Study On Self-management Ability And Influence Factors In Lung Cancer Patients Undergoing Chemotherapy

Objective:(1)To develop the lung cancer chemotherapy patient self-management questionnaire suitable for our country.(2)To discuss the current status of lung cancer chemotherapy patients self-management and the influence factors.(3)To analyze the dependency of lung cancer chemotherapy patient self-management level on the self-efficacy, on the survival quality, depression evaluation and social support.Methodology:This survey is divided into two stages.Stage 1:To establish the content framework of lung cancer chemotherapy patients’ self-management questionnaire, with the purpose of testing the questionnaire’s reliability and validity.Stage 2:Tested by the self-designed self-management of lung cancer chemotherapy questionnaire, Chinese version of Strategies Used by People to Promote Health (SUPPH), short form 36 health survey questionnaire (SF-36), Self-rating depression scale (SDS), the social support rating scale (SSRS) and a self-designed questionnaire for general lung cancer patients. A commercial statistical software SPSS 17.0 was employed for data analysis.Results:(1) Project analysis and preliminary factor analysis, the lung cancer chemotherapy patient self-management questionnaire was determined to consist 4 dimensions of 29 items. The self-designed questionnaire was found to have a satisfactory reliability and validity.① Reliability test, Cronbach’s a coefficient turned out to be 0.920, split half reliability 0.882, and test-retest reliability 0.890.② Validity test, assessed by the experts the content validity was 0.901, the construct validity, the correlation coefficient between each dimension and the total system is between 0.692～0.882; Exploratory factor analysis showed that all the items were more than 0.40. The cumulative contribution rate of variance was 64.35%.(2) The average score of lung cancer chemotherapy patient self-management was 59.5±8.4, and 51.3% after conversed to standard score. According to the standard score, the dimension of self-management from high to low were diet management, daily life management, treatment related management and social psychological management in turn. To be specific, the high, medium and low score in self-management were 12.5%,38.0% and 49.5% respectively, which reveals that the lung cancer chemotherapy patient self-management behavior is generally on a low level.(3) By conducting the Strategies Used by People to Promote Health for lung cancer chemotherapy patients, the results showed that the total score of the self-management efficacy, the scores of positive attitude in each dimension, self-decision and self-decompression was 86.18±19.5,46.29±12.1,9.73±2.2 and 29.36±7.6 respectively. Therefore, to the patients the total score of the self-management efficacy and the score in each dimension are on a medium level.(4) The score of health status, analyzing the health status of lung cancer chemotherapy patients showed that the 8 dimensions (i.e. physiological function, physiological function, pain health, general health, energetic health, social function, emotional function and mental health) were lower than the domestically norm level.(5) Depression status analysis showed that the average SDS score was 46.31±11.64, clearly higher than the domestic norm (41.88±10.57), the detection rate of depressive symptoms was 39%, which accounted for 17.5% of mild depression, moderate depression accounted for 15%, severe depression accounted for 6.5%.(6) Analyzing the social support score showed that objective support, subjective support, support utilization and social support total score was 11.4±2.9,27.46±4.7, 8.5±2.3 and 44.2±6.1; patients with medium lever social support accounted 61.0%; high level took 26.4% and low lever accounted 12.5%.(7) Analyzing the influencing factors of self-management ability for 200 lung cancer chemotherapy patients, the single factor analysis showed that the scores of self-management were significantly different in age, gender, educational level, marital status, living style, occupation, medical payment and chemotherapy times (P<0.05); the age ranged from 31 to 40 scored the highest in self-management behavior, the lowest score occurred for >60 years; women score higher than male; the ones living with a spouse or child obtained higher scores, while the solitaries scored the lowest; the higher education level received, the higher scores were achieved; bachelors and married scored higher than the divorced or widowed; cadres scored the highest while farmers the lowest; those who paid at their own expense scored lowest and those who paid at public expense scored the highest; those who received 5-8 times chemotherapies scored the highest, then the self-management ability score decreased gradually with the increase of the chemotherapy number. Taking the total score of self-management behavior as the dependent variable, and the patients’ data files which are statistically meaningful in single factor analysis of variance as the independent variables, multiple logistic regression analysis showed that the factors related to low ability of self-management are more than 60 years old, male, cultural degree of elementary school or below, divorced or widowed, medical payment at their own expense, the number of chemotherapy for 9～12,13～16, or greater than 17 times, P<0.05, the variance has statistical meaning. The factors related to the medium level of self-management ability were age 41～50, male, junior middle school education, occupation, medical insurance, the number of chemotherapy was 2～4 times, P<0.05, the variance has statistical meaning.(8) Pearson correlation analysis showed that the score of self-management ability was positively correlated with the self-management efficacy, health status and social support (P<0.05), and negatively correlated with the depression Evaluation (P<0.05).Conclusions:(1) The self-developed self-management questionnaire for lung cancer chemotherapy patients is a high reliable and validate. It could provide a new tool for evaluating the self-management level of lung cancer chemotherapy patients.(2) The self-management for most lung cancer chemotherapy patients are on a low level(3)The influence factors on self-management ability of lung cancer chemotherapy patients were age, gender, education level, marital status, living style, occupation, medical fee payment means and also the number of chemotherapy. The factors related to low ability of self-management are more than 60 years old, male, cultural degree of elementary school or below, divorced or widowed, medical payment at their own expense, the number of chemotherapy for 9～12,13～16, or greater than 17 times. The factors related to the medium level of self-management ability were age 41～50, male, junior middle school education, occupation, medical insurance, the number of chemotherapy was 2～4 times.(4) Self-efficacy, self-rating depression, social support and health status are the main factors.The score of self-management ability was positively correlated with the self-management efficacy, health status and social support, and negatively correlated with the depression evaluation.