The Relationship Between Pain Knowledge And Cancer Pain Management Disorders In Cancer Patients:The Mediating Effects Of Self-efficacy And Pain Self-Management Behavior

ObjectivesTo describe the current status of cancer pain management disorders in cancer patients and the influence of pain knowledge on cancer pain management disorders;to explore the mediating role of self-efficacy and pain self-management behavior between pain knowledge and cancer pain management disorders,and to provide a theoretical basis for cancer patients to improve pain management.MethodsA descriptive study was conducted with cancer patients with cancer pain selected from a third-grade Class-A hospital in Shandong Province.Disease information and sociodemographic information questionnaire was used to collect the patient’s general condition data.Pain knowledge level(FPQ)was investigated through the home pain questionnaire,and the general self-efficacy scale(GSES)was used to investigate the patient’s self-efficacy.The postoperative pain self-management behavior questionnaire(PPSMB)was used to investigate the level of pain self-management behavior,and the pain management disorder scale Taiwan(BQT)was used to investigate the degree of pain management disorder.The data was entered into the database established by EXCEL 2013 after double checking the statistical description and univariate analysis and common method deviation test were completed using SPSS 24.0.Pain knowledge was used as the independent variable,selfefficacy and pain self-management behavior were used as the mediating variables,and cancer pain management disorder was used as the dependent variable.Statistically significant variables in univariate analysis were controlled.The Process 3.3 plug-in was used to analyze the mediation effect of Model 4 and Model 6.Results1.A total of 278 cases were included in this study,and the age distribution was 21-80 years old,with an average(50.91 ± 13.52)years old.Males(159 cases)accounted for 57.2%.Most of them had less than high school education(182 cases,65.5%),200 cases(71.9%)had per capita monthly income of<4000 yuan.Most tumors(187 cases,67.3%)have metastasized.The overall average score of pain management disorder was(3.00±0.39),the score of pain self-management behavior was(27.56±6.24),pain knowledge score was(48.78± 17.29)and self-efficacy score was(25.16±6.26).2.The correlation analysis results showed that pain management disorders were negatively correlated with pain self-management behavior(r=-0.407),self-efficacy(r=0.347)and pain knowledge(r=-0.463),with all Ps<0.001.Pain self-management behavior was positively correlated with self-efficacy and pain knowledge(r=0.186,P<0.05.r=0.349,P<0.001),self-efficacy was positively correlated with pain knowledge(r=0.189,P<0.05).3.The mediating effect model of pain self-efficacy behavior between pain knowledge and pain management disorder showed that the total effect(path c)of pain knowledge on pain management disorders was β=-0.397(t=-7.530.P<0.001);The pathway coefficient of indirect pathway pain knowledge and self-efficacy(path a)was β=0.162(t=2.59,β=0.01);The pathway coefficient of indirect pathway self-efficacy and pain management disorder(path b)was β=-0.259(t=-5.293.P<0.001).After adding the self-efficacy of the mediating variable,the direct effect(path c’)path coefficient was β=-0.355(t=-6.977,P<0.001).The Bootstrap method was sampled 5000 times to further test the mediation effect,and the results showed that the effect value of the mediation effect was-0.095.95%CI=-0.19～-0.03,indicating that self-efficacy-mediated mediation is established.4.The mediating effect model of pain self-management behavior between pain knowledge and pain management disorder showed that the overall effect(path c)of pain knowledge on pain management disorder was β=-0.397(t=-7.530,P<0.001);the pathway coefficient of indirect pathway pain knowledge and pain self-management behavior(path a)was β=0.341(t=5.758,P<0.001);the pathway coefficient for indirect pathway pain selfmanagement behavior and pain management disorder(path b)was β=-0.247(t=-4.727,P<0.001);after adding the mediating variable pain self-management behavior,the direct effect(path c’)path coefficient was β=-0.313(t=-5.815,P<0.001).The Bootstrap method was sampled 5000 times to further test the mediation effect,the results showed that the mediation effect value was-0.190,95%CI=-0.3～-0.1,indicating that the mediating role of pain selfmanagement behavior mediation was established.5.The chain mediation effect model of self-efficacy and pain self-management behavior between pain knowledge and cancer pain management disorder showed that the total effect(path d)of pain knowledge on cancer pain management disorder was β=-0.397(t=-7.530,P<0.001);indirect pathway pain knowledge on self-efficacy(path a),self-efficacy on pain self-management behavior(path b),pain self-management behavior on cancer pain management disorder(path c),the pathway coefficients of self-efficacy on cancer pain management disorder(path e)and pain knowledge on pain self-management behavior(path f)were β=0.162(t=2.590,P<0.01),β=0.117(t=2.034,P<0.05),β=-0.216(t=-4.284,P<0.001),β=-0.234(t=-4.892,P<0.001),β=0.322(t=5.404,P<0.001),respectively After adding the mediating variables self-efficacy and pain self-management behavior,the direct effect(path d’)path coefficient was β=-0.285(t=-5.493,P<0.001).The Bootstrap test showed that none of the 95%CI of three indirect effect pathways,included 0,and the chain mediation effect was established.Conclusions1.The study subjects in this study had a high degree of cancer pain management and need to be addressed.2.The relationship between pain knowledge and cancer pain management disorder was the most significant,and patients with lack of pain knowledge had higher pain management disorders.3.The general self-efficacy and pain self-management behavior of cancer patients had a mediating role between pain knowledge and pain management disorders,and general selfefficacy and pain self-management behaviors were between pain knowledge and pain management disorders play a chain intermediary role.4.Compared with self-efficacy,pain self-management behaviors had a more significant mediating role between pain knowledge and pain management disorders.