Relationship Between Disease Perception And Medication Adherence In Patients With Differentiated Thyroid Cancer And Mediating Effect Analysis

ObjectivesTo understand the current situation of medication compliance in patients with differentiated thyroid cancer(DTC),and analyze the factors that affect the medication compliance of DTC patients.To explore the correlation between medication adherence and disease perception,psychological capital and social support in DTC patients.In order to provide a basis for the clinical formulation of nursing interventions,improve the prognosis of DTC patients and improve their quality of life.MethodsFrom March 2021 to September 2021,a cross-sectional study was conducted on DTC patients returning to the outpatient clinic of grade A tertiary hospital in Kaifeng City,Henan Province,and a questionnaire survey was conducted on 326 DTC patients by convenience sampling method.The survey tools include General Information Questionnaire,Morisky Medication Adherence Scale(MMAS-8),Brief Illness Perception Questionnaire(BIPQ),and Positive Psychological Questionnaire(PPQ)and the Social Support Rating Scale(SSQ).The Epidata3.1 database was established,and the questionnaire data was checked and entered by two persons.SPSS26.0 software was used to analyze the survey data,and descriptive analysis of frequency and percentage was performed on general demographic data.Descriptive analyses of mean plus and minus standard deviation were performed for medication adherence,disease perception,psychological capital and social support scores.Independent samples t test and one-way ANOVA were used to analyze the influencing factors of differences in medication adherence behavior among DTC patients.Pearson correlation analysis was used to understand the correlation between medication adherence and disease perception,psychological capital and social support in DTC patients.Multiple linear stepwise regression analysis of the influencing factors of medication compliance in DTC patients.The ROC curve was used to understand the predictions of disease perception,psychological capital and social support on medication adherence in DTC patients.p<0.05 indicated that the difference was statistically significant.Process 3.5 of SPSS26.0 was used to analyze the mediation effect and chain mediation effect between disease perception and medication compliance with psychological capital and social support as mediating variables.Results(1)A total of 326 patients taking medication after DTC were investigated in this study,104(31.90%)were male DTC patients and 222(68.10%)were female DTC patients.The mean age of the patients was(47.29±10.25)years,with a medication adherence score of(6.62±1.35)and the highest score on the scale was "Did you take your medication yesterday?"(0.98±0.15)and the lowest score was for "Do you sometimes forget to take your medication"(0.41±0.49).The highest number of people with a medium level of medication adherence(41.41%),a high level of medication adherence(30.37%)and a low level of medication adherence(28.22%).(2)Univariate analysis results: Gender,place of residence,time of taking medication,and whether to return for consultation on time were the influencing factors of medication compliance in DTC patients(p <0.05).(3)Correlation analysis results: The disease perception score of DTC patients was(41.49±8.00)points,the psychological capital score was(119.20±19.37)points,and the social support score was(41.53±5.94)points.Medication compliance of DTC patients was significantly negatively correlated with disease perception(r=-0.420,p<0.01),significantly positively correlated with psychological capital(r=0.456,p<0.01),and social support(r=0.457,p<0.01)showed a significant positive correlation.(4)Multiple linear regression analysis: There were significant differences in medication adherence levels among non-timely follow-up visits,disease cognition,subjective social support and social support utilization(p<0.05).The medication adherence and disease cognition of DTC patients negatively correlated.(5)ROC curve analysis of disease perception,psychological capital and social support in DTC patients: disease perception,psychological capital and social support can predict the level of patients’ medication compliance.When the disease perception score was less than 39.5,the psychological capital score was higher than 128.5,and the social support score was higher than 42.5,the medication compliance of DTC patients was at the level of complete compliance.(6)When psychological capital is the mediating variable,the total effect size(path c’)of disease perception on medication compliance in DTC patients is-0.405(95%CI :-0.505,-0.306,p<0.001);indirect path The value was-0.164(95%CI:-0.232,-0.096,p<0.001);the direct effect value was-0.242(95%CI:-0.357,-0.127),and the 95%CI interval value did not include 0,indicating that the partial mediating effect of psychological capital between disease perception and medication compliance was established,and the mediating effect accounted for 40.49%.(7)When social support is the mediating variable,the total effect size(path c’)of DTC patients’ disease perception on medication compliance is-0.405(95%CI:-0.505,-0.306,p<0.001);indirect path The value was-0.141(95%CI:-0.200,-0.089,p<0.001);the direct effect value was-0.265(95%CI:-0.369,-0.159),and the 95%CI interval value did not include 0,indicating that the partial mediating effect of social support between disease perception and medication compliance was established,and the mediating effect accounted for 34.81%.(8)Chain mediation: When psychological capital and social support are used as mediating variables between disease perception and medication adherence,the total effect size of disease perception on medication adherence is-0.405(95%CI:-0.505,-0.306,p<0.001);the direct effect value of disease perception on medication adherence was-0.216,95% CI by Bootstrap test(-0.329,-0.102,p<0.001).The indirect effect value is-0.082,the 95%CI of the Bootstrap test is(-0.128,-0.040),and the 95% CI interval value of the Bootstrap test does not contain 0,indicating that psychological capital and social support are in the relationship between disease perception and medication compliance.The chain mediation effect is established.Conclusion⑴ The medication adherence of DTC patients is at an intermediate level.Gender,place of residence,regularity of follow-up,duration of medication,perception of illness,psychological capital and social support are the main factors influencing the medication adherence of DTC patients.⑵ Medication adherence in patients with DTC was significantly negatively correlated with perceived illness and significantly positively correlated with psychological capital and social support.⑶ The psychological capital of DTC patients partially mediates the relationship between illness perception and medication adherence,and the social support of DTC patients partially mediates the relationship between illness perception and medication adherence.⑷ The psychological capital and social support of DTC patients play a chain mediating role between illness perception and medication adherence.