The Status Research And Study On Fear Of Progression Of Primary Liver Cancer Patients And Their Spouses

Objective 1.To adapt the English version of Fo P-Q-SF and Fo P-Q-SF/P to Chinese condition and test the validity and reliability of the Chinese version.2.To understand the Fo P(Fear of Progression)of primary cancer(PLC)patients and their spouses,then analysis the influencing factors.To explore the relationship between the Fo P and Qo L(Quality of Life).3.To explore the differences and correlations of Fo P between PLC patients and their spouses.To know their demands for psychological intervention.4.To understand the PLC patients and their spouses' s experiences of feeling and coping for Fo P.To get their family stuck points during the cancer process.Methods 1.By extensive literature review,we distinguished the concept of Fo P,introduced Fo P-Q-SF and Fo P-Q-SF/P as measuring tools.Based on the standard localization process of translation,back-translation,culture adaption,we completed the statistic test to ensure the excellent reliability and validity of the Chinese version scales(Fo P-Q-SF & Fo P-Q-SF/P).2.A convenient sampling method of 1031 PLC inpatients in one of Class III hepatobiliary specialized hospitals in Shanghai were carried out from January to October,2015 for a cross-sectional survey.The survey instruments included general information,Fo P-Q-SF,Qo L-LC,and SAS.Statistic package of SPSS(19.0)was used,containing statistical description,Chi-square test,Jonckheere–Terpstra test,Logistic regression analysis,Stepwise multiple linear regression analysis,Pearson correlation analysis.We would know the level of Fo P of PLC patients,the factors that influencing and its correlation with quality of life.3.A convenient sampling method of 625 spouses of PLC patients from the hepatobiliary specialized hospitals were carried out from January to October,2015.The survey instruments included general information,Fo P-Q-SF/P,and SAS.Statistic package of SPSS(19.0)was used,containing statistical description,Chi-square test,Jonckheere–Terpstra test,Logistic regression analysis,Stepwise multiple linear regression analysis.We would know the level of Fo P of spouses of PLC patients,and that influencing factors.4.Paired t-test,Spearman correlation analysis,Wilcoxon rank sum test,statistical effect size test were used to analysis the “Levels of patient's understanding of disease” between the couples,the differences and correlation of Fo P,and demand for psychological intervention between PLC patients and their spouses.5.Through the phenomenological research of qualitative research methods,a purposive sampling method of 13 PLC patients and 10 spouses from the hepatobiliary specialized hospitals were carried out from January to October,2015 for semi-structured interview.We explored the influencing factors and coping experiences of patients and their spouses for Fo P,as well as family stuck points during cancer process.Results 1.The statistic test results of Chinese version of Fo P-Q-SF and Fo P-Q-SF/P:(1)Chinese version of Fop-Q-SF:Item analysis showed that a total of 12 items had good discrimination and identification;Exploratory factor analysis(EFA)indicated that Chinese version of Fo P-Q-SF consisted of 2 factors which explained of 54.3% of total variance;Confirmatory factor analysis(CFA)indicated the fit indices of the measurement was:SRMR=0.052,GFI=0.913,IFI=0.905,CFI=0.904,NNFI=0.881;Cronbach's ? was 0.883 for total scale,and split-half coefficient was 0.855.Our findings showed a good reliability and validity of the Chinese version of Fo P-Q-SF.(2)Chinese version of Fo P-Q-SF/P:Item analysis showed that a total of 12 items had good discrimination and identification;Exploratory factor analysis(EFA)indicated that Chinese version of Fo P-Q-SF/P consisted of 2 factors which explained of 50.6% of total variance;Confirmatory factor analysis(CFA)indicated the fit indices of the measurement was : c2/df=2.75,GFI=0.923,IFI=0.909,CFI=0.908,NNFI=0.885,RMSEA=0.075;Cronbach's ? was 0.834 for total scale,and split-half coefficient was 0.818.Our findings showed a good reliability and validity of the Chinese version of Fo P-Q-SF/P.2.Overall score for Fo P of PLC patients in this study was(33.60±9.26);The highest score of the top three were: I worry about what will become of my family if something should happen to my partners(3.21±1.16),(3)I am afraid of pain(3.16±1.19),(9)I am afraid of severe medical treatments over the course of the illness(3.11±1.10).ANOVA analysis indicated that differences of Fo P between genders,ages,medical burdens,degree of education,living environments,occupations,and levels of understanding of the disease was statistically significant(P <0.05).We could get four factors that influencing Fo P by Logistic regression:gender(OR=1.660,95%CI:1.227,1.247,P<0.01),age(OR=0.743,95%CI:0.657,0.841,P<0.01),medical burden(OR=1.779,95%CI:1.493,2.120,P<0.01),and levels of understanding of the disease(OR=1.983,95%CI:1.557,2.525,P<0.01).Multiple linear regression analysis:gender,age,medical burden,levels of understanding of the disease,history of liver surgery are major factors of Fo P of PLC patients,explainging 15% of the total variance.The correlation between Fo P-Q-SF and Qo L(total score and each dimension)of PLC patients is significant(P<0.05).3.Overall score for Fo P of spouses of PLC patients in this study was(35.77±7.91);The highest score of the top three were:(3)I am afraid that my partner may have pain(3.87±0.95),(1)I become anxious if I think the disease may progress(3.66±0.93),(10)I worry that the medications could damage my partner's body(3.57±1.05).ANOVA analysis indicated that differences of Fo P between ages,medical burdens,and levels of understanding of the disease was statistically significant(P <0.05).We could get three factors that influencing Fo P of spouses by Logistic regression:age(OR=0.804,95%CI:0.685,0.944,P<0.01),medical burden(OR=1.514,95%CI:1.219,1.879,P<0.01),and levels patient's of understanding of the disease for patients(OR=1.638,95%CI :1.203,2.231,P<0.01).Multiple linear regression analysis: age,medical burden,levels patient's of understanding of the disease are major factors of Fo P of spouses of PLC patients,explainging 9.1% of the total variance.4.“Levels of patient's understanding of disease” for patients and their spouses issignificant different(P<0.01);Statistics showed no differences of SAS between patients and spouses,butlevel of Fo P of spouses is higher than that of patients;Effect size indicated the degree of the difference between couples is most significant for the item of the pain caused by cancer(d=0.55);The correlation of Fo P between the couples is also significant(P<0.05);The degree of demand for psychological intervention is not different between the total of PLC patients and their spouses;The patients' demand has a greater relevance with Fo P,while spouses' demand has a greater relevance with SAS.5.Results of interviewing with PLC patients and their spouses for qualitative research:(1)We got 5 themes by interviewing with 13 PLC patients:factors influencing Fo P,triggers of Fo P,experiences of Fo P,coping with Fo P,and communication with the spouses.(2)We got 4 themes by interviewing with 10 spouses of PLC patients:factors influencing Fo P,experiences of Fo P,coping with Fo P,and communication with the spouses.Conclusions1.Chinese version of Fo P-Q-SF and Fo P-Q-SF/P have good reliability and validity,can be used as psychological measuring tools for Fo P of patients with primary liver cancer and their spouses.2.PLC patients and their spouses had different degree of Fo P,and coursed a great adverse impact on their health and quality of life.Overal,Fo P leverl of spouses is higher than the patients themselves,fear of cancer pain is particularly prominent.Couples influenced each other on cognition of disease treatment and psychological reactions.Medical staff in clinical work should pay attention to the knowledge and understanding of disease and treatment for the couples,to further standardize the treatment of cancer pain,improve the level of cancer pain controlling,and concerns the adverse psychological reactions of the couples due to symptoms of cancer.3.Medical burden and the level of understanding of disease are important factors affecting Fo P for PLC patients and their spouses.Patients with heavier medical burden and lower level of disease understanding showed a higher level of Fo P.Further attention should be given to the Medical Security for cancer patients,to improve the health service system and reduce the ecomomic pressure on cancer patients.To further promote the doctor-patient communication by taking varieties of forms or ways and ensure that each family can get the information they need.To improve the informed stratigies of diseses condition and treatment.Negative emotions should be concerned during the told process,give the answers for that couples confused about to relieve their psychological pressure.4.The process of Fo P response is a complexed and multiple interwined psychosocial transition.During the continuous process of adaptiong and adjustment,cancer patients and their spouses faced the pressure of how to express concerns for each other,how to make a supportive communication,and how to make a balance between family life and cancer.Health services should give necessary support to cancer families for meeting their needs of information,emotion,communication and coping,etc.,and take psychological intervention based on individual characteristics.