| Objective:Cancer is a disease that seriously threatens human health and life.In recent years,cancer incidence and mortality rates have remained high.The transformation of the new medical model and the health management policy of ensuring people’s health in an all-round and full-cycle way advocated at the national level have greatly promoted the formation of the health management model in the field of cancer,the survival time of cancer patients can be extended,and researchers are beginning to focus on the role of psychological factors in the development,treatment,and prognosis of cancer.In the long process of fighting cancer,cancer patients must suffer significant physical and psychological pains and are prone to negative emotions and even psychological disorders,which seriously affect the survival period.Therefore,effectively reducing negative emotions in cancer patients and improving their sense of happiness are essential in improving cancer health management.With the rise of positive psychology,the mission of psychology has gradually expanded from treating mental illness to helping healthy people become happier and realize their human potential.Psychological capital is an essential part of positive psychological resources.A high level of psychological capital can help cancer patients cope positively with the stress caused by disease diagnosis and treatment and avoid negative emotions.Therefore,the assessment and improvement of the psychological capital of cancer patients are of great importance to the treatment and care of patients.However,there is a lack of assessment tools for the psychological capital for cancer patients.Therefore,based on the reality that cancer is harmful to human society and the positive effect of psychological capital on the psychological health of cancer patients,This study proposes to develop a psychological capital questionnaire for cancer patients,and to apply classical measurement theory(CTT)and item response theory(IRT)to assess the performance of the psychological capital questionnaire for cancer patients;and to apply the psychological capital questionnaire for cancer patients to explore the positive effects of psychological capital between anxiety,depressive symptoms and quality of life for cancer patients,using breast cancer as an example;Finally,the positive effects of web-based positive psychological interventions on psychological capital,quality of life,anxiety and depressive symptoms among breast cancer patients were explored.Methods:This study included three parts.The first part was the development and measurement properties of the psychological capital questionnaire for cancer patients based on CTT and IRT.This part was performed in three phases,including the construction of a pool of items for the Psychological Capital Questionnaire for Cancer Patients and the development of the original scale,the screening of items and the formation of the formal scale,and the evaluation of the scale’s measurement properties.Based on the literature research and patient interview,members of this group discussed forming a pool of items in the first phases.They asked 15 experts in related fields to evaluate the importance of indicators for each item to determine the content of the original questionnaire on the psychological capital of cancer patients.The second phase recruited 500 cancer patients who met the inclusion and exclusion criteria from September 2020 to February 2021.The study used multistage stratified whole-group sampling in one tertiary hospital in each of the five regions of Liaoning Province in the east,south,west,north,and center.Quantitative analysis methods such as the discrete trend,Cronbach’s alpha coefficient,correlation coefficient,discriminant,and exploratory factor analysis were used to screen the items,resulting in a formal questionnaire.In Phase III,CTT and IRT analysis techniques were mainly used to evaluate the performance of normative measures of psychological capital questionnaires for cancer patients.CTT mainly evaluates questionnaire performance through indicators such as reliability and validity,and IRT mainly evaluates questionnaires through item characteristic curves,item information functions,and threshold parameters.The second and third parts of this study focused on the practical application of the Psychological Capital Questionnaire for Cancer Patients and psychological intervention studies,taking breast cancer as an example,to conduct an empirical study related to the psychological capital of cancer patients.The second part explored the profile of psychological capital among cancer patients and its positive effects between anxiety,depressive symptoms and quality of life,using breast cancer as an example.This part used a convenience sampling method to select breast cancer patients who attended a third-rate hospital in Shenyang from June 2021 to February 2022 for a questionnaire survey,and 229 valid questionnaires were included,with an effective response rate of 86.4%.This chapter used a self-administered questionnaire to collect information on demographic and clinical data,anxiety,depression symptoms,psychological capital,and quality of life of breast cancer patients.The statistical analysis methods included the common method variance test,internal consistency test,descriptive analysis,latent profile analysis,t-test,ANOVA,chi-square test,and multiple linear regression analysis,and Bootstrap method test.The third part of the study on the effect of web-based mindfulness interventions on psychological capital,quality of life,anxiety and depressive symptoms among breast cancer patients.From June 2021 to May 2022,eligible breast cancer patients were recruited for positive psychological intervention according to inclusion exclusion criteria in a tertiary care hospital in Shenyang.Using the random number method,48 individuals were assigned to each of the intervention and control groups,and the control group was given the mindfulness interventions and the control group was given conventional care.Measurement time points included before the intervention(T0),immediately after the end of the intervention(T1),and 3 months after the end of the intervention(T2).Outcome indicators included psychological capital,quality of life,anxiety and depressive symptoms in breast cancer patients.The statistical analysis methods used included descriptive analysis,chi-square test,t-test and repeated measures ANOVA.In this study,Epidata 3.1 software was used for questionnaire entry and verification to ensure the accuracy of the data.SPSS 26.0 software was used to perform the common method deviation test,internal consistency test,descriptive analysis,t-test,ANOVA,chi-square test,exploratory factor analysis,correlation analysis,and multiple regression analysis on the data.Confirmatory factor analysis was performed using Amos 24.0software;IRT analysis was performed using R 4.1.1 software,and latent profile analysis was performed using Mplus 8.0 software.P<0.05 indicates statistical significance.Result:1)Through qualitative research such as expert consultation determined that the original psychological capital questionnaire for cancer patients included 44 items.Through five statistical analysis methods,such as discrete trend method,differentiation method and factor analysis method,20 items were removed,resulting in a final psychological capital questionnaire for cancer patients that included 24 items in four dimensions:self-efficacy,hope,resilience,and optimism.The factor analysis results showed that the overall variance explained by the four factors was 56.72%.The feasibility evaluation results showed that the psychological capital questionnaire for cancer patients had a return rate of 90.9%and was feasible and acceptable.The Cronbach’s alpha coefficient of the Psychological Capital Questionnaire for Cancer Patients was 0.886,and the Cronbach’s alpha coefficient for each dimension ranged from0.696 to 0.880.The retest reliability results showed that the intra-group correlation coefficients of the Psychological Capital Questionnaire for Cancer Patients and dimensions were more significant than 0.7.The four-factor model fitting results were significantly better than the one-,two-and three-factor models,and the results of the validated factor analysis of the four-factor model indicated that the item factor loadings range from 0.44 to 0.82,except for items 3 and 5,all of which are 0.5 and above.The model fit index is relatively good(X~2/df=2.072,GFI=0.925,RMSEA=0.046,CFI=0.951,NFI=0.910,TLI=0.943,AGFI=0.906,IFI=0.951).The convergent and discriminant validity results indicated that the mean variance extracted for the total questionnaire was0.430.The mean variance extracted for each dimension ranged from 0.409 to 0.485,indicating good convergent validity of the questionnaire.The correlation coefficients between the four common factors were between 0.314 and 0.484,and the average variance extracted from the common factors was more significant than the square of the corresponding correlation coefficients,indicating good discriminant validity of the questionnaire.After the operation of principal component analysis,the ratio of the first eigenvalue to the second eigenvalue of all four dimensions is greater than 3,indicating that the assumption of one-dimensionality is satisfied.The distinctions(a)for each item in each dimension of the Psychological Capital Questionnaire for Cancer Patients were2.18-3.51(self-efficacy),2.63-3.35(hope),1.34-3.30(resilience),and 1.44-4.92(optimism),respectively.Except for items 3-7,11,and 12,the response threshold b for all items exceeded the theoretical range of-3 to 3.In the item information curve,only seven items,such as items 3-6 and 10-12,have good information,while the other items got average amount of information.2)The results of the latent profile analysis showed that the psychological capital of breast cancer patients could be divided into three categories,namely,“low psychological capital”(n=53,23.1%),“medium psychological capital”(n=110,48.1%),and“high psychological capital”(n=66,28.8%).The mean score of psychological capital of breast cancer patients was 3.66±0.56,3.39±0.48 for the low psychological capital,3.59±0.38for the medium psychological capital,and 4.30±0.32 for the high psychological capital,with significant differences in the scores of each dimension of psychological capital among different categories of breast cancer patients.According to the patient health questionnaire and generalized anxiety disorder-7 scale thresholds,66.4%of breast cancer patients reported depressive symptoms,of which 19.3%reported moderate to severe depression;62.0%of breast cancer patients reported anxiety,of which 16.6%reported moderate to severe anxiety.Multiple linear regression analysis showed that anxiety(β=-0.450,P<0.001)and depressive symptoms(β=-0.575,P<0.001)were significantly and negatively associated with quality of life;psychological capital was a significant positive predictor of quality of life.Moreover,the interaction term between anxiety and depressive symptoms and psychological capital were both significant predictors of quality of life,suggesting that psychological capital plays a moderating role between anxiety and depressive symptoms and quality of life.3)The web-based mindfulness interventions were able to significantly improve positive psychological capital and its dimensions(including optimism,resilience,hope,and self-efficacy),significantly improve quality of life and its dimensions(physical,emotional,social/family,functional,and additional status),and significantly alleviate anxiety and depressive symptoms in breast cancer patients.A significant difference was found in the trend of change over time in the intervention group(P<0.01),psychological capital and its dimensions,quality of life and its dimensions after the intervention and 3months after the intervention were significantly higher than before the intervention(P<0.01),and anxiety and depressive symptoms were significantly lower than before the intervention(P<0.01),indicating that the positive thinking intervention was effective in increasing the level of psychological capital,improving quality of life and relieving negative anxiety and depression in breast cancer patients,and was sustained until 3months after the intervention.There were no significant changes in psychological capital and its dimensions,anxiety and depressive symptoms in the control group patients at the three time points(P>0.05),and the quality-of-life scores of the control group patients at time point T2 were significantly lower than those at time point T0(P<0.05).Comparison of the two groups at different time points showed that the levels of psychological capital and its dimensions,quality of life and its dimensions in the intervention group were significantly higher than the levels of psychological capital in the control group at the same time point both after and 3 months after the intervention(P<0.01),and the levels of anxiety and depressive symptoms in the intervention group were significantly higher than the levels of anxiety and depressive symptoms in the control group at the same time point both after and 3 months after the intervention(P<0.01).Conclusion:1)In this study,we developed a psychological capital questionnaire for cancer patients based on their clinical characteristics and psychological status.The scale adopted a five-point so that patients can more objectively describe their attitudes,coping styles,and psychological expectations after cancer.The CTT and IRT analysis techniques were applied to scientifically assess the performance of the Psychological Capital Questionnaire for Cancer Patients.The results showed that the Psychological Capital Questionnaire for Cancer Patients has good reliability and validity and can reflect the psychological capital ability of cancer patients stably,reliably,and accurately.The psychological capital questionnaire for cancer patients has good discrimination.However,the difficulty coefficient of the items was significant,and the patients could not easily understand the content of the items.Therefore,a larger sample size may be considered in future studies before considering whether to revise the entries.2)Taking breast cancer patients as an example,the potential profiles of psychological capital can be divided into 3 categories:low psychological capital,medium psychological capital,and high psychological capital.The level of psychological capital positively predicted their quality of life;the level of anxiety and depressive symptoms negatively predicted their quality of life.Moreover,psychological capital moderated the relationship between anxiety and depressive symptoms and quality of life,which means the higher the level of patients’psychological capital,the weaker the negative effect of depressive symptoms on quality of life.3)The web-based mindfulness interventions had a positive impact on the positive psychology of breast cancer patients,effectively improving their psychological capital and all dimensions(optimism,resilience,hope and self-efficacy),significantly improving their quality-of-life status,and effectively reducing their anxiety and depression,and the positive effects of the intervention had short-term effects. |
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