| Background Breast cancer is a malignant tumor with the highest incidence in the female globally,which poses a great risk for their health and wellbeing.In recent years,with the rapid development of tumor diagnosis and treatment technology,the survival rate of breast cancer patients has been significantly improved.Therefore,the mental health and quality of life of the long-term survivors of breast cancer have become the hotpoint of the research field.In this study,to provid the evidence and practical guidance for improving the psychological and quality of life of patients,we evaluated the effect of bibliotherapy on the mental health and quality of life of patients undergoing chemotherapy after breast cancer surgery.Aims 1.To investigate the mental health status and life quality of the postoperative chemotherapy patients with breast cancer,and analyze the risk factors,especially the modiable factors,in order to provide empirical evidence for clinical interventions.2.In order to establish a reading bibliography and implementation plan of bibliotherapy for breast cancer patients.3.To evaluate the effect of bibliotherapy on mental health and quality of life in postoperative chemotherapy patients with breast cancer,and to explore the impact of bibliotherapy on emotional management,disease cognition and quality of life.Methods 1.Cross-sectional study Patients underwent postoperative chemotherapy for breast cancer in a tertiary teaching hospital in Xi’an,Shanxi province were selected as subjects by using convenience sampling method.The patients met the inclusion criteria were investigated using the Baseline Characteristics Questionnaire,Self-rating Anxiety Scale(SAS),Five Facet Mindfulness Questionaire(FFMQ),Functional Assessment of Cancer Therapy-Breast Cancer(FACT-B)and Self-rating Depression Scale(SDS).Continuous variables were expressed as mean ± standard deviation(SDS)and were compared using t test.Category variables were expressed as count(percentage)and were compared using Chi-square test or Fisher’s exact probability test where appropriate.One-way ANOVA was used to analyze the differences among various groups.Risk factors for anxiety,depression,mindfulness,and quality of life were analyzed by using the multiple linear regression models.2.Quasi-experiment In the first stage,literature research,patient interview and research group discussion were carried out firstly.Thereafter,the reading bibliography and a specific implementation plan of bibliotherapy were determined.In the second stage,a total of 98 patients with negative emotions in the cross-sectional study were selected and divided into control group(49 patients)and study group(49 patients)according to the order of admission.The control group received routine health education and psychological nursing,and the study group received bibliotherapy in addition to the interventions employed in the control group.Patients were investigated with the ASA,SDS,FACT-B and FFMQ at 1 month and 3 months after the initiation of bibliotherapy.3.Qualitative interview Fifteen patients in the study group were selected by the objective sampling method.According to the interview outline,face-to-face semi-structured interviews were conducted to collect data,analyze and refine themes,and investigate patients’ experience and physical and mental changes in the process of bibliotherapy.Results: 1.The status of mental health and life quality of the patients underwent post operative chemotherapy for breast cancer 1.1 The mental health status A total of 373 questionnaires were assigned and 356 valid questionnaires were completed.The overall score and the incidence of anxiety were 49.15±10.71 and 50.3%,respectively.The overall score and the incidence of depression were 49.47±10.89 and 43.8%,respectively,and the overall score of mindfulness was 101.10±15.74.The averaged scores of items in each dimension from high to low were ono-judgment of internal experience(2.72±1.04),description(2.72±1.12),non-response to internal experience(2.65±1.04),observation(2.61±1.11)and perceptual action(2.23±1.00).1.2 The status of life quality The overall score of life quality was 86.02±18.68.The averaged scores of items in each dimension from high to low were: social/family status(2.53±1.26),emotional status(2.49±1.18),physiological status(2.44±1.13),additional attention condition(2.29±1.30)and functional status(2.27±1.13).2.Factors affecting metal health and life quality 2.1 Risk factors for negative emotions in patients underwent postoperative chemotherapy for breast cancer The results of multiple linear regression analysis indicated that occupational status,marital status,frequency of chemotherapy,TNM stage,education level,family per capita monthly income,and level of mindfulness were the influencing factors of anxiety,which could explain 40.4% of the overall variation of anxiety.While occupational status,marital status,frequency of chemotherapy,TNM stage,family per capita monthly income and level of mindfulness were the influencing factors of depression,which could explain 36.9% of the overall variation of anxiety.2.2 Factors affecting mindfulness level Multiple linear regression results showed that education level,income level,frequency of chemotherapy and TNM stage were the influencing factors for the mindfulness level,which could explain 42.4% of the overall variation of mindfulness level.2.3 Factors affecting life quality Multiple linear regression results showed that anxiety,depression,mindfulness level,frequency of chemotherapy and TNM stage were the influencing factors of life quality,which could explain 51.7% of the total variation of life quality.3.The effect of bibliotherapy on psychological status and life quality of the patients underwent postoperative chemotherapy for breast cancer.A total of 98 patients were included.Three patients were excluded due to the aggravation of their illness,and four patients were lost to follow-up(two patients in the study group and two patients in the study group).Finally,91 patients were enrolled in this study,including 45 patients in the study group and 46 patients in the control group.There were no statistically significant differences in anxiety,depression,mindfulness,and life quality scores between the study group and the control group at baseline(P>0.05).After intervention for 3 months,the results of Repeated Measures Anova indicated that the scores of anxiety,depression,mindfulness level and life quality in the two groups were significant differences in the intervention method main effect,time main effect and interaction effect(P < 0.05).The scores of anxiety and depression in the study group were significantly lower than those in the control group(P < 0.05).In addition,the scores of anxiety and depression in the study group decreased gradually over time,while those in the control group decreased firstly and then stabilized.After 1 and 3 months of intervention,the life quality and mindfulness level scores of the study group were significantly higher than those of the control group(P < 0.05).Furthermore,in the study group,the life quality and the mindfulness level showed an upward trend over time.Conclusion: 1.The incidence of anxiety and depression in patients underwent postoperative chemotherapy for breast cancer was at high level,which was affected by education level,income level,marital status and mindfulness level.These patients had a low level of mindfulness,which was affected by education,income,frequency of chemotherapy and TNM stages.Medical staff should pay attention to the emotional changes of patients with repeated chemotherapy and low income,and employ easy-to-understand intervention programs for patients with low education level to alleviate their negative emotions and improve their positive psychological state.2.The life quality of patients underwent postoperative chemotherapy for breast cancer was negatively correlated with the degree of anxiety and depression,positively correlated with the level of mindfulness,and was affected by the number of chemotherapy times,income,and TNM stages as well.Medical staff should not only instruct patients to regulate negative emotions,but also pay attention to their level of mindfulness in a bid to improve patients’ life quality from multiple perspectives.3.Bibliotherapy could significantly relieve anxiety and depression,and effectively improve the mindfulness level and life quality in breast cancer patients.Bibliotherapy could effectively improve patients’ self-psychological adjustment skills,and positively promote patients’ disease cognition level,positive coping ability and physical condition adaptation ability. |
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