The Effect Of Coping Style On Demoralization Syndrome In Patients With Breast Cancer And Its Characteristics

Objective:With quantitative research method,this study aims to investigate the current situation of demoralization syndrome in patients with breast cancer,and to analyze the influence and mechanism of illness uncertainty and trait coping style on demoralization syndrome.Combined the qualitative study,from the perspective of situational factors,to analyze the coping styles of breast cancer patients at different stages of the disease and its influence on demoralization syndrome,in order to provide a basis for guiding clinical psychological intervention.Methods:Both quantitative and qualitative approaches were used to carry out the research.A total of 211 breast cancer patients from a specific Grade A and First-Class hospital in Shijiazhuang were selected by convenient sampling and investigated by questionnaire;The questionnaire included general data questionnaire,Trait Coping Style Questionnaire(TCSQ),Mishel's Uncertainty in Illness Scale(MUIS)and the Mandarin version of the DS(DS-MV);In order to construct the influencing model of demoralization syndrome in patients with breast cancer,we performed independent sample t-test,one-way ANOVA,pearson correlation analysis,hierarchical regression analysis and mediation effect analysis to analyze data.Qualitative research adopted Grounded Theory,16 patients with breast cancer were selected as interview subjects to analyze their coping style and psychological experience at different stages of the disease;Sampling methods included convenience sampling,purposive sampling and theoretical sampling;Face-to-face semistructured interviews were conducted,and the data was analyzed using open coding,axial coding and selective coding,and constant comparison technique was used throughout the analysis stage.Results:Influencing factors and mechanism of demoralization syndrome in patients with breast cancerThe score of demoralization syndrome in patients with breast cancer was(29.55±13.21),and 47.4%of the patients had severe demoralization syndrome(DS-MV>30).1.1 Univariate analysis of demoralization syndrome in patients with breast cancerThe results of univariate analysis showed that there were statisticallysignificant differences in the scores of demoralization syndrome among breast cancer patients with different occupational status and disease status(P<0.05).The score of demoralization syndrome of unemployed patients was higher than that of employed patients(P<0.05).The score of demoralization syndrome in patients with metastasis or recurrence was higher than that in patients with primary diagnosis(P<0.01).The results suggested that occupational status,metastasis or recurrence were the influencing factors of demoralization syndrome.1.2 The mechanism of influencing factors on demoralization syndrome in breast cancer patientsThe correlation analysis showed that demoralization syndrome was positively associated with illness uncertainty and negative coping style(P<0.001),and negatively associated with positive coping style(P<0.001);The differences of illness uncertainty and coping styles of patients with DS-MV>30 group and DS-MV?30 group were further analyzed.The results showed that the DS-MV>30 group was significantly higher than the DS-MV?30 group in the score of illness uncertainty and negative coping(P<0.001),and significantly lower than the DS-MV?30 group in the positive coping score(P<0.001);Hierarchical regression analysis showed that after controlling the influence of occupation and disease status,illness uncertainty and negative coping had a positive effect on demoralization syndrome,while positive coping had a negative effect on demoralization syndrome(P<0.01);Path analysis showed that illness uncertainty could indirectly affect their demoralization syndrome by affecting positive coping and negative coping(Model fit was good:?~2=536.557,?~2/df=1.682<5,TLI=0.901>0.9,CFI=0.91>0.9,RMSEA=0.057<0.8,P<0.01).The mediation effect test was conducted by Bootstrap method,and the results showed that the mediation effect was significant,accounting for 26%of the total effect.The results suggested that illness uncertainty of breast cancer patients could affect demoralization syndrome through trait coping style,and trait coping style may play a part in mediating effect.2.The impact characteristics and developmental trajectory of coping style in the diagnosis,treatment and rehabilitation of breast cancer patients with demoralization syndromeBy coding and summarizing the contents of the interview,a total of 12main categories were extracted,including“acute stress response,inability to cope,self-reflection,raising the awareness of disease management,seeking social support,avoiding reality,role management,disease management,emotion management,changing attitudes to life,returning to society and serving society”.Through the in-depth analysis of the main category,four core categories were obtained,namely“self-concept loss stage,passive acceptance stage,struggle stage and meaning reconstruction stage”.The results suggested that in the process of diagnosis,treatment and rehabilitation,the coping style of breast cancer patients with demoralization syndrome undergone four stages:self-concept loss stage,passive acceptance stage,struggle stage and meaning reconstruction stage,presenting a positive evolutionary trend.It adapted to the treatment stage,had some common stage characteristics,and participated in the occurrence and development of demoralization syndrome.Conclusion:Illness uncertainty and coping styles were potential targets for improving demoralization syndrome and promoting rehabilitation.The results of the study can be used to develop personalized intervention programs to improve demoralization syndrome of breast cancer patients from different perspectives and promote their rehabilitation process.