| Objective:The purpose of this study was to analyze the status and influencing factors of stigma,coping modes and marital quality in patients undergoing radical mastectomy,and to explore the mediating effect of coping modes between stigma and marital quality,which would provide the reference basis for guiding patients to choose effective coping modes to reduce the stigma and improve the quality of marriage.Methods:A cross-sectional survey was used to investigate 266 patients undergoing radical mastectomy in the Department of Breast Surgery and Oncology at the tertiary hospital in Nanchong city from February to December 2019.Using general information questionnaire,medical coping modes questionnaire(MCMQ),social impact scale(SIS),Olson marriage quality questionnaire to conduct questionnaire.A total of 266 questionnaires were issued and recovered,with a recovery rate of 100%,and 255 valid questionnaires,with an effective rate of 95.9%.Statistic analyzed using software SPSS 23.0.Use frequency and composition ratio to describe general demographic data and disease-related data,and use mean and standard deviation to describe the stigma,coping modes and marital quality of patients after radical mastectomy.The stigma,coping modes,marital quality and scores of all dimensions were subject to normal distribution(P>0.05)by Kolmogorov-Smimov normality test,and compared by independent sample t test or one-way ANOVA.Taking the patient’s stigma,confrontation,avoidance,resignation and marital quality as the dependent variables,the general data with differences in single factor analysis were used as independent variables,and multiple regression analysis was performed.The Pearson correlation analysis method was used to analyze the correlation between patients’ stigma,coping modes,and marital quality.According to the intermediary effect analysis program proposed by Wen Zhonglin,the Bias-Corrected Bootstrap intermediary effect test was used to treat patients with breast cancer after radical surgery.The mediating effect between feeling and marriage quality was analyzed,and P<0.05 had statistical difference.Results:1.The total score of patients with stigma after the radical mastectomy was 62.38 ± 9.37 points,and the items were all divided into 2.60 ± 0.81 points.The items in each dimension were averaged from high to low:intrinsic shame dimension(2.69± 0.72 points),economic discrimination dimension(2.67 ± 0.55 points),social isolation dimension(2.50± 0.54 points),social exclusion dimension(2.49 ± 0.60 Minute).Differences in the scores of patients with different levels of age,education,occupation,work status,medical expenses reimbursement,monthly household income per capita,personality type,surgical method,postoperative time,and adjuvant treatment were statistically significant(P<0.05).2.The score of coping modes of patients after radical mastectomy were as followings:17.53± 6.27 points for confrontation,which was lower than the domestic norm(P<0.01);avoidance with 15.86 ± 3.32 points,resignation for 10.14± 2.73 points,both higher than domestic norm(P<0.01).Different age,education level,occupation,monthly household income per capita,medical expenses reimbursement method,personality type,postoperative time have statistically significant differences in the scores of confrontation,avoidance and resignation(P<0.05).During coping with adjuvant therapy,the difference in scores of surgical methods in avoiding coping was statistically significant(P<0.05).3.The total score of marital quality of the patients was 92.69±25.68 points,of which the marriage satisfaction dimension score was the highest(31.11±9.16 points),followed by the couple communication dimension(30.80± 9.08 points),and the sex life dimension score was the lowest(30.78± 8.34 points).Compared with the domestic norm,the difference is statistically significant(P<0.01).Differences in marital quality scores of patients of different ages,residence,education,occupation,work status,medical expense reimbursement methods,family monthly income per capita,personality type,and postoperative time were statistically significant(P<0.05).4.Stigma was negatively correlated with marital quality(r=-0.533,P<0.01).The correlations between different coping modes and stigma were as followings:confrontation was negatively correlated with stigma.(r=-0.585,P<0.01);avoidance and resignation were positively correlated with stigma.(r=0.615,r= 0.394,P<0.01).The correlations between different coping modes and marital quality were as the followings:Coping with confrontation was positively correlated with marital quality(r=0.539,P<0.01);avoidance and resignation were positively correlated with marital quality(r=-0.314,r=-0.515,P<0.01).5.As a mediating variable,coping modes can adjust the influence of stigma on marital quality.Among them,confrontation(effect volume is 45.5%),avoidance(effect volume is 20.9%),and resignation(effect volume is 10.4%)all have partial mediating effects between the stigma and marital quality.Conclusions:1.The patients who took radical mastectomy of breast cancer have high experience of stigma,among which the internal sense of stigma and economic discrimination are the most obvious.2.The patients who took radical mastectomy of breast cancer tend to adopt the pattern of coping with avoidance and resignation more than positive coping mode.3.The patients who took radical mastectomy of breast cancer have low marital quality,and the sexual dimension score is the lowest.4.Patients aged 40～55 years old,having a junior high school degree or below,working in agriculture,not on duty,medical insurance for urban and rural residents,after 1～3 months of operation and the type C personality with strong stigma experience,negative coping modes and poor marital quality are the focus of attention to the groups.5.The stigma,coping modes and marital quality of the patients who took radical mastectomy of breast cancer are correlated with each other.Coping modes play a part in mediating the relationship between stigma and marital quality,among which the mediating effect of confrontation works most significantly.Adopting the mode of coping with confrontation can relieve the negative effects of stigma on marital quality while the modes of coping with avoidance or resignation will increase them. |
