A Study On The Relationship And Mediating Effect Between Perceived Stress And Post-Traumatic Growth In Chemotherapy Patients After Breast Cancer Surgery

ObjectivesBy investigating the current situation of perceived stress,rumination,self-efficacy and post-traumatic growth in chemotherapy patients after breast cancer surgery and their influencing factors,exploring the relationship between these four factors,and analyzing the mediating effects of rumination and self-efficacy between perceived stress and post-traumatic growth,so as to provide theoretical basis and guidance for the development of appropriate intervention programs to improve post-traumatic growth in chemotherapy patients after breast cancer surgery.MethodsIn this study,chemotherapy patients after breast cancer surgery who met the inclusion and exclusion criteria were selected from December 2021 to October 2022 at three Grade three Grade A hospitals in Henan Province as the study population using convenience sampling method.The General Data Questionnaire,the Chinese version Perceived Stress Scale,the Chinese Event Related Rumination Inventory,the General Self-Efficacy Scale and the Post-Traumatic Growth Inventory were used as the study instruments.A total of 320 questionnaires were distributed,and 306 were validly returned,with a valid return rate of 95.63%.We employed Epidata 3.1 for data entry and SPSS 26.0 software and Process macro program for statistical analysis of the data.The statistical methods we used included descriptive analysis,one-way ANOVA,t-test,Pearson correlation analysis,multiple linear regression analysis,stepwise test regression coefficient method and Bootstrap test.Results(1)A total of 306 participants were included in this study.The perceived stress score of chemotherapy patients after breast cancer surgery was(35.15 ± 9.89);the score of invasive rumination was(17.05 ± 7.20);the score of purposeful rumination was(16.21 ± 7.06);the score of self-efficacy was(25.63 ± 5.57);and post-traumatic growth score was(61.37 ± 19.45).(2)The results of the univariate analysis showed that there were significant differences in perceived stress scores among chemotherapy patients after breast cancer surgery with different residence,education level,work status,per capita monthly income of households and chemotherapy cycles(P < 0.05);significant differences in invasive rumination scores among chemotherapy patients after breast cancer surgery with different residence and tumor stage(P < 0.05),and significant differences in purposeful rumination scores among chemotherapy patients after breast cancer surgery by work status(P < 0.05);significant differences in self-efficacy scores among chemotherapy patients after breast cancer surgery with different age,residence,education level and per capita monthly income of households(P < 0.05);significant differences in post-traumatic growth scores among chemotherapy patients after breast cancer surgery with different age,residence,education level,per capita monthly income of households,tumor stage and whether breast conservation or not(P < 0.05).(3)The results of correlation analysis indicated that perceived stress was significantly negatively correlated with purposeful rumination(r =-0.221,P < 0.01),self-efficacy(r =-0.286,P < 0.01),and post-traumatic growth(r =-0.340,P < 0.01),and significantly positively correlated with invasive rumination(r = 0.294,P < 0.01);invasive rumination was significantly negatively associated with self-efficacy(r =-0.222,P < 0.01)and post-traumatic growth(r =-0.262,P < 0.01),while purposeful rumination was significantly positively correlated with self-efficacy(r = 0.231,P < 0.01)and post-traumatic growth(r = 0.235,P < 0.01);self-efficacy was significantly positive correlated with post-traumatic growth(r = 0.382,P < 0.01).(4)The results of multivariate analysis showed that per capita monthly income of households,tumor stage,perceived stress,invasive rumination,purposeful rumination and self-efficacy were the main influencing factors of post-traumatic growth in chemotherapy patients after breast cancer surgery(P <0.05).(5)The results of mediating effect analysis indicated that perceived stress not only directly influenced post-traumatic growth in chemotherapy patients after breast cancer surgery,but also indirectly influenced post-traumatic growth through the mediating effects of rumination and self-efficacy.The mediating effect of invasive rumination between perceived stress and post-traumatic growth was-0.043,accounting for 16.54% of the total effect;the mediating effect of purposeful rumination was-0.026,accounting for 10.00% of the total effect;the mediating effect of self-efficacy was-0.033,accounting for12.69% of the total effect;the chain mediating effect between intrusive rumination and self-efficacy was-0.011,accounting for 4.23% of the total effect;the chain mediating effect between purposeful rumination and self-efficacy was-0.009,accounting for 3.46% of the total effect.ConclusionChemotherapy patients after breast cancer surgery had higher levels of stress,tended to adopt negative thinking,had higher levels of self-efficacy,and had moderate levels of post-traumatic growth.Meanwhile,the variables of perceived stress,rumination,self-efficacy and post-traumatic growth were closely related to each other.In addition,perceived stress could indirectly influenced post-traumatic growth through rumination or self-efficacy as mediating variables,and could also influence post-traumatic growth through the chain mediating effect of rumination and self-efficacy.Therefore,clinical nursing staff could promote post-traumatic growth by strengthening psychological assessment and timely psychological intervention for patients with high perceived stress levels,encourage patients to adopt a positive way of thinking about illness and improve their self-efficacy level,so as to improve their post-traumatic growth level.