| 【Objectives】1.To explore the interaction between social isolation and different covariates by assessing the level of social isolation in postoperative breast cancer patients and grouping them characteristically,and to identify the characteristics and differences of patients under different groups to provide guidance for social isolation interventions.2.To further investigate the trend of social isolation in breast cancer patients over time,and to identify the characteristics of people at high risk of social isolation and its predictors,so as to provide guidance for the intervention of social isolation.3.To investigate the experience and perception of social isolation among people with high performance of social isolation,to deeply explore the characteristics and influencing factors of social isolation,to supplement the results of quantitative studies,and to evaluate the rationality and necessity of individualized interventions for people at risk of social isolation.4.To evaluate the intervention effect of personalized intervention program-solution focused approach on social isolation in postoperative breast cancer patients(i.e.,social isolation potentially high-risk groups)in the stage of surgical treatment.To provide theoretical and practical guidance for the intervention of social isolation in clinical postoperative breast cancer patients,and to help patients improve their social isolation status and quality of life.【Methods】Survey on the current situation of social isolation in postoperative patients with breast cancerBased on the prior literature review,the survey instruments for social isolation were established: the Social Anxiety Scale(SAS),the 14-item Social Avoidance Scale(14-SAS),and the UCLA Loneliness Scale(UCLA).A general information questionnaire,a social isolation survey instrument,and the Pittsburgh Sleep Quality Index(PSQI)were used to investigate the current status of 300 postoperative breast cancer patients.Latent Profile Analysis(LPA)and multiple logistic regression analysis were used to explore the subpopulation characteristics and factors influencing social isolation in.patients.1.Construction of a trajectory model of change in social isolation of postoperative patients with breast cancer and analysis of predictive factorsUsing a longitudinal study design,a questionnaire was administered to 144 patients with breast cancer who were to undergo surgery at six time points of social isolation before surgery(T1),one month after surgery(T2),three months after surgery(T3),six months after surgery(T4),nine months after surgery(T5),and one year after surgery(T6).The Growth Mixture Model(GMM)and multiple logistic regression analysis were used to understand the types of trajectories and predictors of longitudinal changes in each variable of social isolation over time in the sample patients.Then the Latent Class Model(LCM)was fitted based on the results of fitting the trajectory types of social anxiety,social avoidance,and loneliness,combined with the multiple logistic regression analysis method to understand the trajectory categories of social isolation and their influencing factors.3.A phenomenological study of social isolation experience and influencing factors in postoperative patients with breast cancerA qualitative research approach was used to interview 22 postoperative breast cancer patients in Study 2 who completed the one-year follow-up and exhibited persistently high social isolation to gain insight into their experience of social isolation and the factors influencing it.4.Intervention study of social isolation in postoperative patients with breast cancerBased on the previous study on the factors influencing social isolation,an exploratory application of an individualized intervention solution focused approach was used to construct an intervention program and to intervene with postoperative breast cancer patients in the stage of surgical treatment.We used the convenience sampling method and random number table method to equally divide 72 postoperative breast cancer patients into2 groups,and implemented a 6-week regular follow-up and solution focused model intervention respectively,and finally compared the intervention effect of solution focused approach on social isolation in postoperative breast cancer patients.【Results】1.Survey on the current situation of social isolation in postoperative patients with breast cancerThe cross-sectional findings showed that the mean levels of social isolation in patients after breast cancer surgery were social anxiety(9.24 ± 4.51),social avoidance(6.34±3.69),and loneliness(41.20±8.65).The mean level of sleep quality was(8.42±4.38).The LPA results showed that research subjects as social isolation were identified into three subpopulations: high symptom group(N=34),moderate symptom group(N=136),and low symptom group(N=123).Compared to the low-symptom group,risk factors in the high-symptom group were mainly sleep quality(OR=1.121,P=0.016),radiotherapy(OR=8.385,P=0.017),and risk factors in the moderate-symptom group were mainly per capita monthly household income(3000-5000: OR=2.101,P=0.034),chemotherapy(OR=3.059,P=0.005),and stage of surgical treatment(OR=4.072,P<0.001;OR=8.063,P=0.010)were common risk factors for both.2.Construction of a trajectory model of change in social isolation of postoperative patients with breast cancer and analysis of predictive factorsGrowth mixture models were constructed for each variable of social isolation separately,and the results of the GMM combined with repeated measures variance design showed that social anxiety could be divided into two groups: the group with decreasing social anxiety(N=65),and the group with persistently low social anxiety(N=79).The first group had a high onset of social anxiety and showed a decreasing trend over time;the other group had a lower onset than the first group and also showed a decreasing trend over time.Melancholia(RR=5.095,P=0.040)was a predictor of decreasing social anxiety in the group with persistently low social anxiety compared to the group with persistently low social anxiety.Social avoidance can be divided into two groups: the persistent social avoidance group(N=50),and the no social avoidance group(N=94).The first group showed a higher starting value of social avoidance,reaching the highest value in T2 period,and the overall trend of increasing and then decreasing over time;the other group showed no social avoidance in T1 period,and the overall score showed a decreasing trend over time.Melancholia(RR=5.406,P=0.015)and sanguineous(RR=0.233,P=0.021)were predictors of persistent social avoidance compared to the no social avoidance group.Loneliness can be divided into two groups: the persistently high loneliness group(N=54),and the persistently low loneliness group(N=90).The first group had a higher starting value of loneliness and an overall insignificant change over time.The other group had a lower onset value than the first group and showed a slight overall decreasing trend over time.Melancholia(RR=5.418,P=0.024)was a predictor for the persistently high loneliness group compared to the persistently low loneliness group.The results of fitting the Latent Class Model(LCM)based on the trajectory type fitting results of social anxiety,social avoidance,and loneliness,combined with the trend and incidence results of each latent class group showed that social isolation could be divided into two categories: persistent high symptom group(N=54),and persistent low symptom group(N=90).Melancholia(OR=10.962,P=0.002)was a predictor of the persistent high symptom group compared to the persistent low symptom group.3.A phenomenological study of social isolation experience and influencing factors in postoperative patients with breast cancerFour themes emerged from the qualitative interview analysis of 22 patients who completed follow-up in Study 2 and were classified in the persistently high symptom group:(1)emotional experience of social isolation in post-breast cancer patients: feelings of loneliness,psychological breakdown,disturbed self-image,fear of recurrence;(2)behavioral manifestations of social isolation in post-breast cancer patients: self-world closure,avoidance of unknown risks,restricted active socialization;(3)subjective causes of social isolation in post-breast cancer: self-perception bias,internalized self-discrimination,denial of self-worth;(4)objective causes of social isolation in post-breast cancer: restrictions on receiving treatment,changes in the surrounding groups,changes in life and work,and the impact of epidemic.4.Intervention study of social isolation in postoperative patients with breast cancerSeventy-two patients with postoperative breast cancer were included in the randomized intervention study,with one case lost in the intervention group and four cases lost in the control group,and finally 35 cases in the intervention group and 32 cases in the control group were included in the final statistical analysis.The results showed that there was no statistical difference in SAS,14-SAS,UCLA scores and general information in the pre-intervention group compared with the control group(P>0.05),and the two groups were comparable.The SAS,14-SAS,and UCLA scores decreased in the intervention group after the intervention compared with the pre-intervention group(P<0.05).There was no statistically significant difference in SAS,14-SAS,and UCLA scores in the control group after the intervention compared with the pre-intervention period(P>0.05).SAS,14-SAS,and UCLA scores in the intervention group were lower than those in the control group after the intervention(P<0.05).【Conclusions】1.Patients with postoperative breast cancer have high overall levels of social isolation and poor sleep quality in this sample.The cross-sectional survey identified three groups of potential categories,and being at the stage of surgical treatment was a predictor for the high and moderate symptom groups.Thus patients in the surgical treatment stage may become high-risk groups for social isolation.2.The individual symptoms of social isolation in postoperative breast cancer patients often occur simultaneously and have a similar trajectory of change: i.e.,higher starting values and less change over time.This suggests that surgery is an important stimulus for it,and patients with high starting values are the focus of attention.Melancholia is a predictor of social isolation and its various high symptom groups,and identifying the patient’s temperament type may be important for the early identification of social isolation.3.Postoperative breast cancer patients with persistent high social isolation manifestations have not only emotional but also behavioral manifestations.There are subjective and objective differences in the causes of their social isolation.This suggests that the experience of social isolation in highly symptomatic postoperative breast cancer patients is unique and complex,and that individualized intervention programs may be more effective.4.The solution focused approach is patient-centered,which can stimulate individual potential and significantly improve the social isolation problem of patients after breast cancer surgery.Therefore,future intervention for the social isolation of patients with breast cancer in combination with solution focused approach. |
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