| Objective:This study longitudinally explored the change trend of fear of progression in patients with systemic lupus erythematosus(SLE)from hospitalization to 3 months after discharge,and analyzed its influencing factors,so as to provide basis for clinical nursing staff to formulate targeted psychological intervention strategies to reduce the fear of progression in patients with SLE.Methods:This study adopted a longitudinal study design.From November 2021 to November 2022,206 patients with systemic lupus erythematosus who were hospitalized in two hospital areas of a tertiary grade-A hospital in Shandong Province were conveniently selected as the study subjects.The patients’ general information questionnaire,Fear of Progression Questionnaire Short Form,Brief Illness Perception Questionnaire,Medical Coping Modes Questionnaire Chinese Mandarin Version of the Medical Outcomes Study Social Support Survey and the 10 item Connor-Davidson resilience scale were investigated at three time points,namely,during hospitalization(T1),1 month after discharge(T2),and 3 months after discharge(T3).SPSS 25.0 software was used for statistical analysis,including descriptive analysis,independent sample t-test,one-way ANOVA,Pearson correlation analysis,repeated measures ANO VA and generalized linear mixed model analysis.Results:1.The level and trend of fear of progression in patients with systemic lupus erythematosus at different time points T1-T3The total scores of systemic lupus erythematosus patients’ fear of progression were(34.30±9.26),(31.53±8.33),and(26.79±7.98)respectively.Among them,the proportion of high-level fear was 52.9%,36.9%and 11.2%respectively.The analysis of variance of repeated measurements showed that the total score T1>T2>T3 showed a downward trend over time(P<0.05).Two dimension scores of systemic lupus erythematosus patients’ fear of progression at three time points:The scores of physical health dimension were(17.81±4.37),(16.01 ±4.18),and(13.35±3.71)respectively;scores of social and family dimension were(16.49±5.41),(15.52±4.72)and(13.40±3.91)respectively.The analysis of repeated measures ANOVA showed that the scores of both dimensions were T1>T2>T3,showing a downward trend(P<0.05).2.T1-T3 Relationship between general data characteristics of patients with systemic lupus erythematosus at different time points and fear of progressionAt the three time points of T1-T3,the fear of progression score of patients with family per capita monthly income≥3000 yuan was lower than that of patients with family per capita monthly income<3000 yuan(P<0.05).3.T1-T3 Relationship between disease cognition,coping style,social support,resilience and fear of progression in patients with systemic lupus erythematosus at different time pointsDisease cognition:T1-T3,scores of systemic lupus erythematosus patients’ disease cognition scores were(41.30±11.53),(37.76±10.29)and(33.65±9.21)respectively,which were positively correlated with the fear of progression scores(T1:r=0.336,P<0.01;T2:r=0.510,P<0.01;T3:r=0.201,P<0.01).Coping mode:T1-T3,scores of systemic lupus erythematosus patients’ "face" coping style were(18.41±4.22),(21.40±4.45)and(23.16±4.98)respectively,which were negatively correlated with the the scores of fear of progression(T1:r=-0.192,P<0.01;T2:r=-0.160,P<0.05;T3:r--0.162,P<0.05);the scores of "avoidance"coping style were(21.17±5.11),(17.25±4.93)and(15.20±4.32)respectively,which were positively correlated with the scores of fear of progression(T1:r=0.190,P<0.05;T2:r=0.214,P<0.01;T3:r=0.266,P<0.05);the scores of "yielding" coping style were(13.49±4.66),(10.38±3.77)and(8.42±2.53)respectively,which were positively correlated with the scores of fear of progression(T1:r=0.1465,P<0.05;T2:r=0.219,P<0.01;T3:r=0.145,P<0.05).Social support:T1-T3,the total scores of systemic lupus erythematosus patients’ social support were(67.65±14.61),(63.24±15.65),and(60.37±16.15)respectively,which were negatively correlated with the score of fear of progression(T1:r=-0.275,P<0.01;T2:r=-0.386,P<0.05;T3:r=-0.217,P<0.05).4.Longitudinal analysis of factors affecting the fear of progression in patients with T1-T3 systemic lupus erythematosusUsing the generalized linear mixed effect model analysis,considering the time effect,the results of univariate analysis showed that there were statistically significant differences in the scores of fear of progression in patients with systemic lupus erythematosus in terms of family per capita monthly income,Systemic Lupus Erythematosus Disease Activity Index(SLEDAI),hormone amount,number of hospitalizations,disease cognition,facing,avoidance,yielding,medical social support and psychological resiliencethe univariate analysis results(P<0.05);the multivariate analysis results showed that the average monthly income per capita(B=-2.839,P<0.001),SLEDAI(B=0.621,P<0.001),the number of hospitalizations(B=-1.928,P<0.05),disease cognition(B=0.218,P<0.001),face(B=-0.272,P<0.001),avoidance(B=0.234,P<0.001),yield(B=0.163,P<0.001)and social support(B=-0.117,P<0.001)were the influencing factors of the scores of fear of progression in patients with systemic lupus erythematosus from hospitalization to 3 months after discharge.Conclusions:1.The incidence of fear of progression in patients with systemic lupus erythematosus is high and tends to decline with time;some patients are at a high level and urgently need to be paid attention to and treated by medical staff,especially the patients with low per capita monthly income,high SLEDAI and first hospitalization.2.Poor disease cognition of patients with systemic lupus erythematosus positively affects the level of fear of progression,suggesting that medical staff should pay more attention to patients with poor disease cognition,improve their disease cognition,and reduce the fear of progression.3.The "face" coping mode of patients with systemic lupus erythematosus negatively affects the level of fear of progression,while the "avoid" and "yield" coping mode positively affects the level of fear of progression,suggesting that medical staff should take intervention strategies to encourage patients to actively "face",reduce "avoid" or "yield",and then reduce the fear of progression of patients.4.The social support of patients with systemic lupus erythematosus negatively affects the level of fear of progression,suggesting that medical staff should actively take intervention measures to enhance the social support of patients,so as to reduce the fear of progression. |
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