| Objective:Clear current status of post-traumatic growth of breast cancer patients during chemotherapy and its differences in general demographic and disease-related data.Analysis of correlation between psychosomatic symptoms,resilience and post-traumatic growth based on post-traumatic growth theory and resilience theory.To explore whether psychosomatic symptoms play a role in post-traumatic growth through resilience,that is,the psychological mechanism of psychosomatic symptoms on post-traumatic growth of breast cancer patients.And analyze whether the effects of psychosomatic symptoms on post-traumatic growth in patients with different levels of psychoelasticity are different.The aim is to provide a basis for intervention studies to improve the post-traumatic growth of breast cancer patients during chemotherapy.Methods:This study used a cross-sectional survey to conduct research.From November 2017to January 2019,the department of gynecology and general surgery of a tertiary general hospital in Shanxi province was selected to investigate the 260 cases of breast cancer patients who were included in the exclusion criteria.General demographic data questionnaire was issued during the first chemotherapy of the patient,Chinese version of"Hospital Anxiety and Depression Scale","Anderson Symptom Scale","Resilience Scale",and"post-traumatic growth scale"based on psychosomatic medical model,post-traumatic growth theory,and psychological resilience theory was issued in the last chemotherapy.Data was entered using Excel,and SPSS 22.0,Amos 21.0 were used for statistical analysis of the entered data.General demographics and case data were descriptively analyzed using frequency,percentage,mean,and standard deviation.The post-traumatic growth level,psychosomatic level(anxiety,depression level,status of cancer-related somatic symptoms)and resilience were described by means and standard deviation.One-way analysis of variance and multiple regression analysis were used to analyze the influencing factors of general demographic data.Pearson's bivariate product difference correlation analysis was used to understand the relationship between anxiety and depression,cancer-related somatic symptoms,resilience and post-traumatic growth.Using AMOS software,psychosomatic symptoms(anxiety and depression,cancer-related somatic symptoms)were exogenous latent variables,resilience was used as a mediator,and post-traumatic growth was an endogenous potential,we built a mediation effect model.The maximum likelihood method was used to fit the model.The model was fitted and evaluated by the absolute fitting index and the relative fitting index.The quantitative analysis was used to analyze the mediating effect of resilience on the psychosomatic symptoms and post-traumatic growth of breast cancer patients during chemotherapy.In order to further clarify whether the effects of psychosomatic symptoms on post-traumatic growth were different in patients with different levels of resilience,stratified regression and simple slope-adjusted effect maps were used for quantitative analysis,and the scores of each scale were averaged and analyzed.The study used a two-sided test with a test level of?=0.05.Results:(1)In this survey,260 questionnaires were issued and 244 valid questionnaires were returned.The effective recovery rate was 93.8%.(2)The anxiety and depression of patients with breast cancer during chemotherapy were(7.47±3.13)points,(7.48±2.88)points,respectively,indicating suspicious symptoms but not yet developing anxiety or depression.The subject's score of cancer core symptoms was(5.55±1.54)points,which was moderately severe(5-6)points,the degree of interference with life items is(4.61±1.91)points,at a moderate level(4-6)points.The patient's resilience and post-traumatic growth score were(69.46±6.82)points,respectively,and(66.31±5.29)points were at a medium level.(3)Multiple linear regression analysis of general demographic data showed that marital status,monthly household income,and disease stage were the general predictors of post-traumatic growth in breast cancer patients during chemotherapy,accounting for 18.1%of total variation.(4)Correlation analysis of psychosomatic symptoms,resilience and post-traumatic stress in patients with breast cancer showed a significant negative correlation between anxiety and resilience(r=-0.237,P<0.01),and a significant negative correlation with post-traumatic growth(r=-0.344,P<0.01),there was a significant negative correlation between depression and resilience(r=-0.283,P<0.01),and a significant negative correlation with post-traumatic growth(r=-0.317,P<0.01).There was a significant negative correlation between the severity of cardiac body symptoms and resilience(r=-0.249,P<0.01),and a significant negative correlation with post-traumatic growth(r=-0.543,P<0.01).There was a significant negative correlation between the degree of interference and resilience(r=-0.332,P<0.01),and a significant negative correlation with post-traumatic growth(r=-0.644,P<0.01).There was a significant positive correlation between resilience and post-traumatic growth(r=0.379,P<0.01).(5)In this study,the root mean square error of approximation>1,relative fit index<0.9of the initial model of the mediating effect of resilience on psychological symptoms and post-traumatic growth of breast cancer patients during chemotherapy,poor model adaptation.Model corrections were performed using Bias-corrected confidence intervals and relaxed variable limits.The revised model meets the normal adaptation criteria.The regression coefficients of each path in the psychological symptom model reached a significant level.Anxiety and depression directly predicts resilience negatively,and the standardized estimation of path coefficient is-0.388(P<0.05);resilience directly predicts post-traumatic growth positively,and the standardized estimated value of path coefficient is 0.253(P<0.05);Anxiety and depression indirectly predicts of post-traumatic growth negatively with resilience as a mediator,and the standardized estimate of path coefficient was-0.223(P<0.05).The overall effect of anxiety and depression on post-traumatic growth was-0.321(P<0.05),and the direct effect was-0.223(P<0.05).The effect of anxiety and depression on post-traumatic growth can be partially buffered by the mediator of resilience.The mediating effect accounted for 30.53%of the total effect(indirect effect/total effect,-0.098/-0.321).The root mean square error of approximation>1,non-canonical fit index and relative fit index<0.9 of the initial model of the mediating effect of resilience on psychological symptoms and post-traumatic growth of breast cancer patients during chemotherapy,poor model adaptation.The revised models all meet the common adaptation criteria.The cancer-related somatic symptoms directly predict the resilience,and the standardized estimated value of the path coefficient is-0.438(P<0.05).The cancer-related somatic symptoms directly predict the post-traumatic growth,and the standardized estimated value of the path coefficient is-.0708(P<0.05);The upper and lower limits of standardized indirect effects of breast cancer-related somatic symptoms on post-traumatic growth(-0.066,0.050),including0,indirect effects did not exist.In this study,the physical symptoms of breast cancer patients in the chemotherapy phase did not affect the post-traumatic growth through resilience.The weighted normalized regression coefficient weights of the structural equation model showed that the tenacity has a greater effect on chemotherapeutic breast cancer patients than optimism and strengthon.The interpersonal relationship has greater effects than mental changes,personal strength,new possibilities,and appreciation of life.The anxiety and depression of breast cancer patients during chemotherapy mainly affect the post-traumatic growth through the tenacity of resilience.(6)The results of stratified regression and simple slope adjustment showed that the effects of anxiety and depression on post-traumatic growth were different in patients with different levels of resilience,interaction effect is significant.Patients with high resilience receives high levels of post-traumatic growth outcomes.Patients with high resilience have larger slopes(negative values)than those with moderate or low resilience,that is,patients with high resilience.The effect of anxiety and depression on post-traumatic growth is greater than that of patients with moderate or low resilience.Equivalent anxiety and depression,high resilience can achieve greater post-traumatic growth rate relative to patients with moderate or low resilience.Resilience is not significant in the regulation of cancer-related somatic symptoms and post-traumatic growth in breast cancer patients(?R~2 significance test P>0.05,95%Bootstrap confidence interval included 0),interaction is not significant.Cancer-related somatic symptoms in patients have the same effect on post-traumatic growth with different levels of resilience.Patients with high,medium and low resilience had the same slope of the simple slope adjustment effect,and the parallel lines.The patients with high resilience,the influence of cancer-related physical symptoms on post-traumatic growth was not significantly different from that of patients with moderate or low resilience.The same cancer-related physical symptoms,the difference growth rate of post-traumatic growth between patients with high resilience and those with moderate or low resilience was not statistically significant.Conclusions:(1)The post-traumatic growth level of breast cancer patients in this study was influenced by the marital status of the patients,the monthly income level of the family,and the disease stages.Disease staging and the family's monthly income level are uncontrollable factors,but can help patients create a good family atmosphere by improving their cognitive attitudes towards their own diseases,improve family members'support for cancer patients.Together to help patients form a positive psychological coping habits,improve the post-traumatic growth of patients with chemotherapy breast cancer.(2)Anxiety and depression are the most common negative emotions in patients during chemotherapy.The severity of the core symptoms of cancer and the core symptoms of cancer disturbed in life are moderate,and the post-traumatic growth level is also moderate.For the anxiety and depression,cancer-related symptoms,we need to develop a professional program for systematic intervention,from the perspective of psychosomatic medicine holistic theory to comprehensively analyze the patient's state of mind growth and trends to promote patients'post-traumatic growth.(3)Post-traumatic growth in patients with chemotherapy breast cancer is closely related to psychosomatic symptoms(anxiety and depression,cancer-related somatic symptoms),and is affected by the patient's level of resilience.The patient's anxiety and depression can partially achieve post-traumatic growth through resilience,while cancer-related somatic symptoms do not achieve post-traumatic growth through resilience.Whether the psychosomatic symptoms of breast cancer patients can achieve good psychosomatic development through other single mediators,or there are parallel or chain intermediary relationships,it is worth further discussion.(4)High resilience corresponds to a higher post-traumatic growth level than low,middle resilience,and high resilience patients receive high levels of post-traumatic growth outcomes.Different levels of psychological resilience were not significantly regulated in the body-related symptoms and post-traumatic growth of breast cancer patients.Specialized and scientific clinical psychological intervention research needs to be further developed to improve the potential level of psychological resilience and promote post-traumatic growth of breast cancer patients.Relief of cancer-related somatic symptoms can be achieved through collaboration among clinicians,nurses,and family members to choose the optimal treatment plan for the patient and create a good medical environment. |
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