The Effects Of Schema Health Education On Symptom Distress And Perceived Control For Patients With Lung Cancer Undergoing Chemotherapy

ObjectiveTo investigate symptom experience of lung cancer patients during their chemotherapy,and evaluate the relationships among the patients' perceived control,symptom distress and symptom interference.Evaluation the effects of schema health education on the symptom distress and perceived control for patients with lung cancer undergoing their chemotherapy.The schema health education was designed to improve individual self-care support and collaborative efforts in managing symptom distress and enhance patients' perceived control and psychological well-being,and thus provide the basic references for nursing managers on innovating the reform of health education.Methods(1)The demographic and medical characteristics questionnaire,Chinese version of the M.D.Anderson Symptom Inventory,Self-rating Anxiety Scale,Self-rating Depression Scale,Cancer Experience and Efficacy Scale were used to collect the total of 456 patients' socio-demographic and clinical characteristics,assess severity and interference of symptoms,cancerexperience and efficacy scores during their treatment.Descriptive statistics,Pearson and Spearman correlation were used to analyze the data.(2)Based on Cognitive Schema Theory,according to the random method and scores of perceived control,the researcher chose 46 patients as the schema education group,48 patients as the control group.The demographic details,symptom distress,anxiety,depression and perceived control between the two groups were respectively compared.Patients in the schema education group were given the schema education based on Cognitive Schema Theory for three months on the basic of daily teaching activities like as those in the control group.Each group patients' scores of the symptom distress,anxiety,depression and perceived control of were assessed before or after the schema education.All statistical analyses were performed using IBM SPSS statistics version 18.0 software.Description statistics were calculated for frequency distribution,means,and standard deviations,t-test,chi-square test,analysis of variance,multiple linear regression and linear correlation of the participants' socio-demographic and clinical characteristics,symptom severity,symptom interference,and perceived control.Results(1)The prevalence of lung cancer patients,who had symptom,ranged from 25.7% to 96.5% in Hunan province.The five most severe symptoms were distress,fatigue,poor appetite,sleep disturbance,and sadness,respectively.The patients' work and enjoyment of life were the most influentfactors for their daily life.(2)The total score of CEES-experience was(62.95 ± 7.01).It showed the negative experience of the patients with lung cancer during their chemotherapy was at a moderate level.According to the scores of three subscales of CEES-experience,the highest score was for the socioeconomic strain(4.30±0.60),it was higher than that for personal strain(3.83±0.39);the lowest score was for emotional strain(3.79±0.58).Besides,The scores of three dimensions on CEES-efficacy from higher to lower were followed by collective efficacy(4.26±1.13),proxy efficacy(4.02±0.67)and personal efficacy(2.88±0.84).(3)Symptom distress scores of the patients were positively related to their experience subscales(r=0.375,P<0.001),but they were negatively associated with their perceived personal control(r=-1.85,P<0.001)or collective control(r=-0.296,P<0.001).There was no correlation between their symptom distress and proxy efficacy(r=-0.019,P >0.05).(4)Before the cognitive schema education,there were not significant differences for the demographic details,symptom distress and perceived control between two groups(P > 0.05).(5)After cognitive schema education,mean scores of the lung cancer patients' symptom distress including fatigue,distress,sleep disturbance,poor appetite,and sadness,Pain,Shortness of breath,Drowsiness were more significantly improved in the cognitive schema education group(P<0.05);mean scores of symptom distress including fatigue,distress,sleep disturbance,poor appetite,and sadness,Pain,Shortness of breath,Drowsiness were more significantly improved in the cognitive schema group than those in the control group(P<0.05).(6)After cognitive schema education,mean scores of the lung cancer patients' personal strain,emotional strain,personal efficacy,collective efficacy and proxy efficacy were more significantly reduced in the cognitive schema education group(P<0.05);mean scores of the lung cancer patients' personal strain,emotional strain,personal efficacy,collective efficacy and proxy efficacy were more significantly reduced in the cognitive schema education group than those in the control group(P<0.05).Conclusions(1)The symptom distress of lung cancer patients' was at moderate level.Fatigue,distress,sleep disturbance,poor appetite,and sadness were the most severe symptoms of lung cancer.(2)The cancer experience and efficacy of lung cancer patients was at moderate level,income,gender,matastasis,operation were the influencing factors for their cancer experience;income,education,gender,histologic types matastasis and operation were the influencing factors for their efficacy.(3)Lung cancer patients experience multiple symptom distress and relatively low perceived control and efficacy during their chemotherapy.(4)Cognitive schema education could correct patient's cognitive bias,improve the self-care ability,and thus alleviate the symptom distress and negative emotions.