| 【Objectives】To understand the current situation of fear of cancer recurrence in postoperative breast cancer survivors and its influencing factors,to analyze the correlation between illness perception,psychological flexibility,and fear of cancer recurrence,and to explore the mediating role of psychological flexibility in the relationship between illness perception and fear of cancer recurrence.From the perspective of illness perception and psychological flexibility,this paper explores the feasible ways to reduce the fear of cancer recurrence and provides the theoretical basis and practical guidance for formulating effective intervention strategies for psychological distress of breast cancer survivors.【Methods】With the cross-sectional survey method,a total of 221 postoperative survivors with breast cancer were selected from the breast department of 3 grade Ⅲ-A hospitals by convenience sampling.The field survey was carried out from March to June 2021 using the general information questionnaire,Fear of Cancer Recurrence Inventory,Brief Illness Perception Questionnaire,and Commitment Action Questionnaire.Databases were created and statistical analyses were performed using SPSS 21.0 and AMOS 21.0 software.General information and variable scores were analyzed by descriptive statistics using frequencies,percentages,means,and standard deviations.The effects of different characteristics on fear of cancer recurrence were analyzed by independent samplest test,one-way ANOVA,and multiple linear stepwise regression.The correlations between illness perception,psychological flexibility and fear of cancer recurrence were analyzed by Pearson correlation analysis.The effects of illness perception and psychological flexibility on fear of cancer recurrence were analyzed by multiple linear stepwise regression.Structural equation models were constructed with psychological flexibility as the mediating variable and estimated using the Maximum Likelihood Estimate for model fitting,and the Bootstrap Confidence Interval was used to validates the mediating effect of psychological flexibility between illness perception and fear of cancer recurrence.【Results】1.The total score of fear of cancer recurrence in postoperative survivors with breast cancer was(93.10±17.54)points,and the average item score was(2.22±0.42)points.The scores of the 7 dimensions from high to low were as follows: reassurance(2.39±0.46),psychological distress(2.37±0.58),insight(2.36±0.52),trigger(2.27±0.41),coping strategies(2.26±0.56),severity(2.21±0.50)and functioning impairments(1.82±0.52).Among 221 postoperative breast cancer survivors,the fear of cancer recurrence reached the clinical level in 214 survivors(96.83%).Independent samples t test and one-way ANOVA showed that age,number of children,education level,work status,tumor stage,surgical method,and disease duration were factors influencing the fear of cancer recurrence in postoperative breast cancer survivors(P<0.05).Multiple linear stepwise regression analysis showed that age and education were significant factors of the level of fear of cancer recurrence(P<0.05).2.The total score of illness perception was(48.73±8.07)points,and the average item score was(6.09±1.01)points.The 3 dimensions from high to low were as follows: understanding(6.97±1.41),cognitive(6.08±1.04),and emotional(5.70±1.35).The total score of psychological flexibility was(20.66±5.88)points,and the average item score was(2.58±0.74).The higher score was the negative dimension(2.81±0.88),and the lower was the positive dimension(2.35±0.82).Pearson correlation analysis showed that illness perception was positively correlated with fear of cancer recurrence(r=0.614,P<0.01),psychological flexibility was negatively correlated with fear of cancer recurrence(r=-0.562,P<0.01),and illness perception was negatively correlated with psychological flexibility in postoperative breast cancer survivors(r=-0.543,P<0.01).Multiple linear stepwise regression analysis showed that illness perception and the negative dimension of psychological flexibility were significant factors of the level of fear of cancer recurrence(P<0.05).3.The structural equation model was constructed with psychological flexibility as the mediating variable,and the fitted indicators were CMIN/DF=1.538(<3),GFI=0.949(>0.9),AGFI=0.918(>0.9),TLI=0.976(>0.9),NFI = 0.951(> 0.9),IFI = 0.982(> 0.9),CFI = 0.982(> 0.9),RMSEA =0.049(<0.05),and the Bootstrap method yielded 95% confidence intervals for indirect effects of(0.166,0.620)and 95% confidence intervals for direct effects of(0.075,0.599).The standardized effect value for illness perception directly predicting fear of cancer recurrence was 0.358.The standardized effect value for indirectly predicting fear of cancer recurrence using psychological flexibility of postoperative breast cancer survivors as a mediating variable was-0.707×(-0.476)≈0.337.The total effect value for illness perception on fear of cancer recurrence was 0.358+0.337=0.695,with the mediating effect accounting for 48.49% of the total effect.【Conclusion】1.The fear of cancer recurrence in postoperative survivors with breast cancer is higher.The level of fear of cancer recurrence in postoperative survivors with breast cancer differed significantly by individual characteristics,with age and education being significant predictors of fear of cancer recurrence in postoperative survivors with breast cancer.2.Both illness perception and psychological flexibility were at moderate levels.Illness perception and psychological flexibility were significantly associated with fear of cancer recurrence.The illness perception and negative dimensions of psychological flexibility were significant predictors of fear of cancer recurrence in postoperative survivors with breast cancer.3.Psychological flexibility plays a partially mediating role between illness perception and fear of cancer recurrence.Illness perception can directly influence fear of cancer recurrence in postoperative survivors with breast cancer or indirectly through psychological flexibility. |
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