乳腺癌患者心理复原力、二元应对与恐惧疾病进展的相关性及中介作用

Correlation and mediating effect of psychological resilience,dyadic coping with fear of progression in patients with breast cancer

目的探讨乳腺癌患者恐惧疾病进展(FOP)水平的现状及其影响因素,分析乳腺癌患者心理复原力、二元应对与FOP之间的关系。方法选取408例乳腺癌患者作为研究对象,采用一般资料调查表、康纳-戴维森弹性量表(CD-RISC)、二元应对量表(DCI)、恐惧疾病进展简化量表(FoP-Q-SF)对其进行调查。采用Pearson相关性分析方法分析心理复原力、二元应对及FOP的关系;采用多元线性回归分析乳腺癌患者FOP的影响因素;采用Process Bootstrap程序分析消极二元应对在乳腺癌患者心理复原力与FOP间的中介效应。结果408例乳腺癌患者的CD-RISC总分为(62.40±16.22)分,DCI总分为(118.10±21.40)分,FoP-Q-SF总分为(31.89±8.26)分。不同民族、居住地、文化程度、职业、家庭人均月收入、子女个数、医疗负担程度、疾病知识了解程度、主要照顾者、治疗阶段的乳腺癌患者FoP-Q-SF得分比较,差异有统计学意义(P<0.05)。DCI的支持应对维度得分、授权应对维度得分及共同应对维度得分与FoP-Q-SF的社会家庭维度得分呈负相关,DCI的支持应对维度得分及共同应对维度得分与FoP-Q-SF总分呈负相关,DCI的消极应对维度得分、应对质量评价维度得分及总分,CD-RISC各维度得分及总分与FoP-Q-SF各维度得分及总分呈负相关,CD-RISC各维度得分及总分与DCI各维度得分及总分呈正相关(P<0.05)。多元线性回归分析结果显示,CD-RISC的自强维度得分、DCI的消极应对维度得分、治疗阶段、医疗负担程度、主要照顾者及疾病知识了解程度是乳腺癌患者Fo P-Q-SF总分的影响因素(P<0.05)。心理复原力可直接影响乳腺癌患者的FOP,二元应对在心理复原力与FOP间起部分中介作用,其中介效应占比为13.29%。结论乳腺癌患者FOP处于中等水平,受自强、消极应对、治疗阶段、医疗负担、主要照顾者及疾病知识了解程度的影响,患者心理复原力可直接影响乳腺癌患者的FOP,亦可通过二元应对间接影响FOP。

Objective To explore the current status of fear of progression(FOP)level in patients with breast cancer and its influencing factors,and to analyze the relation between psychological resilience,dyadic coping and FOP.Methods A total of 408 patients with breast cancer were selected as the research subjects.The general data inventory,Connor⁃Davidson Resilience Scale(CD⁃RISC),Dyadic Coping Inventory(DCI),and Fear of Progression Questionnaire⁃Short Form(FoP⁃Q⁃SF)were employed to perform investigation.The Pearson correlation analysis method was used to analyze the relation of psychological resilience,dyadic coping with FOP.The factors for influencing FOP in patients with breast cancer were analyzed by using the multivariate linear regression model,and the mediating effect of negatively dyadic coping between psychological resilience and FOP was analyzed by using the Process Bootstrap program.Results The total score of CD⁃RISC among 408 patients with breast cancer was 62.40±16.22,DCI total score was 118.10±21.40,and FoP⁃Q⁃SF total score was 31.89±8.26.There were statistically significant differences in FoP⁃Q⁃SF score between breast cancer patients with different nationalities,residences,educational levels,occupations,per capita monthly household incomes,number of children,medical burden degree,knowledge of disease,main caregivers,and treatment stages(P<0.05).The support coping dimension score,empowerment coping dimension score,and joint coping dimension score of DCI negatively correlated with FoP⁃Q⁃SF social family dimension score,whereas support coping dimension score and joint coping dimension score of DCI negatively correlated with FoP⁃Q⁃SF total score;furthermore,negative coping dimension score,coping quality assessment dimension score and total score of DCI,various dimensions scores and total score of CD⁃RISC negatively correlated with various dimensions scores and total score of FoP⁃Q⁃SF;in additon,various dimensions score and total score of CD⁃RISC positively correlated with various dimensions score and total score of DCI(P<0.05).The results of multivariate linear regression analysis revealed that CD⁃RISC self⁃improvement dimension score,DCI negative coping dimension score,treatment stage,medical burden,main caregivers,and disease knowledge degree were the influencing factors for the total score of FoP⁃Q⁃SF in patients with breast cancer(P<0.05).Psychological resilience could directly affect FOP in patients with breast cancer.Dyadic coping exerted partial mediating effect between psychological resilience and FOP,and its proportion of mediating effect was 13.29%.Conclusion FOP of patients with breast cancer is at a medium level,which is affected by self⁃improvement,negative coping,treatment stage,medical burden,main caregivers and disease knowledge degree.Psychological resilience can directly affect FOP in patients with breast cancer,and can indirectly affect FOP through dyadic coping.