The Effects Of Schema Education On Perceived Control And Quality Of Life For Patients With Lung Cancer Undergoing Chemotherapy

ObjectiveTo investigate the cognitive function,perceived control and quality of life of lung cancer patients undergoing chemotherapy,and to analyze the influencing factors and explore its correlation,path relationship and mediation effect;to explore the impact of schema education on the perceived control and quality of life of patients with low cognition,and to provide practical experience for increasing the attention to their cognitive function and innovative health education models.Methods(1)The self-made general data questionnaire,the Mini-Mental State Examination scale(MMSE),the Cancer Experience and Efficacy Scale(CEES),and the Chinese version of Quality of Life Questionnaire were used to collect the cognitive function,perceived control,and quality of life in 462 lung cancer patients undergoing chemotherapy,to analyze the influencing factors.The structural equation model being constructed was used to analyze the path relationship and mediation effect between the three.(2)Guided by schema theory,we carry out schema education.Lung cancerchemotherapy patients with low cognitive level were randomly divided into the intervention group(n=40)and the control group(n=40).Patients in the control group received routine health education,and patients in the intervention group underwent 8 weeks of schema education on the basis of routine health education.The scores of cognitive function,perceived control and quality of life of the two groups were tested before the intervention and after the 8 weeks intervention.The IBM SPSS21.0 and Amos23.0 software was used to do the statistical analyze.Descriptive statistics was performed using sample rate,mean,and standard deviation,independent sample t-test,paired sample t-test,one-way analysis,chi-square test,analysis of variance,and stepwise linear regression.Results(1)The total score of cognitive function in patients with lung cancer undergoing chemotherapy was(25.529±4.454),and the scores in other fields from low to high respectively were: recall ability(0.716±0.339),attention and calculation ability(0.802±0.275),language ability(0.823±0.176),memory(0.877±0.259),and orientation ability(0.933±0.115).And patients with low cognition accounted for 18.85%.Education level,medical payment form,marital status,chemotherapy cycle,Karnofsky(KPS)score,physical exercise,age,monthly personal income,whether metastasis and TNM stage were all major factors affecting the cognitive function of the patients.(2)The total score of cancer experience in lung cancer patients undergoingchemotherapy was(56.499±6.881),and the total score of cancer efficacy was(43.271±10.454),it was suggests that the patients have a moderate perceived control ability.Educational level,KPS score,and type of lung cancer were the major influencing factors of patients' perceived control ability.The total health score was(59.406±22.631);the physical function score was the best(86.038±15.075);the social function score was the lowest(72.989±23.657);the highest score was economic difficulty(30.728±27.311);the lowest score was diarrhea(3.065±10.409).The KPS score,metastasis,chemotherapy cycle,marital status,medical payment form and education level were the main factors affecting the quality of life of patients with lung cancer undergoing chemotherapy.(3)The quality of life of patients with lung cancer undergoing chemotherapy was positively correlated with the scores in each areas of cognitive function and the total score of cancer efficacy(P<0.05),and negatively correlated with the total score of cancer experience(P<0.05);The scores in each area of cognition were positively correlated with the total score of cancer efficacy(P<0.05),and negatively correlated with the total score of cancer experience(P<0.05).The results of the structural equation model showed that the perceived control ability of the patients was an intermediate variable between cognitive function and quality of life.The quality of life in the patients was not only directly affected by cognitive function,but also indirectly affected by perceived control.(4)The social experience and total scores of cancer experience in the control group after the intervention were higher than those before the intervention(P<0.05);their scores in each areas of cancer efficacy were lower than those in the intervention group,and their scores in each areas of cancer experience were significantly higher than those in the intervention group(P<0.05).The social experience,emotional experience,and total scores of cancer experience of patients in the intervention group were significantly lower than those before the intervention,and the personal efficacy,medical care efficacy,and total scores of cancer efficacy were significantly higher than those before the intervention(P<0.05).(5)There was no significant difference in the scores of each areas of cognitive function and each areas of quality of life in the control group after the intervention(P>0.05);the intervention group's orientation ability,recall ability,language ability,total score of MMSE,physical function,role function,emotional function,Social function and total health scores were higher than before intervention(P<0.05),and the scores of shortness of breath,fatigue,and insomnia symptoms were significantly lower than before intervention(P<0.05).After intervention,the orientation ability,recall ability,language ability,and the total score of MMSE,role function,emotional function and social function in the intervention group were significantly improved compared with the patients in the control group,and the symptoms of shortness of breath,fatigue,nausea and vomiting,insomnia and diarrhea weresignificantly improved compared with the patients in the control group(P<0.05).Conclusion(1)Perceived control in patients with lung cancer undergoing chemotherapy was influenced by education level,KPS score,and type of lung cancer;their quality of life was influenced by socio-demographic and treatment factors.There is a correlation between patients' cognitive function,perceived control and quality of life,and the perceived control ability plays a mediating role in their cognitive function and quality of life.(2)Schema education can improve the negative cancer experience of patients with lung cancer undergoing chemotherapy with low cognitive level and enhance the sense of disease control.and It has a positive effect on improving patients' cognitive function,improving perceived control ability and quality of life.