| ?Objective?Under the background of growing blood tumor survivors and lack of cancer survival care,the purpose of this study was to investigate the unmet needs,medical coping modes,individual social capital and quality of life(QOL)of blood tumor survivors,to explore the relationship between unmet needs and QOL,and to examine the mediating and regulating effects of medical coping modes and individual social capital on the path of unmet needs affecting QOL.It provides a theoretical basis for improving the QOL,rational utilization of medical resources and improvement of survival care for survivors of blood tumor.?Methods?In this study,the literature research method was used to understand the research progress of blood tumor survivors' unmet needs and QOL,and the medical coping style and individual social capital were selected as the main intermediate variables,so as to preliminarily construct the theoretical model.A cross-sectional study was conducted to investigate the unmet needs,medical responses,individual social capital and QOL of 314 blood tumor survivors who were admitted to a level-iii,grade-a hospital in nanjing from December 2018 to December 2019.SPSS22.0 were used to descriptive analysis,t-test,one-way analysis of variance and correlation analysis.AMOS22.0 and Mplus7.4 software were used to analyze the ways that the unmet demand affected the QOL.And to test the mediating effect of medical coping style,and test the moderating effect of individual social capital,and the moderated mediation model.?Results?1.Status of all variables :(1)the total score of unmet needs of blood tumor survivors was(67.97±16.97).The dimension scores from high to low is: care or continuity of care(46.2% for low to moderate levels,high levels of 51.3%),information(58.3% for low to moderate levels,high levels of 32.5%),jobs and economic(79.6% for low to moderate levels,high levels of 20.4%),sharing and emotional(94.6% for low to moderate levels,high levels of 5.1%).(2)the total score of QOL(60.98±17.83).(3)the medical coping modes: the face score was(2.35±0.36),the avoidance score was(2.38±0.47),and the yield score was(1.62±0.64).(4)the total individual social capital was(29.90±8.33),the bonded individual social capital(16.67±2.94),and the bridge individual social capital(13.23±6.27).2.The analysis of demographic differences: the unmet needs of blood tumor survivors were statistically significant in gender,age,medical expense bearing mode and disease course.Medical coping style: the differences in gender,medical expense bearing style and disease course were statistically significant.The differences of avoidance in gender,age,medical expense bearing and disease course were statistically significant.The differences in gender,age,and medical affordability were statistically significant.The differences of individual social capital in gender,age,medical expense bearing mode and disease course were statistically significant(P<0.05).3.The Correlation analysis: Unmet demand is negatively correlated with QOL,face and individual social capital,and positively correlated with yield.It is positively correlated with social capital and QOL.Avoidance is positively correlated with social capital;Yield is negatively correlated with social capital and QOL.Individual social capital is positively correlated with QOL.4.Mediating effect of medical coping modes: face and yield play a partial mediating role between unmet demand and QOL.(1)indirect effect 1: unmet demand ? face ? QOL,the estimated effect value is-0.030,and the confidence interval does not include 0,indicating that the mediating effect of face is valid,and the mediating effect accounts for 17.05% of the total mediating effect.(2)indirect effect 2 : unmet demand ? yield ? QOL,the estimated effect value is-0.147,the confidence interval does not include 0,indicating that the mediating effect of yield is established,and the mediating effect accounts for 82.95% of the total mediating effect.5.Moderating effect of individual social capital: individual social capital plays a significant role in the adjustment between face and QOL(?=0.472,P<0.05).And individual social capital plays a significant moderating role between yield and QOL(?=0.125,P<0.05).6.Moderated mediation model: in the overall model where unmet demand affects QOL,in a path mediated by the face,when individual social capital is at a high level(+1SD)and when individual social capital is at a low level(-1sd),the difference in standardized estimation is 0.506,which is significant(P<0.05).In the path mediated by yield,the standardized estimated difference between the high level of individual social capital(+1SD)and the low level of individual social capital(-1sd)was 0.010,and the difference was not significant(P>0.05).It shows that in the overall model,only the mediating function is regulated by the individual social capital,that is,the higher the individual social capital is,the stronger the mediating function will be.The moderated mediation model is established.?Conclusion?The unmet needs of blood tumor survivors mainly include access to or continuity of care,information,work and economy,sharing and emotion,and the unsatisfied level is high.The level of QOL is low.The medical coping style is mainly avoidance;The level of individual social capital is low.Focus should be placed on the unmet needs and QOL of women,the elderly,the uninsured and the elderly with a longer course of disease.The overall model of the impact of unmet demand on the QOL is a moderated mediation model:the failure to meet demand can not only directly affect the QOL,but also affect the QOL through the multiple mediating effects of face and yield.At the same time,individual social capital also plays a moderating role in the mediating effect of face.The negative impact of the unmet demand on the QOL of blood tumor survivors can be reduced by guiding positive coping style,making full use of and enriching individual social capital. |
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