Study On The Current Situation,Influencing Factors,and Pathways Of Social Isolation In Patients With Gynecological Cancer

ObjectivesThe purpose of this study was to investigate the current situation of social isolation and its influencing factors in gynecologic cancer patients;to explore the pathways of social support,negative emotions,adaptive cognitive coping strategies,and mal-adaptive cognitive coping strategies on social isolation by constructing a structural equation model,and to provide a reference for promoting early identification of social isolation and its influencing factors in gynecologic cancer patients by health care professionals and implementing individualized clinical care interventions.MethodsFrom November 2021 to January 2023,463 gynecological cancer patients from gynecological wards of three tertiary care hospitals in Lanzhou City were selected using convenience sampling method.The survey instruments included the General Information Questionnaire,General Alienation Scale(GAS),Social Avoidance Scale(SAS),Perceived Social Support Scale(PSSS),Cognitive Emotion Cognitive Emotion Regulation Questionnaire(CERQ),and Depression,Anxiety and Stress Scale(DASS).After double-entry of data using Epidata 3.1 software,the data were analyzed statistically using descriptive analysis,two independent samples t-test,ANOVA,and Person correlation analysis using SPSS 25.0 software;structural equation modeling was constructed using AMOS 23.0 software to analyze the specific paths of influence factors.Results(1)The mean score of subjective social isolation in gynecologic cancer patients was(39.20±4.16),the mean score of others isolation dimension was(12.50±1.84),the mean score of suspicion dimension was(10.83±1.43),the mean score of self-isolation dimension was(8.01±1.18),and the mean score of meaningless dimension was(7.86±1.16).The mean score of objective social isolation was(6.35±1.75).(2)The results of univariate analysis showed that marital status,religious belief,monthly per capita family income,medical payment method,place of residence,disease diagnosis,disease duration,whether metastasis or recurrence,whether other chronic diseases,and number of chemotherapy had an effect on subjective social isolation of gynecologic cancer patients with statistically significant differences(P<0.05);age,education level,per capita monthly household income,and place of residence had effects on objective social isolation of gynecologic cancer patients and the differences were statistically significant(P<0.05).(3)The results of correlation analysis showed that social isolation of gynecologic cancer patients was positively correlated with mal-adaptive cognitive coping strategies and negative emotions(P<0.05)and negatively correlated with adaptive cognitive coping strategies and social support(P<0.05).(4)The structural equation model fit well(X~2/df=1.937,RMSEA=0.045,CFI=0.953,NFI=0.908,IFI=0.953,GFI=0.938,AGFI=0.919).The direct effects showed that:social support,adaptive cognitive coping strategies could significantly and negatively predict social isolation(=-0.213,P<0.001;=-0.372,P<0.001).Maladaptive cognitive coping strategies could significantly and positively predict social isolation(=0.431,P<0.001).social support could also predict social isolation through adaptive cognitive coping strategies,mal-adaptive cognitive coping strategies and negative emotions,with a total mediating effect of-0.231,accounting for 52.1%of the total effect of social support on social isolation.Specifically,there were five paths of mediating effects:(1)social support→adaptive cognitive coping strategies→social isolation path,with an indirect effect of-0.068;(2)social support→mal-adaptive cognitive coping strategies→social isolation path,with an indirect effect of-0.046;(3)social support→adaptive cognitive coping strategies→mal-adaptive cognitive coping strategies→social isolation path,with an indirect effect of-0.062;(4)social support→negative emotions→adaptive cognitive coping strategies→social isolation path,with an indirect effect of-0.029;(5)social support→negative emotions→adaptive cognitive coping strategies→mal-adaptive cognitive coping strategies→social isolation path,with an indirect effect of-0.026.Conclusions(1)Social isolation among gynecologic cancer patients is generally at a moderate to high level,which should be taken seriously by health care professionals.(2)Age,education level,marital status,religious belief,per capita monthly family income,medical payment method,place of residence,disease diagnosis,disease duration,whether metastasis or recurrence,whether other chronic diseases are present,and the number of chemotherapy treatments are factors influencing social isolation of gynecologic cancer patients.The influencing factors of social isolation of gynecologic cancer patients with different characteristics differ greatly,and it is suggested that health care professionals should make targeted interventions to meet the individual needs of patients in accordance with their actual conditions.(3)Social support,adaptive cognitive coping strategies,mal-adaptive cognitive coping strategies,and negative emotions can directly or indirectly predict social isolation in gynecologic cancer patients.It is suggested that caregivers and health care personnel should give patients adequate attention and support,improve patients’social support system,improve patients’cognitive coping ability,and help patients maintain a good emotional state to avoid social isolation,a psychosocial maladaptive behavior.