Investigation On Self-management Postoperative Level Of Esophageal Carcinoma Patients And Their Influential Factors

Objectives1. To develop a self-management questionnaire for Chinese patients with esophageal carcinoma, to analyze and examine the items in the questionnaire for reliability and validity.2. To investigate the level of self-management and influential factors in patients with esophageal carcinoma.3. To explore the relationship between self-management and quality of life, depression evaluation, social support.MethodsThis research was performed in two consecutive phases.In the first phase, to advice and interviews experts about the self-management questionnaire, do pre-experiment in small samples and format the initial self-management questionnaire was designed for esophageal carcinoma patients after operation in 2～6,2010.165 esophageal carcinoma patients after operation were investigated with this questionnaire in The First Affiliated Hospital of Zhengzhou University and Henan Cancer Hospital. Exploratory factor analysis (EFA) was used to deduce items and determine the structure of the questionnaire. Another 20 patients with standards-compliant were extracted to pilot for the preliminary questionnaire's reliability and validity.The reliability analysis included the test-retest reliability, Cronbach's a coefficient, split-half reliability. The validity analysis included content validity, construct validity and criterion-related validity.In the second stage:A convenience sample of 150 esophageal carcinoma patients who met the criteria were investigated with short form 36 heath survey questionnaire, self-rating depression scale, social support rating scale and the designed questionnaire in the above two hospitals in 7-11,2010.Data was analyzed by SPSS 17.0 statistical software. Statistical analysis included descriptive statistics, ordinal logistic regression analysis, correlation analysis and multiple linear stepwise regression.Results1. Item reduction and questionnaire construction were carried out using principal component and the final questionnaire comprised 4 dimensions grouping 27 items.2. Reliability verification:①Cronbach' sa coefficient:0.784～0.823 for sub-questionnaire, and 0.803 for total questionnaire;②plit-half reliability:coefficient was 0.785～0.829 for sub-questionnaire, and 0.827 for total questionnaire;③The retest reliability:the sub-questionnaire coefficient was 0.852～0.921, the total was 0.887;④the sub-questionnaire of consistency:The correlation coefficient between each item and sub-questionnaire was 0.473～0.796, between sub-questionnaire was 0.622～0.748, between sub-questionnaire and total questionnaire was 0.822～0.900.3. Validity verification:①Content validity:The questionnaire was assessed by 10 experts in this field, and content validity index was 0.852;②Structure validity:4 factors were extracted using EFA again which accounted for 59.966% of the accumulated variance;③Criterion-related validity:The correlation coefficient between sub-questionnaires and general self-efficacy scale was 0.267～0.515. The correlation between the questionnaires and general self-efficacy scale was 0.480 (P> 0.05). There was not statistical significance among the score of questionnaires and sub-questionnaires in the two hospitals.4. The results of ordinal logistic regression analysis:There was not statistical significance in the level of self-management among gender, marriage status; patients who are less than 65 have higher level than other people, patients who have no economic burden or light burden are super than others.5. The results of correlation analysis:Their coefficient correlation were 0.547,-0.518,0.570 between sub-questionnaires and quality of life, depression, social support respectively.6. The results of analysis showed that major factors affecting self-management are quality of life, depression, social support.Conclusions1. Psychometric properties analyses showed that the SMS for patients with esophageal carcinoma after operation achieved good to excellent levels of internal consisteney, test-retest reliability, and content validity, construct validity, criterion-related validity.2. The SM of patients with esophageal carcinoma are influenced by age, education level, occupation, personal monthly income, medical care, economic burden in the form. There are liner correlation among depression, social support, quality of life and self-management for esophageal carcinoma patients after operation, and have an impact on it.3. Self-management questionnaire for esophageal carcinoma patients after operation including four aspects:dietary management, treatment-related manage-ment, physical activity management, postoperative psychological management. Therefore, investigation and analysis is done on its various dimensions in the future, medical staff can give educational guidance on the basis of the patients' weaknesses. On the other hand, the patients should give full play to their own initiative, enhance the capacity of managing activities and mood, promoting patients to recover soon.