Relationship Between Illness Perception,Fear Of Progression And Quality Of Life In Patients With Interstitial Lung Disease

ObjectiveThe purpose of this study is:(1)to investigate the current status of illness perception,fear of progression and quality of life in patients with interstitial lung disease(ILD);(2)to analyze the influencing factors of ILD patients’ quality of life;(3)to explore the mediating role of fear of progression in the relationship between illness perception and quality of life based on the Common-Sense Model of Self-regulation.Moreover,we explore the related feelings and experiences of illness perception and fear of progression in patients with different disease stages,and to further understand the impact of the two on the quality of life and supplement the results of questionnaire survey.It will provide references to improve patients’ illness perception and weaken negative emotion,which will ultimately improve patients’ quality of life.MethodThis is a non-experimental study.The data collected via a paper-based questionnaire and through semi-structured interviews:1.Questionnaire method: From August 2019 to December 2020,we recruited 185 patients with ILD using convenient sampling at 4 Grade-3A general hospitals(5 districts)in Qingdao,Shandong Province.General information questionnaire,brief illness perception questionnaire,fear of progression questionnaire-short form and St.George’ s respiratory questionnaire were used to collect the data of sociodemographic and clinical characteristics,illness perception,fear of progression and quality of life.Excel 2016 was used to input valid questionnaire data;SPSS 26.0(IBM Corp.,Armonk,NY)was used for descriptive analysis,one-way ANOVA,Pearson correlation analysis and multiple linear stepwise regression analysis;model 4 in process 3.4 macro program was used to verify the mediating effect.2.Semi-structure interview method: From December 2020 to January 2021,we recruited 16 patients with ILD from a tertiary Grade A comprehensive in Qingdao by purposive sampling and conducted a one-to-one half structured interview based on the theory of Timing it Right.The interview data were coded,classified and theme extracted by the method of directed content analysis to understand the illness perception and fear of progression in different stages of illness.Results1.The results of the questionnaire:(1)The average score of St.George’ s respiratory questionnaire in ILD patients was(45.00 ± 15.33),and the average scores of each dimension from high to low were(47.30 ±17.70)for symptoms,(46.37 ± 15.71)for activity ability,(43.49 ± 17.74)for daily life impact.The average score of brief illness perception questionnaire was(50.82 ± 5.63),and the average score of fear of progression questionnaire-short form was(38.43 ± 6.00),and the average scores of each dimension from high to low were(19.74 ± 3.31)for physical health,(18.69 ± 3.94)for social family.(2)There were significant differences in the scores of St.George’s respiratory questionnaire among ILD patients with different hormone application,severity of disease,course of disease and degree of dyspnea(P < 0.01).(3)Multiple stepwise regression analysis showed that severity of disease(β = 0.188,P< 0.01),course of disease(β = 0.156,P < 0.01),degree of dyspnea(β = 0.342,P < 0.01),illness perception(β = 0.200,P < 0.01)and fear of progression(β = 0.159,P < 0.01)were the influencing factors of quality of life in patients with ILD.(4)Pearson correlation analysis showed that there was significantly correlated between the total score of the brief illness perception questionnaire and fear of progression questionnaire-short form(r = 0.335,P < 0.01).The total score of the brief illness perception questionnaire was positively correlated with St.George’ s respiratory questionnaire(r =0.462,P < 0.01),and the total score of the fear of progression questionnaire-short form was positively correlated with the total score of the St.George’s respiratory questionnaire and its dimensions(r = 0.410,P < 0.01).(5)The results of process mediation model test showed that the total effect of illness perception on quality of life of ILD patients was 0.605(P<0.01),the direct effect of illness perception on quality of life was 0.537(P<0.01),fear of progression partially mediated the relationship between illness perception and quality of life,the indirect effect value was 0.068,95% CI [0.002,0.164],and the proportion of mediation effect in the total effect was 11.18%.2.The results of the semi-structured interview:Based on the theory of Timing it Right and literature retrieval,it is concluded that patients can go through three stages: symptom occurrence and diagnosis stage,admission stage and discharge life stage.Based on the interview data,the illness perception and fear of progression were extracted into nine thematic categories: “symptom recognition”,“trouble to see a doctor”,“perception of illness diagnosis and treatment”,“perception of the impact of life”,“perception of self care and prevention of recurrence”,“acute attack and fear of disease diagnosis and treatment”,“fear of the future”,“fear of recurrence and readmission” and “fear of the unknown”.Conclusion1.ILD patients experience relatively poor quality of life,and the quality of life is affected by severity of disease,course of disease,degree of dyspnea,illness perception and fear of progression;illness perception is relatively negative,and fear of progression is in an average state of psychological disorder;fear of progression exerts a mediating role between illness perception and quality of life.2.The illness perception and fear of progression with ILD patients are characterized by stages.Negative illness perception and excessive fear may lead to patients delay medical treatment,avoid reexamination,affect clinical prognosis and reduce the quality of life of patients.It is suggested that the clinical medical staff should intervene the patients’ negative illness perception and excessive fear emotion.We can develop specialized nurses of ILD to provide patients with disease diagnosis and management information,and to provide support for patients in different stages of disease,so as to improve their quality of life.