| ObjectivesBased on a common sense model of self-regulation,this study aims to explore the overall level and influencing factors of fear of disease progression in patients with pulmonary nodules,and construct a structural equation model to explore the path relationships between factors influencing the progression of fear diseases driven by theory.Longitudinal investigation of the level of fear of disease progression in newly diagnosed pulmonary nodule patients at four different time points within 6 months,analysis of their development trajectory and influencing factors,aiming to provide theoretical basis and scientific basis for medical personnel to develop targeted intervention measures.MethodsStudy 1:Current status and influencing factors of fear of disease progression in patients with pulmonary nodulesThis study is a cross-sectional study.Taking the patients with pulmonary nodules in the thoracic surgery clinics of two tertiary first-class hospitals in Yangzhou City as the research objects,the convenient sampling method was used to select 500 patients who met the inclusion criteria for investigation.Finally,457 valid questionnaires were collected(the effective recovery rate was 91.4%).Conduct a survey using a general information survey questionnaire,Fear of Progression Questionnaire-Short Form,Brief Illness Perception Questionnaire,Simplified Coping Style Questionnaire,Perceived Social Support Scale,and Ruminative Responses Scale Chinese Version.Establish a database using Epidata 3.1 and conduct data analysis using SPSS 26.0.Statistical methods mainly include descriptive analysis,t-test,one-way ANOVA,Pearson and Spearman correlation analysis,and multiple linear regression analysis.Study 2:Construction of a structural equation model of factors affecting the progression of fear of disease in patients with pulmonary nodulesBased on the results of the first part of the study,SPSS 26.0 and Amos 23.0 were used for statistical analysis.Use SPSS 26.0 to analyze the pairwise correlation between fear of disease progression,illness perception,coping styles,social support,and rumination in patients with pulmonary nodules.Use Amos 23.0 to construct a structural equation model of the factors influencing the fear of disease progression in patients with pulmonary nodules.Study 3:Progress and development trajectory of fear disease in newly diagnosed patients with pulmonary nodulesThis section is a longitudinal study.187 patients who were diagnosed with pulmonary nodules for the first time and voluntarily participated in this study with informed consent were selected.Through face-to-face,telephone follow-up,WeChat friends,and other methods,their fear of disease progression was investigated during the initial detection,follow-up for 1 month,follow-up for 3 months,and follow-up for 6 months(T1-T4).Finally,157 patients were included in the statistical analysis.Using SPSS 26.0 software,the influencing factors of fear of disease progression in newly diagnosed pulmonary nodule patients at four time points were analyzed through repeated measurement analysis of variance and multiple linear regression;Using Mplus 8.3 software,identify heterogeneous subgroups of fear disease progression trajectories in newly diagnosed pulmonary nodule patients using latent variable growth models;Using 2-test,one-way ANOVA,and multiple logistic regression to identify the influencing factors of different heterogeneity subgroups.ResultsStudy 1:Current status and influencing factors of fear of disease progression in patients with pulmonary nodules1.The total score of the fear of disease progression scale for 457 patients with pulmonary nodules was(31.30±6.26),with a physical health dimension score of(16.63±3.06)and a family social dimension score of(14.67±3.62);165 people reported fear of disease progression and psychological disorders,accounting for 36.1%of the total sample.2.The results of univariate analysis showed that there were significant differences in the fear of disease progression scores among patients with pulmonary nodules in terms of marital status,medical insurance methods,whether they were initially diagnosed,solid nodules,ground glass nodules,and pulmonary tuberculosis(P<0.05);Fear of disease progression was significantly positively correlated with disease perception,negative coping,and ruminating thinking(r=0.572,0.433,0.492),and negatively correlated with positive coping,and social support(r=-0.437,-0.420).3.Multiple stepwise linear regression results show marital status(β=0.071),Medical payment method(β=-0.083),initial diagnosis or not(β=-0.165),ground glass pulmonary nodules β=-0.096),illness perception(β=0.328),positive coping(β=0.153),negative coping(β=0.174),social support(β=-0.198),and ruminating thinking(β=0.206)are risk factors for fear of disease progression in patients with pulmonary nodules,accounting for 58.4%of the total variance.Study 2:Construction of a structural equation model for factors affecting the progression of fear of disease in patients with pulmonary nodulesBased on the theory of the common sense model of self-regulation,this study constructed a structural equation model for the fear of disease progression in patients with pulmonary nodules.The model was well fitted,with fitting indicators:χ 2=111.560,df=56,NC value=1.923,GFI=0.964,AGFI=0.944,NFI=0.949,RFI=0.932,IFI=0.975,TLI=0.966,CFI=0.975,RMSEA=0.045.Illness perception has the strongest positive effect on fear of disease progression(the total effect is 0.460,of which the direct effect is 0.412,and the indirect effect through negative coping is 0.048,respectively);Ruminating thinking has a positive effect on the progression of fear of disease(the total effect is 0.428,of which the direct effect is 0.285.The mediating effects of illness perception,negative coping,and illness perceptionnegative coping are 0.087,0.046,and 0.010,respectively).Negative coping has a direct positive effect on the progression of fear of disease,with a value of 0.229.Social support has a negative effect on the progression of fear of disease(The total effect is-0.350,of which the direct effect is-0.254,and the indirect effect through illness perception and illness perception-negative coping is-0.086 and-0.010,respectively).Further using the Bias-Corrected Bootstrap method to test the significance of the mediating effect,5000 samples were conducted,and the results showed that 95%CI of the path did not contain 0,indicating that the mediating effect was significant.Study 3:Progress and development trajectory of fear disease in newly diagnosed patients with pulmonary nodulesThe overall score of fear of disease progression in newly diagnosed patients with pulmonary nodules showed a downward trend over time,and analysis of variance showed a statistically significant difference(P<0.05);The influencing factors for fear of disease progression in newly diagnosed patients with pulmonary nodules at T1 time point were marital status,illness perception,negative coping,and friend support.The influencing factors at T2,T3,and T4 time points were marital status,illness perception,positive coping,negative coping,and friend support.The fear of disease progression in newly diagnosed patients with pulmonary nodules has a population heterogeneity,and four potential categories of trajectory groups were obtained:the ascending group(20.4%),the high stability group(15.9%),the descending group(33.2%),and the low stability group(29.3%).Using the"low stability group" as a reference,multiple logistic regression analysis showed that the influencing factors for the "ascending group" were women(OR=1.184,P=0.004),multiple lung nodules(OR=17.621,P=0.008),and a family history of lung cancer(OR=12.532,P=0.029);The influencing factors of "high stability group" were illness perception(OR=1.202,P<0.001),negative coping(OR=1.657,P=0.007),and ground glass pulmonary nodules(OR=15.496,P=0.010);The influencing factor for the decline group was marriage(OR=6.123,P=0.008);The influencing factor for the low stability group is friend support(OR=0.799,P=0.006).Conclusions1.The overall level of fear of disease progression in patients with pulmonary nodules is high,and the detection rate of psychological disorders for fear of disease progression is also high.The current situation is not optimistic.Marital status,medical insurance reimbursement method,whether to make a first diagnosis,ground glass pulmonary nodules,disease perception,positive coping,negative coping,social support,and ruminating thinking are the influencing factors for fear of disease progression in patients with pulmonary nodules.Medical personnel should pay attention to and screen patients with pulmonary nodules who have a high level of fear of disease progression,and construct targeted intervention plans based on influencing factors.2.The negative coping strategies of patients with pulmonary nodules can directly affect the progression of the disease;Disease perception can directly or indirectly affect the progression of fearful diseases through negative coping,while rumination thinking can directly or indirectly affect the progression of fearful diseases through disease perception,negative coping,and disease perception-negative coping;Social support can directly or indirectly affect the progression of fear diseases through disease perception and disease perception negative coping.In clinical practice,medical personnel should provide patients with sufficient social support,explain disease related knowledge,enable patients to correctly recognize the disease,reduce negative thinking,improve their ruminating thinking,and promote patients to adopt positive coping styles to alleviate their fear of disease progression.3.The fear of disease progression in newly diagnosed patients with pulmonary nodules has a downward trend over time.Marital status,disease perception,positive coping,negative coping,and friend support are influencing factors at T1-T4 time points for newly diagnosed patients with pulmonary nodules.There are four heterogeneous subgroups of patients with newly diagnosed pulmonary nodules who fear disease progression:the ascending group,the highly stable group,the descending group,and the low stable group.Factors such as female,married,multiple pulmonary nodules,ground glass nodules,family history of lung cancer,disease perception,negative coping,and friend support were predictive factors for the fear of disease progression trajectory subgroup in newly diagnosed patients with pulmonary nodules.Clinical medical workers should promptly pay attention to and identify the development and changes of fear of disease in newly diagnosed patients with pulmonary nodules,especially within 6 months after the detection of the nodules.At the same time,targeted interventions were developed based on the influencing factors of different subgroups to reduce the level of fear of disease progression in patients with pulmonary nodules,thereby promoting their physical and mental health. |
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