Analysis Of Self-Management Status And Influencing Factors Of Patients After Hepatectomy For Liver Cancer And A Descriptive Study Of Symptom Self-Management Experience

BackgroundLiver cancer is a common gastrointestinal malignancy with high morbidity and mortality worldwide.China is a country with high incidence of liver cancer,and the main treatment for the disease is hepatectomy.With the development of modern surgical techniques and the application of symptom management and self-management in the medical field,the survival time of cancer patients continues to prolong.Studies have shown that patients have a heavy burden of physical and mental symptoms after hepatocellular carcinoma resection,and their postoperative self-management behavior and ability are closely related to the prognosis of the disease.At present,there are few reports on the experience of symptom self-management and the influencing factors of self-management in patients with liver cancer after hepatectomy.ObjectiveTo understand the symptoms self-management experience of patients after liver cancer resection,evaluate the self-management ability of patients and analyze the influencing factors.To provide a theoretical basis for improving the self-management ability of liver cancer patients and reducing the burden of postoperative symptom management.Methods1.According to the principle of data saturation,18 patients with liver cancer were included in the semi-structured in-depth interview,and the traditional content analysis method was used for data analysis.2.Using the convenience sampling method,363 patients with liver cancer who were hospitalized in three tertiary hospitals in Henan Province from December 2020 to October2021 were selected as the research subjects.Using the Patient General Information Questionnaire,Cancer Patient Self-Management Assessment Scale,Memory Symptom Assessment Scale（MSAS）,Social Support Rating Scale（SSRS）,Herth Hope Inventory（HHI）and Chinese Version of the Brief Illness Perception Questionnaire（BIPQ）evaluated separately.SPSS 25.0 software was used for univariate analysis,correlation analysis and multiple linear regression analysis,and Amos 22.0 software was used to construct a structural equation model for liver cancer patients’self-management,social support,hope level,symptom experience,and disease perception,and for inter-variable path analysis and mediation Effects analysis.Results1.The symptom self-management experience of patients after hepatectomy can be divided into three themes:（1）the symptom experience is complicated;（2）Insufficient symptom management ability;（3）Self-management has individual differences and is influenced by environmental factors.2.After investigation,The self-management score of patients after hepatectomy were（128.09±20.41）.The scores of TMSAS were（0.78±0.93）.The scores of SSRS were（33.67±4.44）.The scores of HHI were（33.04±5.12）.The scores of BIPQ were（47.65±17.92）.3.Univariate analysis results showed that age,gender,family type,educational level,occupational status,monthly family income and postoperative course were the factors influencing postoperative self-management of liver cancer patients（P<0.05）.4.Pearson correlation analysis showed that the level of hope and social support were significantly positively correlated with the self-management score of patients with liver cancer(r _HHI=0.560,r _SSRS=0.670,P<0.001),and the disease perception and symptom experience were significantly negatively correlated with the self-management score of patients with liver cancer(r _Bipq=-0.664,r _MSAS=-0.530,P<0.001).5.The results of regression analysis show that education level,family monthly income,social support,hope level,disease perception and symptom experience are the main influencing factors of self-management of patients with liver cancer,which together explain 49.1%of the variation.6.The results of structural equation path analysis showed that both social support and hope had a positive effect on self-management,and the standardized path coefficients were0.304 and 0.162,respectively.Both disease perception and symptom experience had a negative effects on self-management,and the standardized path coefficients were-0.347and-0.277,respectively.Social support negatively affected symptom experience and disease perception,and the standardized path coefficients were-0.348 and-0.570,respectively.Social support positively affected the level of hope,and the normalized path coefficient was 0.265.Both symptom experience and disease perception had a negative effect on hope level,and the standardized path coefficients were-0.200 and-0.254,respectively.The mediating effects analysis showed that the mediating effects of disease perception,symptom experience and hope level on social support and self-management were 39.92%,24.56%and 12.24%,respectively.The mediating effect of hope level between symptom experience and self-management was 10.39%,and that between disease perception and self-management was 10.42%.ConclusionsAfter hepatectomy,patients with liver cancer have heavy burden of physical symptoms,obvious negative emotions and low self-management.The level of social support and hope is the protective factor of self-management of liver cancer patients,and the disease perception and symptom experience are the risk factors.Social support can reduce the disease perception and symptom experience of patients with liver cancer after hepatectomy,and improve the level of hope.Both disease perception and symptom experience can reduce the hope level of patients with liver cancer after hepatectomy.