| Chapter one:Development of the demand scale in female breast cancer hospitalized patients and evaluation of reliability and validityObjective:To develop a demand scale in Chinese and test the reliability and validity.Methods:On the basis of Maslow’s model and the new medical model, we read the foreign and domestic papers, refer to foreign demand tables, interviews with medical staff and patients, follow the suggestions of the experts, make the frame of scale. After these, the original table was made.115inpatient breast cancer patients were chosen to test the initial scale randomly. More than10methods were used to analysis the initial scale, including experts importance score, response rate, t-test, correlation coefficient, method variability, responsiveness analysis, stepwise regression analysis, Cronbach’s coefficient. The remaining entries form the breast cancer beta sheet, the reliability and validity were tested by test-retest reliability, Cronbach’s coefficient, split-half reliability, content validity, construct validity, discriminant validity criterion-related validity testing methods and so on.Results:Original scale has64items, which was analyzied by10methods. There were8methods where items were deleted. The items were chosen if selected by more than6methods,3items in sex knowledge dimension were adjusted and retained. The scale had38items and4dimension including disease knowledge, environment needs, knowledge needs, Psychological needs of the investigation. The scale was consistent with theoretical ideas. The four dimensions and scale of the test-retest reliability score was0.791、0.815.0.753.0.632and0.781respectively. Cronbach’s coefficients were0.914.0.889.0.879.0.936and 0.959. Every dimensions of split-half reliability varied between0.837to0.913, total scale split-half reliability were0.935. Principal component factor analysis was used to extract four common factors; the orthogonal rotation method was used for factor rotation,58.605%of total variance can be explained.Psychological dimensions had16items, the variance contribution rate was19.203%.Disease knowledge dimension has12items, variance contribution was17.359%. environment demand dimension had7items, the contribution rate was12.576%. Sex knowledge dimension had3items, variance contribution was7.944%.Four dimensions and total scale of the path map were drawn with equation, the model fit well,5model AIC values were less than the saturated model and independent model. The correlation coefficients between the items and its dimension was significant than the correlation with other dimensions, the correlation coefficients varied between0.213and0.564. The dimensions and total score correlation coefficients were between0.499and0.778. Equations were used to build six relationships between four dimensions, which showed six combinations unrestricted model and restricted models were significantly different, the four dimensions had good discriminate validity. The correlated factors between four dimensions and the total and simple satisfaction scale score were-0.371、-0.315.-0.241、-0.261and-0.353. The correlation coefficient factors with European quality of life scale for breast cancer patients were between-0.310and0.402.Conclusion:The demand scale for Breast cancer patients demand is reliable, sensitive and effective, it is independent and representative, which can serve as a tool for breast cancer patient needs analysis and be used in clinical practice as a supplement for clinical diagnosis and treatment. Chapter two:Health care Demand and Influence factors of Demand in female breast cancer hospitalized patientsObjective:To find the needs condition of breast cancer in China and explore the influence factors of demand. Provide a reference for health education.Methods:To investigate the breast cancer patients with self made scale including general demographic scale, clinical data questionnaire and breast cancer demand scale. To test estrogen receptor, progesterone receptor and human epidermal growth factor receptor2expression with SP immunohistochemical staining. T-test was used to compare the difference of demand in different stages of treatment, different age groups, different working conditions, and different surgical procedures. The one way variance analysis was used to compare the difference of patient needs in different family incomes, different education levels, different marital status, different payment ways, different pathological expression, different surgical methods and different classification of immunohistochemical expression. Multiple linear regression was used to explore the influence factors in the scale score, disease knowledge dimensions scores, physical dimensions score, dimensions of sex knowledge, social and psychological dimensions of score, ain=0.05, aout=0.10. Structural equation was used to build the reod map between dimensions, scale and influence factors.Results:The total score of demand scale is63.433±17.132, the score of disease knowledge, physical needs, sex knowledge needs and psychosocial needs were65.615±20.854,67.636±20.131,42.854±28.640, and63.743±18.334individually. Sex knowledge score was significantly lower than other dimensions, the environment needs were more than emotional needs. Young patients had stronger knowledge than old patients. Patients in operative period had higher scores than in chemotherapy or radiotherapy in disease knowledge needs, physical needs and psychosocial needs. Patients with high family income had higher needs than other groups in environment needs and psychological needs. Knowledge needs of patients living alone were significantly lower than patients with other family structures. Knowledge、environment and total needs in patients at rest were significantly higher than patient working. Environment、emotional and total needs in patients who participate new rural medical care were lower than patients with other payment methods. Environmental、emotional and total needs in patients with ER and PR positive expression were higher than patients with ER and PR negative expression. The main way to obtain demand were information brochures for the knowledge, the medical staff face to face and get information from television programs. The needs of patients were affected by many factors, including Work status, family income, whether to use traditional Chinese medicine, treatment of the stage, ER expression. Work status, family income, the treatment stages were influence factors of disease knowledge needs. Work status, family income, the treatment stages, ER expression were the influence factors in physical needs. Age and family income were influence factors in sex knowledge needs. PR expression and family income were the influence factors in psychosocial demands.There are8maps in the scale and four dimensions. All the values between chi-square degrees and freedom are less than2in all the8models. All CFI values are greater than0.90, all NFI values greater than0.90, all RMSEA values are less than0.08, all P values are greater than0.05, models are good settled.Conclusions:The doctors should pay different attention to need to different patients. Younger patients had stronger knowledge needs. Surgical patients had more disease knowledge needs. Patients with high monthly income had high physical needs and psychological needs than in other groups. Patients at rest had more knowledge needs and environmental needs. Patients who had good medical care had more environmental and emotional needs. The influencing factors of needs had working status、family income、treatment stage and ER expression. More active health education should be given in old, low income, young, surgical patients, and immunohistochemical negative expression patients. |
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