肺癌根治术后患者自我管理效能感与运动依从性的关系-交叉滞后分析

Correlation of self-management efficacy with exercise compliance in patients after radical resection of lung cancer:a cross-lagged regression analysis

目的探讨术后6个月内肺癌根治术后患者自我管理效能感与运动依从性的变化趋势,并分析二者间的预测关系,为改善术后患者运动依从性提供参考。方法采用便利抽样法,选取2022年12月至2023年5月南充市2所三级甲等综合医院胸外科首次行肺癌根治术的188例患者作为研究对象,采用中文版癌症自我管理效能感量表(Chinese-version strategies used by people to promote health,C-SUPPH)、运动依从性量表调查患者出院前1d(TI)与术后1个月(T2)、3个月(T3)、6个月(T4)的自我管理效能感及运动依从性水平,构建交叉滞后模型分析自我管理效能感与运动依从性间的因果关系。结果178例患者完成研究;术后6个月内,肺癌根治术后患者自我管理效能感、运动依从性均呈先上升后下降趋势(均P<0.05);交叉滞后模型显示,术后早期(TI~T2)患者自我管理效能感与运动依从性互为因果(β=0.254,P=0.003;β=0.332,P=0.007);中期(T2~T3)患者自我管理效能感能正向预测运动依从性(β=0.286,P<0.001);后期(T3~T4)两者不能相互预测(均P>0.05)。结论肺癌根治术后患者自我管理效能感处于中等水平、运动依从性处于低水平;肺癌根治术后患者自我管理效能感、运动依从性的初始水平并不代表长期治疗后的变化趋势,两者间的预测关系也会发生改变。医护人员需考虑其动态变化特征和个体差异,在患者术后的各个阶段进行评估,及时给予针对性的干预。

Objective To explore the trend in self-management efficacy and exercise compliance among patients within 6 months after radical resection of lung cancer and analyse the predictive correlation between the factors to provide references for improvement of exercise compliance in patients after lung cancer surgery.Methods Convenience sampling was used to select patients who had surgery of radical resection of lung cancer for the first time in the departments of thoracic surgery of two Grade IIIA hospitals in Nanchong between December 2022 and May 2023.The Chinese-version strategies used by people to promote health(C-SUPPH)and exercise compliance scale were employed to assess the self-management efficacy and patient exercise compliance at four time points:1 day before discharge(T1)and 1 month(T2),3 months(T3)and 6 months(T4)after surgery.A cross-lagged model was constructed to analyse the causal correlation between self-management efficacy and exercise compliance.Results Within 6 months after surgery,both of self-management efficacy and exercise compliance in the patients after radical resection of lung cancer were seen initially increased and then decreased(P<0.05).The cross-lagged model revealed that self-management efficacy and exercise compliance during the early postoperative period(TI-T2)exhibited reciprocal causation(β=0.254,P=0.003;β=0.332,P=0.007).Between T2 and T3,higher self-management efficacy positively predicted an increased exercise compliance(β=0.286,P<0.001).However,during T3 and T4,no predictive relationship was observed between the indicators(P>0.05).Conclusion The self management efficacy of patients after lung cancer sugery is at middle level and their exercise compliance is at low level.This study indicates that the initial levels of selfmanagement efficacy and exercise compliance among patients after radical resection of lung cancer do not necessarily reflect a longterm trend.The predictive correlation between the two factors also varies over the time.Healthcare providers should consider the dynamic changes and individual differences across different stages after surgery,and implement timely and targeted intervention.