A Study On The Relationship Between Fear Of Disease Progression,self-management Efficacy And Post-traumatic Stress Disorder In Breast Cancer Patients After Surgery

Objective:The purpose of this study was to investigate the status of fear of disease progression,self-management efficacy,and post-traumatic stress disorder in breast cancer patients after surgery and their differences in general demographic and disease-related data.Based on the fear theory model of PTSD and self-efficacy theory,the correlation between fear of disease progression,self-management efficacy and POST-traumatic stress disorder was analyzed to explore whether fear of disease progression affected the level of POST-traumatic stress disorder through self-management efficacy.It provides direction and theoretical basis for medical staff to improve post-traumatic stress disorder in patients after breast cancer surgery from the perspective of fear of disease progression and self-management efficiency.Methods:In this cross-sectional study,203 patients with breast cancer who underwent surgical treatment in the department of breast cancer in two tertiary general hospitals in Taiyuan were selected by convenience sampling method from March to June 2021.The patients were investigated by general information questionnaire,simplified version of fear of Disease Progression Questionnaire(FOP-Q-SF),Chinese version of Cancer Self-management Efficacy Scale(Chinese-version SUPPH)and Chinese version of POST-traumatic stress Disorder Questionnaire(PCL-C).SPSS 25.0 software was used for data entry and statistical analysis.General demographic and case data were descriptively analyzed by frequency,percentage,mean and standard deviation.The status of fear of disease progression,self-management efficacy and PTSD were described by mean and standard deviation.One-way analysis of varience were used to analyze the influence factors of patients’ fear of disease progression,self-management efficacy and post-traumatic stress disorder general demographic data.Pearson correlation analysis was used to explore the relationship between fear of disease progression,self-management efficacy and post-traumatic stress disorder in breast cancer patients after surgery.Multiple linear regression analysis was used to determine the stabilizing factors of post-traumatic stress disorder in breast cancer patients after surgery.Hayes was used to compile Model-4 in Process V3.4 macro program.With fear of disease progression as independent variable,self-management efficacy as mediating variable and post-traumatic stress disorder as dependent variable,the mediating effect of self-management efficacy on fear of disease progression and post-traumatic stress disorder in patients after breast cancer surgery was analyzed.Bilateral test was used in this study,and the test levelα=0.05.Results:1.The fear of disease progression score of postoperative breast cancer patients was(28.62±9.10),in which the score of physiological health dimension was(15.96±4.95),and the score of social and family function dimension was(12.66±5.01).Among them,50 patients(24.63%)had disease progression fear score ≥34(psychological dysfunction).The score of self-management efficacy of patients after breast cancer surgery was(92.61±21.22).According to the average score of each dimension item,the highest score was positive attitude(3.37±0.78),followed by the self-decision dimension(3.32±0.90),and the lowest score was self-decompression dimension(3.21±0.78).There were 60cases(29.56%)at the high level,123 cases(60.59%)at the medium level,and 20 cases(9.85%)at the low level of self-management efficacy after breast cancer surgery.The score of posttraumatic stress disorder in 203 patients after breast cancer surgery was(31.45±10.75),and the score of three dimensions from high to low were avoidance/numbness dimension(12.53±4.89),re-experience dimension(9.75±3.61),and hypervigilance dimension(9.17±3.60).There were 15 patients(7.39%)with ≥50 points(PTSD positive patients),37 patients(18.23%)with 38-49 points(certain PTSD symptoms),and 151 patients(74.28%)with 17-37 points(no obvious PTSD symptoms).2.The results of univariate analysis showed that there were statistically significant differences in the score of fear of disease progression in postoperative breast cancer patients in age,marital status,family economic monthly income,medical payment method,self-care status,affordability of medical expenses,axillary lymph node metastasis and axillary lymph node dissection.Self-management efficacy was affected by the factors of residence,chemical treatment course,self-care condition and whether transfer was possible.There were statistically significant differences in marital status,monthly family income,whether there were other physical diseases,the ability to bear medical expenses,the knowledge of disease,axillary lymph node metastasis and cancer molecular classification of PTSD(P<0.05).3.Pearson correlation analysis showed that fear of disease progression was negatively correlated with self-management efficacy(r=-0.394,P<0.001).Fear of disease progression was positively correlated with PTSD(r=0.664,P<0.001).Self-management efficacy was negatively correlated with PTSD(r=-0.387,P<0.001).4.Multiple linear regression analysis results showed that: the fear of disease progression,family economic income,self management effectiveness,cancer molecular classification breast cancer postoperative patients with post-traumatic stress disorder is the main influence factors(P<0.05),the four variables can explain common postoperative breast cancer patients with post-traumatic stress disorder level and 49.9%of total variation.5.The test results of Process mediation model showed that fear of disease progression had a significant predictive effect on PTSD(t=12.599,P<0.001),and the direct predictive effect of fear of disease progression on PTSD was still significant when self-management efficacy entered(t=10.713,P<0.001).The upper and lower bounds of the 95% confidence interval of the direct effect of fear of disease progression on PTSD and the mediating effect of self-management efficacy did not contain 0.Fear of disease progression can directly predict PTSD,and it can also predict PTSD through the mediating effect of self-management efficacy.The direct effect was 0.716 and the mediating effect was 0.069.Conclusion:1.Fear of disease progression and post-traumatic stress disorder are common in postoperative breast cancer patients,and self-management efficiency is at a moderate level.2.There are differences in some aspects of disease progression fear among patients with different postoperative breast cancer,such as the ability to bear medical expenses,self-care status,metastasis,axillary lymph node dissection,etc.Patients living in rural areas,long course of chemical treatment,poor self-care and axillary lymph node metastasis had poor self-management efficiency,which should be paid more attention to.Marital status,concomitant with other physical diseases,medical affordability,knowledge of disease,axillary lymph node metastasis and cancer molecular classification are the main influencing factors of post-traumatic stress disorder after breast cancer surgery,which should be paid attention to by medical staff.3.There is a correlation between fear of disease progression,self-management efficacy and post-traumatic stress disorder in patients after breast cancer surgery.4.Self-management efficacy plays a partially mediating role in fear of disease progression and post-traumatic stress disorder after breast cancer surgery,and can indirectly affect the level of post-traumatic stress disorder in patients after breast cancer surgery.5.The results of this study remind us that the self-management efficiency of breast cancer patients can be improved by reducing their fear of disease progression and carrying out training,thus alleviating the level of post-traumatic stress disorder in patients.In addition to assessing the fear of disease progression and self-management efficiency of breast cancer patients,psychological support should be provided to patients,and methods and strategies for coping with stress should be provided to form positive cognitive evaluation,cultivate patients’ self-management efficiency,and reduce post-traumatic stress disorder.