The Research On Protective Factors Of Resilience Among Breast Cancer Patients Based On Social Ecological Systems Theory

Purpose In order to ascertain the mechanism of resilience and promote physical and mental health of breast cancer patients, we investigate the status of resilience and its protective factors with quantitative and qualitative study design which based on Social Ecological Systems Theory.Methods This study was divided into two parts to explore protective factors among Micro system, Mezzo system and Macro system. PartⅠ: We recruited patients in Anhui province from November 2013 to July 2014 by convenient method. Totally 381 patients were investigated with General Information Questionnaire, Resilience Scale(RS-14), Perceived Social Support Scale(PSSS), The Self-Esteem Scale(SES), General Self-efficacy Scale(GSES), Revised Life Orientation Test(LOT-R), Health-Related Hardiness Scale(HRHS), and Mastery Scale for Chinese version(MSC). Inputting data with Epi Data 3.0 software and processing data with SPSS 13.0 software, we screened protective factors with statistical description, ANOVA, correlation analysis and multivariate regression analysis. PartⅡ: According to purposive sampling method, totally 15 women diagnosed with breast cancer were interviewed by semi-structured of in-depth interview method. All of interviews were guided by checklist-guided interview guidelines based on the social ecosystem theory and digital sound recorded and transcribed verbatim. The data analysis followed published content analysis approach.Results PartⅠ:(1) The average score was(76.82±10.90)for resilience,(2.68±0.46) for self-efficacy,(15.23±3.98)for self-mastery,(21.35±3.40)for self-esteem,(17.45±3.23)for optimistic tendency,(73.50±7.89)for social support,(103.73±9.00) for hardiness personality,(16.76±6.29)for positive coping style.(2) The cutoff score of 73 was obtained for screening breast cancer patients with Resilience Scale.(3) Univariate analysis showed that there existed difference in resilience for breast patient at difference of status of employment, family income, residence, form of payment, exercises after diagnose, exposure disease and retaining breast, efficacy, self-mastery, self-esteem, optimistic tendency, social support, hardiness personality and positive coping style.(P<0.05)(4) Correlation analysis indicated the RS scores were positively correlated with scores of SES, GSES, PSSS, LOT-R, HRHS MSC and positive coping style. And RS scores were negatively correlated with score of HADS(r=0.109-0.604,P<0.05)(5) The result of multivariate linear regression analysis showed that exercises after diagnose, optimism, social support, efficacy and mastery entered the regression equation. Part Ⅱ: Based on the social ecosystem theory, 9 major themes related to the protective factors of resilience among women with breast cancer were identified from three systems. They were: biological factors, psychological factors, social factors, family, occupational groups, other social groups, culture, community, convention, institution and organization.Conclusion The level of resilience among breast cancer patients belongs to superior middling. Optimism, social support, efficacy and self-mastery were possible protective factors of resilience among breast cancer patients. And shortage of exercises after diagnose was possible risk factors. There existed protective factors in three systems of social ecosystem. We should take measures to help patients to adapt to disease based on these findings.