified as symptom burden,resignation medical coping method,and social support.Based on Jiang Qianjin’s theory of psychological stress process and the results of literature studies,a preliminary pathway model of the role of symptom burden on demoralization syndrome in elderly cancer chemotherapy patients was constructed.(2)The score of the demoralization syndrome in elderly cancer chemotherapy patients was(36.7±11.5),and 78.3% of elderly cancer chemotherapy patients had high demoralization syndrome.The demoralization syndrome was significantly and positively correlated(P<0.01)with resignation medical coping method(r=0.507),cancer symptoms(r=0.387),symptom burden(r=0.385),symptom interference(r=0.298),cognitive appraisal(r=0.283),and avoidance coping style(r=0.178).Demoralization syndrome was significantly and negatively correlated(P<0.01)with confronting coping style(r=-0.137)(P<0.05),social support(r=-0.344),objective support(r=-0.158),subjective support(r=-0.326),and utilization of support(r=-0.237)(3)The results of univariate analysis showed that monthly per capita household income had a significant effect on patients’ the demoralization syndrome(p<0.01).And the results of multiple regression analysis showed that cancer symptoms,cognitive evaluation,resigned coping,and social support eventually entered the regression equation and could explain 38.2% of the total variance in the demoralization syndrome.(4)The pathway model showed that cancer symptoms could directly affect the demoralization syndrome in elderly cancer chemotherapy patients,with a direct effect size of 0.145(P<0.01),accounting for 66.8% of the total effect.Resignation medical coping method played a significant mediating role between cancer symptoms and patients the demoralization syndrome,with a mediating effect of 0.040(P<0.01),accounting for 55.6% of the total mediating effect.Resignation medical coping method and social support mediated multiple chains between cancer symptoms and patients demoralization syndrome,with a mediating effect of 0.009(P<0.01),accounting for12.5% of the total mediating effect.Cognitive appraisal mediated significantly between cancer symptoms and patients the demoralization syndrome,with a mediating effect of0.024(P<0.01),accounting for 11.1% of the total mediating effect.Conclusion(1)The incidence of the demoralization syndrome in elderly cancer chemotherapy patients is high,and cancer symptoms,social support,cognitive evaluation,and resignation medical coping method are independent risk factors for the demoralization syndrome in elderly cancer chemotherapy patients.(2)Resignation medical coping method,social support,and cognitive appraisal play a partially mediating role in the process of cancer symptoms affecting patients’ the demoralization syndrome.Cancer symptoms can act not only directly on patients’ the demoralization syndrome,but also indirectly through resignation medical coping method,social support,and cognitive evaluation,and the direct effect of cancer symptoms on patients’ demoralization syndrome.Resignation medical coping method and social support mediated multiple chains between cancer symptoms and patients demoralization syndrome,cognitive appraisal mediated significantly between cancer symptoms and patients the demoralization syndrome.Therefore,nursing staff can reduce the incidence of the demoralization syndrome by reducing patients’ symptom burden,guiding patients to establish a correct view of the disease,providing patients with disease knowledge that matches disease development and treatment,providing group psychological counseling,and guiding patients to adopt appropriate ways to cope with stressful events.