Analysis Of Protective Factors And Pathways Of Resilience In Patients With Gastric Cancer During Chemotherapy

Objective:To investigate the trends and protective factors of resilience in patients with gastric cancer during chemotherapy,and to analyze the protective path.It is expected to provide theoretical and practical basis for early formulation of resilience interventions and improvement of the resilience of patients.Methods:From February 2017 to September 2018,a total of 257 patients with gastric cancer who preparing first chemotherapy were recruited from oncology and gastrointestinal surgery of two third-grade hospital in Anhui Province for on-site questionnaire survey.Before the first chemotherapy,demographic and clinical data of patients were investigated by general situation questionnaire,the Resilience Scale-14（RS-14）was used to assess the baseline level of the resilience,the positive coping subscale of Simplified Coping Style Questionnaire（SCSQ-PC）was used to measure the patients’positive coping level,Social Support Rating Scale（SSRS）was used to evaluate the degree of social support,Family Care Index（Family Adaption,Partnership,Growth,Affection,Resolve Index,APGAR）was used to assess the patient’s family function,and the General Self-Efficacy Scale（GSES）as well as the Herth Hope Index（HHI）were used to measure the self-efficacy and hope levels,respectively.Moreover,we evaluated the level of resilience in patients at 3 months and 6 months after the first chemotherapy.EpiData3.1 was used for data entry.IBM SPSS 24.0 was used for descriptive statistical analysis,univariate analysis,pearson correlation analysis and multiple linear regression analysis for investigating the resilience and its influencing factors in patients with gastric cancer before chemotherapy.Hierarchical linear model analysis was performed by using HLM 7.03to investigate the changes of resilience and it’s change rate in gastric cancer patients during chemotherapy.The protective factors of mental resilience were determined by combining the results of both horizontal and longitudinal studies.Amos 17.0 was used for path analysis to explore the protective mechanism of protective factors on resilience of patients with gastric cancer during chemotherapy.Results:1.The resilience scores of patients with gastric cancer in three stages of chemotherapy were（67.02±9.73）,（69.24±9.15）,（72.09±9.61）,respectively,which were above the middle level.2.Pearson correlation analysis showed that the positive coping（r=0.39,P<0.01）,social support（r=0.62,P<0.01）,family function（r=0.64,P<0.01）,self-efficacy（r=0.69,P<0.01）and hope（r=0.62,P<0.01）of gastric cancer patients before the first chemotherapy were positively correlated with resilience.3.Multiple linear regression analysis showed that the social support（β=0.20,P<0.01）,family function（β=0.26,P<0.01）,self-efficacy（β=0.30,P<0.01）,and hope（β=0.26,P<0.01）of patients with gastric cancer before the first chemotherapy has a significant predictive effect on baseline resilience,and explained 68.9%of all the variation.4.Hierarchical linear model analysis showed that the resilience of patients with gastric cancer showed a significant linear growth trend during chemotherapy,with an average growth rate of 2.71;social support(β₀₂=0.35,P<0.01),family function(β₀₃=1.30,P<0.01),self-efficacy(β₀₄=0.33,P<0.05)and hope(β₀₅=0.29,P<0.01)had a significant predictive effect on the resilience after 6 months of chemotherapy.Positive coping(β₁₁=2.02,P<0.01),self-efficacy(β₁₄=-0.20,P<0.05)and hope(β₁₅=-0.16,P<0.05)had a significant predictive effect on the rate of change in resilience.5.Path analysis showed that the social support and self-efficacy of patients with gastric cancer before the first chemotherapy can directly affect the resilience after 6months of chemotherapy,and they can also indirectly affect the resilience after 6months of chemotherapy through hope.The family function and hope of patients with gastric cancer before chemotherapy can directly affect the resilience after 6 months of chemotherapy.Conclusions:The resilience of patients with gastric cancer during chemotherapy was at a medium-to-high level and with the progression of the disease showed a linear growth trend;The social support,family function,self-efficacy,and hope of gastric cancer patients before the first chemotherapy had a horizontal and vertical predictive effect on resilience,they are important protective factors of resilience in patients with gastric cancer during chemotherapy;Although positive coping cannot directly predict resilience,it can speed up the growth rate of resilience of patients with gastric cancer during chemotherapy;social support and self-efficacy can indirectly affect the resilience of gastric cancer patients 6 months after first chemotherapy through hope.Family function and hope can directly affect resilience 6 months after their first chemotherapy treatment.It is suggested that the future resilience intervention should start with protective factors before their first chemotherapy treatment of patients with gastric cancer,and we should pay attention to the comprehensive utilization of the patient’s family,psychological and social resources,so as to mobilize the individual’s positive mental qualities in the early stage to promote resilience.