An Empirical Study On Influencing Factors And Intervention Of Quality Of Life In Breast Cancer Patients Based On Positive Psychological Resources

Objective:Breast cancer has the highest incidence of women tumor disease worldwide.On account of the continuous improvement of survival rate in cancer and the transformation of medical model,people have put forward higher and higher demand for individual health,and the importance of QOL has came into sight.During the diagnosis,treatment and prognosis process of breast cancer,patients inevitably suffered from multiple accompanying symptoms and negative emotions,which seriously reduced their QOL Therefore,how to integrate clinical,positive psychological resources and social resources to promote psychosomatic rehabilitation and positive transformation of QOL among breast cancer patients is one of the important issues that need to be solved in positive psychological oncology.This study focused on the subject of female breast cancer patients,from the perspective of positive psychology,through exploring psychological resources（resilience and self-efficacy）,social support and loneliness together with demographic and clinical characteristics factors influencing the QOL in postoperative patients with breast cancer,to clarify its overall level and main influential factors of QOL;On the basis of this,a longitudinal study design was conducted to systematically investigate the correlation between social support,loneliness,positive psychological resources（resilience and self-efficacy）and QOL of female breast cancer patients,and to explore the longitudinal predictive relationship among research variables as well as the internal mechanism of the study variables was further discussed and verified.Finally,based on the combination of mindfulness based stress reduction（MBSR）theory course and online,psychological intervention was put into breast cancer patients and to track the intervention effects at three different time points,meanwhile,to compare the therapeutic effect of breast cancer patients who completed online MBSR training with those who only received conventional treatment,in order to explore the effect and feasibility of improving the positive psychological level and alleviating negative emotions of breast cancer patients through online MBSR training,and this study further provided research ideas and reference basis for enriching to promote the QOL among breast cancer patients in the diversity of methods.This study had an important theoretical guiding significance for the exploration and development of positive psychological intervention for breast cancer patients after surgery.Methods:Part Ⅰ:A cross-sectional survey was performed,the research team collected postoperative patients with breast cancer from the department of Breast Surgery of a tertiary hospital from October 2019 to October 2020,Five hundred and twenty questionnaires were distributed,while four hundred and fifty-five patients finally were included in the study after eliminating the information of patients that did not meet the inclusion and exclusion criteria,with an effective recovery rate of 87.5%.The survey tools included the general information questionnaire for breast cancer patients（individual and clinical characteristics）,FACT-B,MSPSS,UCLA Loneliness,Resilience Scale-14 and Gses Scale.Epidata 3.1 software was used for bilateral data entry,and the IBM SPSS 20.0 was used for statistical analysis.The statistical analysis methods adopted in this part mainly included scale reliability test,t-test,one-way ANOVA,least significant difference method,Pearson correlation analysis,and multiple hierarchical regression analysis.Statistical tests were conducted by a two-sided test,and the test level wasα=0.05.Part Ⅱ:A longitudinal study design was adopted to investigate breast cancer patients who participated in the cross-sectional survey in Part I,which was divided into on-site face-to-face survey and telephone follow-up survey.The patient’s contact information,operation time and next review time were accurately recorded through the patient’s medical record system.On the basis of the first baseline survey during hospitalization,subsequent follow-up was performed at3rd and 6th months,respectively.In the end,a total of 294 valid questionnaires were completed for the three surveys.The IBM SPSS 20.0 for windows was used for descriptive statistics and correlation analysis of the data,the Mplus8.3 and IBM SPSS Amos24.0 were used to conduct a longitudinal analysis on social support,loneliness,resilience,self-efficacy and QOL of postoperative breast cancer patients,and verify the longitudinal mediating effect of resilience,self-efficacy respectively between social support,loneliness and QOL.Subsequently,the deviation-corrected percentile Bootstrap method was used to verify the significance of the mediating effect.The fitting quality of the model was evaluated by using the square root of approximate error and fitting parameters.Part Ⅲ:A single-center,randomized,clinical controlled study design was used.The experimental group recruited breast cancer patients meeting the inclusion criteria in the breast surgery department of a tertiary cancer hospital from April 2021 to June 2021.The newly recruited patients in the experimental group were required to sign informed consent and not to communicate with the control group about the intervention content.The control group was selected from the cross-sectional baseline data in part I and matched 1:1 with the experimental group.Patients in the control group received routine treatment and nursing,the experimental group on the basis received the train of 8 weeks online mindfulness decompression,and completed questionnaires（including RS-14 and GSES Scale,FACT-B,MSPSS,UCLA Loneliness Scale）before intervention,after intervention,3 months and 6 months after the first enrollment).In this study,a total of one-hundred patients were recruited into the experimental group.In fact,the effective sample size for the whole intervention and follow-up in the experimental group was 90 cases,and the sample loss rate was 10%,namely 90 cases in the experimental group and 90 cases in the control group.The IBM SPSS 20.0 was used for statistical analysis and processing of the data.The main statistical methods were t-test,chi-square test and repeated ANOVA.Results:Part Ⅰ:1.In our study,the average score of QOL in postoperative patients with breast cancer was 90.17±17.06,which was at a low level.2.The results of univariate analysis of demographic and clinical statistics showed that the emotional dimension score of breast cancer patients with junior middle school and below was the highest;non-religious patients scored higher on the functional dimension than religious patients;patients with a monthly income of 3,001-5,000yuan scored highest on functional dimensions;the breast cancer patients whose primary caregivers were their partners had the highest scores in social family and functional dimensions.Patients who exercised daily scored higher on functional dimensions than those who did not;the scores of QOL and its physiological dimensions in new cases were higher than those in relapsed patients.Breast cancer patients in clinical stage I had the highest score of physiological dimensions;Patients who received radiation therapy scored lower on physiological dimensions than those who did not;Patients with concomitant symptoms scored lower on physiological dimensions than those without（P<0.05）.3.The correlation analysis results showed that the multidimensional perceived social support and its three dimension（family support,significant others support,and friend support）were significantly positively related with QOL and its various dimensions,positive psychological resources（resilience,self-efficacy）were significantly positively related with QOL and its various dimensions,loneliness was negatively correlated with QOL and its dimensions（P<0.05）.4.Multiple linear regression analysis showed that（1）diagnosis type,primary caregiver,exercise and monthly income were the main influence factors for QOL in postoperative patients with breast cancer（P<0.05）;（2）Social support（support from significant others）,resilience and self-efficacy had a significant positive impact on QOL,while loneliness had a significant negative impact on QOL（P<0.05）.And the combined explanatory power of positive psychological resources（resilience and self-efficacy）and social support,loneliness was 36.1%/35.6%（Model 1/Model 2）;（3）Social support（family support）and self-efficacy had a significant positive impact on the physiological dimension of QOL,while loneliness had a significant negative impact on the physiological dimension（P<0.05）.And the combined explanatory power of self-efficacy and social support,loneliness was 23.1%/22.9%（Model 1/Model 2）;（4）Social support（family support）and self-efficacy had a significant positive impact on the social/family dimensions of QOL（P<0.05）,and the combined explanatory power of self-efficacy and social support was 13.9%/13.6%（Model 1/Model 2）;（5）Social support（support from significant others）,resilience and self-efficacy had a significant positive impact on the affective dimension of QOL,while loneliness had a significant negative impact on the affective dimension（P<0.05）.And the combined explanatory power of positive psychological resources（resilience and self-efficacy）and social support,loneliness was23.8%/24.2%（Model 1/Model 2）;（6）Social support（family support）,resilience and self-efficacy had a significant positive impact on the functional dimensions of QOL（P<0.05）,and the combined explanatory power of positive psychological resources（resilience and self-efficacy）and social support was 20.3%/20.5%（Model 1/Model 2）;（7）Social support（significant others’support）and resilience had a significant positive impact on the additional concern dimension of QOL（P<0.05）.And the combined explanatory power of social support and resilience was 10.3%and 11.2%（Model 1/Model 2）.Part Ⅱ:1.Social support at T₁ stage was used as a predictive variable,self-efficacy at T₂stage was used as a mediating variable,and QOL at T₃ stage was used as a dependent variable to perform path analysis.The results showed that the model fit well（χ²/df=1.65,P<0.05,TLI=0.988,CFI=0.992,RMSEA=0.047,SRMR=0.013）;the direct effect of social support at stage T₁ on QOL at stage T₃ was significant（P<0.05）;Social support could indirectly influence the QOL through the mediating effect of self-efficacy;the significance of the mediating path was tested by the deviation corrected non-parametric percentage Bootstrap test and repeated sampling for 5000 times.The results showed that the mediating effect from social support at T₁stage→self-efficacy at T₂ stage→QOL at T₃ stage was 0.025,and the 95%bias corrected confidence interval was（0.002,0.063）together with the interval was not included 0 that indicated the mediating effect was significant.2.Path analysis was conducted with loneliness at T₁ stage as a predictive variable,self-efficacy at T₂ stage as a mediator variable and QOL at T₃stage as a dependent variable.The results showed that the model fit well（χ²/df=1.78,P<0.05,TLI=0.980,CFI=0.987,RMSEA=0.052,SRMR=0.072）.Loneliness at stage T₁ had a significant direct effect on QOL at stage T₃（P<0.05）.Loneliness could indirectly affect the QOL through the mediating effect of self-efficacy;the significance of the mediating path was tested by the deviation corrected non-parametric percentage bootstrap test and repeated sampling for 5000times.The results showed that the mediating effect of loneliness at T₁ stage→self-efficacy at T₂stage→QOL at T₃ stage was 0.035,and the 95%bias corrected confidence interval was（-0.078,-0.005）together with the interval was not included 0 that indicated the mediating effect was significant.3.Path analysis was conducted with social support at T₁ stage as a predictive variable,resilience at T₂ stage as a mediator variable and QOL at T₃ stage as a dependent variable.The results showed that the model fit well（χ²/df=1.52,P>0.05,TLI=0.993,CFI=0.995,RMSEA=0.042,SRMR=0.045）.The direct effect of social support at stage T₁ on QOL at stage T₃ was significant（P<0.05）.Social support could indirectly affect the QOL through the mediating effect of resilience.The significance of the mediating path was tested by the deviation corrected non-parametric percentage Bootstrap test and repeated sampling for 5000 times.The results showed that the mediating effect from social support at T₁ stage→resilience at T₂ stage→QOL at T₃ stage was 0.024,and the 95%bias corrected confidence interval was（0.001,0.054）together with the interval was not included 0 that indicated the mediating effect was significant.4.Path analysis was conducted with loneliness at T₁ stage as a predictive variable,resilience at T₂ stage as a mediator variable and QOL at T₃ stage as a dependent variable.The results showed that the model fit well（χ²/df=1.14,P>0.05,TLI=0.997,CFI=0.998,RMSEA=0.022,SRMR=0.055）.Loneliness at stage T₁ had a significant direct effect on QOL at stage T₃（P<0.05）.However,the indirect effect of resilience at T₂ stage between loneliness at T₁ stage and QOL at T₃ stage was not significant.The significance of the mediating path was tested by the deviation corrected non-parametric percentage Bootstrap test and repeated sampling for 5000times.The results showed that the indirect effect from loneliness at T₁ stage→resilience at T₂stage→QOL at T₃ stage was not significant,and the 95%bias corrected confidence interval was（-0.039,0.002）together with the interval was included 0 that indicated the mediating effect was not significant.Part Ⅲ:Patients in the experimental group received online MBSR training for 8 weeks,the scores of QOL,physiological,social/family,emotional,functional and additional attention dimensions after intervention were higher than before intervention（P<0.05）.The scores of positive psychological resources（resilience,self-efficacy）,social support were higher than before the intervention,the score of loneliness was lower than before the intervention（P<0.05）.The results of self-efficacy,resilience,social support,loneliness and QOL scores of breast cancer patients at different time points between the experimental group and the control group showed that there were no statistically significant differences in study variables between the experimental group and the control group at admission（P>0.05）,while at 3 and 6 months of follow-up after baseline/initial enrollment,the scores of self-efficacy,resilience,social support and QOL were higher in the experimental group than in the control group,the score of loneliness was lower than the control group（P<0.05）.For self-efficacy,social support,loneliness and QOL,the interaction between group and time was statistically significant.They not only showed significant differences between the experimental group and the control group,but also showed statistically significant trends over time（P<0.05）.Conclusions:1.In this study,the QOL in postoperative patients with breast cancer were generally at a low level,social support was the main antecedent variable of QOL and its various dimensions,including support from family and significant others two dimensions were an important protective factor of QOL and its various dimensions;Loneliness had a significant negative impact on QOL and its physiological and emotional dimensions.In positive psychological resources,resilience had a significant positive effect on QOL and its affective,functional and additional attention dimensions,while self-efficacy had a significant positive effect on QOL and its physiological,social/family,affective and functional dimensions,both of which could increase the stock of QOL.These above suggested that clinical medical staff could improve the QOL of breast cancer patients by enhancing social support to alleviate the loneliness of patients.At the same time,targeted positive psychological interventions for breast cancer patients might also help to weaken patients’negative feelings towards diseases in the field of tumor and increase the stock of patients’QOL.2.Social support and loneliness could predict the QOL of breast cancer patients longitudinally,and self-efficacy mediated the relationship between social support,loneliness and QOL;Resilience mediated longitudinally between social support and QOL.3.Online MBSR training could effectively promote the positive psychological level（resilience,self-efficacy）of breast cancer patients,and facilitate social support as well as relieve negative emotions,and ultimately improve the QOL of patients.