A Longitudinal Study On The Trajectory Of Changes In Social Alienation And The Influencing Factors During The Transition Period Of Colorectal Cancer Patients’ Discharge From Hospital

Objective:To longitudinally examine the level of social alienation of colorectal cancer patients at four time points during the transition period of hospital discharge,to identify various subgroups of colorectal cancer patients’ trajectories of change in social alienation during the transition period,and to explore the factors influencing the heterogeneity of the trajectories of changes in social alienation of colorectal cancer patients during the transition period.Methods:1.210 patients with colorectal cancer who were hospitalized and discharged from a 3A grade hospital in Qingdao were selected for longitudinal research using a convenience sampling method.The general information questionnaire,General Alienation Scale(GAS),Perceived Social Support Scale(PSSS),Connor-Davidson resilience scale(CD-RISC),and Mishel Uncertainty in Illness Scale-adult(MUIS-A),were employed at each time point to conduct the follow-up survey,respectively,within one week after discharge(T1),one month after discharge(T2),three months after discharge(T3),and six months after discharge(T4).2.The statistical analysis of the data was performed using SPSS 26.0 and Mplus 8.3software.The trends of T1-T4 social alienation,psychological resilience,social support,and uncertainty in illness scores of colorectal cancer patients during the discharge transition period were examined by repeated measures analysis of variance.The correlations of T1-T4 social alienation,psychological resilience,social support,and uncertainty in illness scores of colorectal cancer patients during the discharge transition period were explored by Pearson correlation method.The independent samples t-test and analysis of variance(ANOVA)were adopted to examine the variability of T1-T4 social alienation scores during the discharge transition period according to the general data of colorectal cancer patients.To explore the heterogeneous subgroups of T1-T4 social alienation trajectories during the period of colorectal cancer patients by latent category growth model(LCGM).Factors influencing the subgroup classification of T1-T4 social alienation change trajectories during the transition period of discharge from colorectal cancer patients were explored by chi-square test,one-way ANOVA,and multivariate logistic regression analysis,with P < 0.05 indicating a statistically significant difference.Results:1.Repeated measures ANOVA showed a decreasing trend in social alienation scores at time points T1-T4 of colorectal cancer patients during the transition period of discharge with scores of(42.29±3.80),(40.06±2.96),(36.58±4.13),(33.76±2.46);the scores of social support were(63.12±2.82),(60.62±4.80),(57.93±4.48),and(54.87±3.15),respectively,showing a decreasing trend;the scores of psychological resilience were(71.76±3.63),(74.94±2.35),(75.77±2.18),and(75.92±3.30),respectively,showing an increasing trend;the scores of illness uncertainty were(42.01±2.78),(38.86±2.35),(36.77±2.54),and(34.28±2.78)points,respectively,presenting a decreasing trend(P < 0.05).2.A correlation analysis revealed that colorectal cancer patients’ scores of social alienation during the transition to discharge were negatively correlated with social support and psychological resilience scores,and positively correlated with the ambiguity,lack of clarification,and unpredictability dimension scores of uncertainty in illness(P < 0.05).3.The difference test showed that gender,age,monthly household income,the condition of the stoma in T1-T4,marital status,type of health insurance,chemotherapy regimen in T2-T4,complication in T1,family medical history,and type of pathology in T2 had a differential effect on the individual level of social alienation during the transition to discharge in colorectal cancer patients(P < 0.05).4.The latent category growth model identified three subgroups of trajectories of social alienation during the transition to discharge in colorectal cancer patients: C1(high stability group),C2(rapid descent group)and C3(low stability group),accounting for 13.16%,67.89%,and 18.95%,respectively(P < 0.05).5.Multi-categorical logistic regression analysis suggested that compared to the high stability group,the influencing factors for the development of social alienation change trajectory to the high-low group during the transition to discharge in colorectal cancer patients were male,age >70 years,monthly household income >5000,and unpredictable T2score;the influencing factors for the development of social alienation change trajectory to the low stability group in patients were social support T1,psychological flexibility T4,ambiguous T1,and lack of clarification T3 scores(P < 0.05).Conclusions:1.Colorectal cancer patients’ level of social alienation during the transition period of hospital discharge presents a descent trend,and there were three distinct trajectories of change in the groups of high stability,rapid descent group and low stability group.Despite the fact that the majority of patients’ social alienation status could be effectively alleviated over time,there was still a smaller proportion of patients with persistently high degrees of social alienation.2.The group heterogeneity of the trajectory of social alienation changes in colorectal cancer patients during the transition period of hospital discharge was influenced by gender,age,monthly household income,psychological resilience,social support,and uncertainty in illness,which provided a reference basis for medical workers to identify and screen patients with persistently high levels of social alienation at an early stage and to adopt targeted intervention measures for different groups.