| ObjectivesThis study conducted a longitudinal survey for the level of post-traumatic growth(PTG)in patients with adjuvant chemotherapy after radical resection of gastric cancer at 1 month,3 months,and 6 months after surgery:(1)To understand the level and longitudinal trend of the patient’s PTG at 3 time points after surgery;(2)To analyze the influencing factors and predictive factors of the change trend of PTG at 3time points after the operation;(3)To explore the influence of PTG on the psychosomatic state of patients;(4)Further to investigate the patient whether there are potential categories of PTG and predictors of different categories.MethodsFrom July 2020 to January 2021,patients who underwent radical gastrectomy and adjuvant chemotherapy in the Second Affiliated Hospital of Zhengzhou University and Henan Cancer Hospital were selected as the research objects.The general data questionnaire,the Chinese Post-traumatic Growth Inventory(C-PTGI),the Chinese-Illness Cognition Questionnaire(C-ICQ),the Perceived Social Support Scale(PSSS),the Cancer Coping Modes Questionnaire(CCMQ)and the Cancer Psychosomatic State Scale(PSSCP)were used to inv-estigate the level of PTG in different time.IBM SPSS 21.0 and Mplus 8.3 st-atistical software were used for data analysis.The statistical methods mainly included descriptive statistical analysis,repeated measurement analysis of varian-ce,multiple stepwise linear regression analysis,linear mixed effects model(LMM),potential profile analysis(LPA),and multiple logistic regression analysis.All test level α=0.05.Results1.A total of 195 patients were included in this study,and 33 patients were lost to follow-up in 3 times.In the end,162 patients participated in the study.The total loss of the study sample was 17.5%.Comparison of general data of patients who were lost to follow-up and those who participated in the study.The difference was not statistically significant(P>0.05).2.The PTG scores of the patients at 3 time points were:(66.23±11.91),(57.22±11.89),(70.93±12.46);The repeated measurement variance results showed that PTG showed a “V” change trend at 3 time points,which first decreased and then increased(F=88.602,P<0.001).3.The results of multiple stepwise linear regression analysis showed at the T1 time point that age,medical payment method,and pathological stage entered the regression equation,which are the influencing factors of the patient’s PTG in one month after surgery(P<0.05),which can explain 55.4 % of the total variation of PTG.At T2 time point,medical payment methods,pathological stages,and perceived benefits enter the regression equation,which are the influencing factors of the patient’s PTG three months after surgery(P<0.05),which can explain 63.8% of the total variation.At T3 time point,age,pathological staging,perceived benefits,feelings of helplessness,and social support entered the regression equation,which were the influencing factors of PTG at six months postoperatively(P<0.05),which could explain 77.2% of the total variation.4.To construct a linear mixed-effects model,Univariate analysis results show that marital status,education level,age,occupational status;surgical methods,pathological staging;helplessness,acceptance,perceived benefits,social support,confrontation,avoidance and depression,fantasy and venting are predictors of PTG,and the helplessness is a negative predictor of PTG(β=-1.69).The variables in the univariate analysis results that have predictive effects on gastric cancer patients are used as independent variables,and PTG is used as the dependent variable,and the linear mixed effects model is entered at the same time.The optimal model was screened,and the results showed that pathological staging and surgical methods of disease-related variables,psychological variables helplessness and perceived benefits,avoidance and depression,and fantasy are predictors of PTG trends,and helplessness is still the negative of PTG.5.To analyze the impact of the patient’s PTG on the psychosomatic status.The low-PTG group and the high-level PTG group scores at the 3 time points of the patient are used as independent variables,and the scores of the psychosomatic state and the scores of various dimensions are used as dependent variables to analyze the influencing factors.For different PTG groups,only the difference in the scores of mental behavior plasticity was statistically significant(P<0.05),and the scores of mental behavior plasticity in the low-PTG group were higher than those in the high-level PTG group scores.The results of the correlation analysis showed that the PTG level of the patient had little correlation with the specific physical and psychological symptoms of the patient,but was related to the plasticity of the psychological behavior in the psychosomatic state(r=-0.384,r=-0.348,r=-0.467,all P<0.001).6.Taking into account the heterogeneity of individuals,the potential profile analysis is used to explore the potential categories of PTG scores at T3 time point.The results show that there are 3 subgroups of patients with PTG at T3 time: “lower relationship with others-high self-transformation growth Group”(n=31,19.1%),“low post-traumatic growth group”(n=101,62.3%),“high post-traumatic growth group”(n=30,18.1%).In order to further explore the predictive factors of PTG in different groups of patients.Influencing factors were analyzed with demographic variables,disease-related variables,and psychological variable scores at T3 time point as independent variables.The results showed that the differences in acceptance,perceived benefit,social support,fantasy,and vent scores in different groups of PTG were statistically significant(P<0.05);multiple unordered logistic regression analysis was used for the meaningful variables of univariate analysis,and the results of the study showed that only the perceived benefit in the disease awareness questionnaire was the predictor of the potential grouping of patients with gastric cancer(P<0.05).Conclusions1.Patients undergoing radical gastric cancer surgery with adjuvant chemotherapy have middle-to-high levels of PTG,and the PTG at 3 time points after the operation showed a trend of first decline and then rise.The trend of the related positive psychological variables at the 3 time points is similar with PTG.Therefore,clinical medical staff develop psychological guidance and psychological intervention programs from the perspective of exploring patients’ positive psychological resources and according to the changing trend of patients’ PTG.2.The influencing factors of PTG in patients undergoing radical gastric cancer surgery with adjuvant chemotherapy are different at different time points,and the trend of PTG changes in patients has its corresponding predictive factors.Therefore,it is reminded that medical staff should consider different factors comprehensively according to the influencing factors at different stages and the predictive factors of PTG change trends,and implement a more comprehensive and dynamic psychological care program.3.PTG of patients undergoing radical gastric cancer surgery with adjuvant chemotherapy has little correlation with physical and psychological specific symptoms,and is negatively correlated with psychological behavioral plasticity.Therefore,it is suggested that medical workers can explore the psychological adaptation model suitable for patients with gastric cancer from the perspective of positive psychology such as PTG,so as to promote the patients to establish a better psychological response and debugging system by themselves.4.The PTG of patients undergoing radical gastric cancer surgery with adjuvant chemotherapy has potential classifications,such as "lower relationship with others-high self-transformation growth group","low post-traumatic growth group",and "high post-traumatic growth group".Therefore,it is reminded that medical workers should combine their individual differences in psychological care of patients,and take a targeted approach,thereby improving the quality of care and the reasonable allocation of nursing resources. |
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