| Research background and purpose:China ’s population structure is entering a deep aging.With the increase of age,the incidence and mortality of cancer are increasing,and the number of cancer patients in the older adults is increasing year by year.Cancer not only seriously threatens the quality of life and safety of patients,but also brings deep fear of disease progression to patients,thus endangering their mental health and affecting the clinical treatment effect.Nowadays,positive psychology has been widely recognized by scholars at home and abroad,and resilience has also become a research hotspot.Resilience can effectively alleviate anxiety and depression,thereby improving the quality of life of individuals.Therefore,the purpose of this study is to analyze the fear of disease progression and its influencing factors in the older adults with cancer,to explore the protective effect of resilience on the fear of disease progression,and to further transform the thinking.From the perspective of positive psychology,the focus of resilience is to explore whether individualized intervention programs have a mitigating effect on the fear of disease progression in the older adults with cancer.Materials and Methods:The current situation of fear of disease progression in 119 older adults diagnosed by Tianjin Cancer Hospital was investigated by random sampling questionnaire,and the influencing factors of fear of disease progression were further analyzed.According to the cross-sectional results and literature basis,an individualized intervention program was constructed and designed under expert opinions and group discussions.Through the time series design,the application effect of the intervention program focusing on resilience in the older adults with cancer was explored.Eleven older adults with severe fear of disease progression were convenient sampled.The pre-test and post-test time series design experiment was used to conduct 10 individual one-to-one interventions focusing on resilience for 5 weeks.The level of resilience and fear of disease progression in the older adults was evaluated before the experiment,at the end of the experiment and 15 days after the experiment.This study used a variety of tools,including general basic information questionnaire,10 concise psychological resilience scale,daily activity ability scale and Chinese version of fear of disease progression simplified scale.Result:1.Cross-sectional study resultsThe average total score of fear of disease progression in the older adults with cancer was 31.83 ± 8.51,and the detection rate of severe fear of disease progression was 39.50%.Chi-square test showed that there were significant differences in religious beliefs,living conditions and family economic treatment among the older adults with cancer(p < 0.05).Specifically,those with no religion,living only with their children,and balanced family financial treatment had a higher risk of fear of severe disease progression.Correlation analysis showed that the fear of disease progression was correlated with the degree of physical function limitation and psychological resilience in the older adults with cancer.Specifically,the fear of disease progression in the older adults with cancer was positively correlated with the degree of physical function limitation.The results showed that there was a significant positive correlation between the fear of disease progression and the degree of physical function limitation in the older adults with cancer(R = 0.499,p < 0.01),and a significant negative correlation between the fear of disease progression and psychological resilience(R =-0.527,p < 0.01).Logistic regression analysis showed that the high degree of physical function limitation was the main risk factor for the fear of disease progression in the older adults with cancer(OR = 1.068,95% CI = 0.977-1.168,p < 0.05).Resilience was a protective factor for fear of progression(OR = 0.901,95% CI = 0.834-0.973,p < 0.05).The results of regulation effect showed that psychological regulation had a significant protective effect on the older adults cancer patients whose physical function limitation was not at a very high level,and the regulation effect of psychological resilience was obvious on the subjects whose physical function limitation was low.With the increase of the degree of physical functional limitation,the regulative effect of resilience was gradually weakened(simple slope = 0.5961,t = 6.09,p < 0.001)。2.Construction results of intervention programBased on the resilience framework theory of "I have,I am,I can",combined with their own reasons,external conditions and the role of both internal and external environments,a complete set of resilience intervention program was finally constructed after several revisions.The five-week intervention program uses a one-to-one intervention with an average duration of 45 minutes twice a week,which is divided into five steps: the first step is to build trust and interpersonal relationships for one week;The second step is based on the strategy of "I have",starting from the external protection reasons,to carry out the core training of psychological resilience.The third stage is based on the strategy of "I am",starting from the reasons of personal internal protection,to carry out the core training of psychological resilience.The fourth stage is based on the interaction between individuals and social living environment,and carries out core training of psychological resilience to enhance individual self-protection ability.Adopt the "I can" strategy to carry out the core training of psychological resilience.The fifth step aims to summarize in depth in order to achieve better consolidation effect.3.Pre-test and post-test results:The change of fear of disease progression showed that the level of fear of disease progression after intervention was significantly lower than that before intervention,and the difference was statistically significant(t = 18.23,P < 0.001,d = 6.08).After 15 days of intervention,the level of fear of disease progression was significantly lower than that before intervention(t = 12.31,P < 0.001,d = 5.78),but slightly higher than that after intervention(P > 0.05).The results of resilience showed that the level of resilience after intervention was significantly higher than that before intervention,and the difference was statistically significant(t(20)=-13.64,P < 0.001,d =-3.73).The level of resilience after 15 days of intervention was significantly higher than that before intervention(t =-15.07,P <0.001,d =-3.48),but slightly lower than that after intervention(P > 0.05).Conclusion :1.The older adults with cancer,whose fear of disease progression is pervasive and conspicuous,deserves to be given due consideration.mmon and prominent,which deserves attention.2.The high level of physical function limitation is the key risk factor of fear of disease progression in the older adults with cancer,and the high level of resilience is the protective factor of fear of disease progression.Resilience plays a moderating role in the relationship between physical function limitation and fear of cancer progression.3.Based on the theory of "I have,I am,I can" resilience framework and the results of cross-sectional studies,we reconstructed and designed a resilience intervention program for the older adults with cancer to alleviate their fear of disease progression.4.The pretest and posttest follow-up study confirmed that the resilience intervention method established in this study could significantly improve the resilience of the older adults with cancer,effectively reduce their panic about the development of the disease,and thus improve their quality of life. |
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