The Effect Of Social Support On The Relationship Between Resilience And Quality Of Life Among Chinese Patients With Breast Cancer

Objective: 1.To provide some insights into the development of resilience in nursing by mapping publication output and exploring hotspots.2.To analyze the relationship among social support,resilience and quality of life in the patients with breast cancer and investigate the role of social support in the relationship between resilience and quality of life.3.To validate,supply and enrich the quantitative research,and further clarify the role characteristics of social support in the relationship between resilience and quality of life,we deeply explored the experiences of social support during their breast journeys based on the grounded theory.Methods: 1.Bibliometric analysis: The articles related to resilience were retrieved from Pub Med.Publication outputs were assessed using BICOMB software,including the distribution of literatures by year,country,publication journals,and high frequency keywords.A total of 52 high frequency keywords were extracted and produced word matrix and co-occurrence matrix from the recent 10 years.The visualized social network diagram produced by UCINET 6.212 software can reflect the close relationship and development trends among the research objects.In addition,clustering analysis was performed by SPSS 21.Finally,the results of social network structure and cluster were summarized and were used to analyze the development trends and the research hotspots.Additionally,CNKI was mainly used as the search database in the current domestic research.The citation analysis system was built in this database that was used to analyze comprehensively the publication year,the amount of articles issued,the author,and the high-frequency keywords.2.Quantitative research: A demographic-disease survey,the Chinese version of the Connor-Davidson Resilience Scale 25,Medical Outcomes Study Social Support Survey,and Functional Assessment of Cancer Therapy Breast Cancer Version 3 were used to interview 120 patients with breast cancer from a teaching hospital in Chongqing,China.Data was double-entered into the software of Epidata 3.0 and SPSS 21.Data analysis was performed by descriptive statistics,independent sample t-test,one-way ANOVA,and regression analyses.3.Qualitative research: Purposive sampling and theoretical sampling were used.The breast cancer patients were recruited until data saturation(n =20)from a tertiary general hospital.Semi-structured interviews were conducted in a private room.The interview data were analyzed using open logging,associated logging and core logging to generate substantive codes through the process of constant comparison based on the grounded theory.Social support theory and behavior change theory were combined together to explain the results.Results: 1.Bibliometric analysis: A total of 1,094 articles were found from 1985 to 2016,of which 78.76% came from the USA and England.The number of publications was increasing year by year.They were published in 549 journals that involved various disciplines.52 high frequency keywords(more than 13 times)were extracted from the 921 publications over 10 years,of which included “Adaptation,Psychological”,“Stress,Psychological”,“and Caregivers”,“Neoplasm”,“Social Support” and so on.The main target population,the various issues,some intervention measures and outcomes were concluded.According to the results of the co-occurrence analysis and cluster analysis,research hotspots were as follows:(1)resilience and mental disorders of neoplasm and HIV patients and related intervention strategies such as social support,improvement of interpersonal relationships,and enhancement of self-concept awareness;(2)resilience and professional burnout and related intervention strategies such as empathy;(3)resilience and health care of the elderly(dementia and chronic diseases);(4)resilience and post-traumatic stress disorders;(5)Resilience and health promotion for people experiencing major accidents;(6)resilience and patient safety;(7)resilience and the behavior of vulnerable people.The results of CNKI database also showed that the number of publications in resilience was increasing year by year.The journal of the highest number of relevant research publications was the Chinese Journal of Health Psychology.The number one author was Li Min,of which there were 5 authors with a medical major.According to the nature and category of the concept,they were summed up in the following research areas,including research subjects,research topics,intervention strategies and outcomes.2.Quantitative research: Participants were 98 Chinese women.1)The mean score for resilience was 54.68(SD=16.83,range=23–93).The scores of the three subscales consist of tenacity,strength,and optimism were 27.70(SD=9.39),18.57(SD=5.72)and 8.40(SD=2.93),respectively.The mean score for social support was 61.73(SD=14.32,range=31–95),and the scores of the domains of emotional–informational support,tangible support,affectionate support,and positive social interactive support were 23.55(SD=7.40),14.24(SD=3.09),10.49(SD=2.32)and 13.45(SD=3.17),respectively.Social support levels differed significantly by participants' marital status,monthly income,living place,time since diagnosis,stage of breast cancer,and surgery type.The total mean score of QOL was 80.74(SD=19.49,range=35–129),and the scores of the domains of physical well-being(PWB),functional well-being(FWB),emotional well-being(EWB),social/family well-being(SWB),and breast cancer-specific concerns(BCS)were 17.32(SD=4.82),16.24(SD=5.74),and 12.87(SD=5.60),13.71(SD=5.47),and 20.60(SD=4.74).QOL levels differed significantly by participants' monthly income,time since diagnosis,stage of breast cancer,and surgery type.2)Resilience and social support were found to be highly related to QOL.Resilience was positively correlated with total social support(r=0.660,p<0.01),the four subscales of social support,and quality of life(r=0.745,p<0.01).Total social support and its domains were also significantly correlated with QOL.Positive social interaction support and QOL had the highest correlation coefficient(r=0.909,p<0.01).The four subscales of social support correlated significantly with each other.Affectionate support and positive social interaction support had the highest correlation coefficient(r=0.859,p<0.01).3)Social support might play a partial mediator role between resilience and QOL.Through three-step regression and bootstrap method,social support had a significant mediating effect,and the mediation effect ratios were 28.0%.3.Qualitative research: Social support played an important role in helping anti-cancer model changes of the patients with breast cancer from negative model(pessimistic personality,negative cognitive style,emotion disorders,lack of communication)to the positive model(Cognitive ability promoted,Interpersonal relationship improved and good mental state).The core category was the behavior change.Conclusion: This study explored the role of social support on the relationship between resilience and quality of life among the patients with breast cancer from multiple perspectives of psychology,sociology,and nursing.This study clarified the mediating role of social support and affirmed that it had positive promotion effect for the anti-cancer behavior of patients.Social support not only helps the patient's behavior to change from the negative mode to the positive mode,but also has an important practical significance for the development of the patient's resilience and improvement of the quality of life.Health professionals should provide appropriate guidelines to help patients seek effective support and enhance their resilience to improve their quality of life after breast cancer.