| Objectives1.To investigate the current status and trajectory of patient activation at different time points in VATS perioperative lung cancer patients;2.To investigate the factors influencing the activation of different simultaneous patient points in VATS perioperative lung cancer patients;3.To analyze the correlation between symptom burden,self-management efficacy and quality of life and patient activation at different points in VATS perioperative lung cancer patients based on unpleasant symptom theory.Methods1.From November 2021 to December 2022,a total of 100 patients with lung cancer treated with VATS in the thoracic surgery ward of a tertiary care general hospital in YangZhou,were selected as the study population using a convenience sampling method.Patient Activation Measure(PAM-13),MD Anderson symptom inventory-cancer(MDASI-C),MD Anderson symptom inventory-lung cancer module(MDASI-LC),Strategies Used by People to Promote Health(SUPPH),Functional Assessment of Cancer Therapy-Lung(FACT-L)were administered to patients at 1 day before surgery(T1),3-4 days after surgery(T2),and 1 month after surgery(T3)at 3 time points,while the General Information Questionnaire was applied at T1.2.SPSS25.0 software was used for data analysis.Frequency and percentage were used to describe the count data,and mean±standard deviation to describe the measurement data;The current descriptions of patient activation,symptom burden,self-management efficacy,and quality of life conformed to a normal distribution using the mean±standard deviation;those that did not conform to a normal distribution were expressed as the median(interquartile range);Friedman test was used to describe the trend of patient activation score,the trend of MDASI-C total score and MDASI-LC total score,the trend of SUPPH total score and each dimension score of lung cancer patients at 3 time points.A repeated-measures ANOVA was used to describe the trends of the total scores and the scores of each dimension of quality of life of lung cancer patients;Pearson’s correlation and Spearman’s correlation were used to analyze the relationship between patient activation and symptom burden,self-management efficacy and quality of life.Multiple linear regression was used to analyze the effects of general information,symptom burden,self-management efficacy and quality of life on patient activation.ResultsIn this study,333 questionnaires were distributed and 300 questionnaires were returned,with a valid return rate of 90.1%.The valid data were analyzed as follows:1.current status and trajectory of change of patients’ activation at different time pointsIn this study,the scores of patient activation at three time points were 51.00(47.95,63.10),67.8(58.10,72.50),and 70.2(63.10,75.00),respectively,and patient activation scores showed a significant upward trend from T1 to T2 and reached a peak at T3,but the increase was flat from T2 to T3.2.correlation analysis between patient activation,self-management efficacy,symptom burden and quality of life at different time points based on unpleasant symptom theoryIn this study,according to the results of correlation analysis,PAM-13 scores in T1 period was positively correlated with MDASI-C scores(r=0.186,p=0.008),negatively correlated with MDASI-LC scores(r=-0.217,p=0.003),positively correlated with SUPPH scores(r=0.656,p<0.01),and positively correlated with FACT-L scores(r=0.536,p<0.01).PAM-13 scores in T2 period was negatively correlated with MDASI-C scores(r=-0.422,p<0.01),negatively correlated with MDASI-LC scores(r=-0.517,p<0.01),positively correlated with SUPPH scores(r=0.584,p<0.01),and positively correlated with FACT-L scores(r=0.547,p<0.01).PAM-13 scores in T3 was negatively correlated with MDASI-C scores(r=-0.388,p<0.01),negatively correlated with MDASI-LC scores(r=-0.425,p<0.01),positively correlated with SUPPH scores(r=0.585,p<0.01),and positively correlated with FACT-L scores(r=0.591,p<0.01).3.Analysis of factors influencing patient activation at different time pointsIn this study,the common influencing factors of patient activation of VATS perioperative lung cancer patients at different time points were:self-management efficacy,symptom burden,and quality of life.The individual influencing factors were:education level,health care payment method and primary caregiver(T1),education level(T2),and number of comorbid chronic diseases(T3).Conclusions1.The patient activation scores of VATS perioperative lung cancer patients at different time points showed an overall increasing trend,but the rate of increase varied between different time points.This suggests that health care professionals should start to pay attention to patients’ activation before surgery,and early nursing interventions for patients with low activation can help to improve patients’ activation in later stages.2.Based on the perspective of unpleasant symptoms theory,patient activation correlates with symptom burden,self-management efficacy and quality of life,but the correlation varies across time.Medical and nursing staff can use patient activation as an indicator to guide patients to improve their discomfort symptoms,enhance their sense of self-management efficacy,and improve their quality of life.3.It is concluded that self-management efficacy,symptom burden,and quality of life are all factors influencing patients’ activation.In addition,personality influences were included at different time points,namely:literacy,health care payment method and primary caregiver(T1),literacy(T2),and number of comorbid chronic diseases(T3).This suggests that health care professionals should work on both physical and psychological aspects of patients to improve their physical health problems as well as to give them adequate psychological support,with both parties working together to improve their activation.Future researchers can refer to the factors influencing patient activation in this study and develop an intervention program for VATS perioperative lung cancer patients that integrally focuses on improving symptoms,enhancing self-management skills,and giving psychological support in an effort to enhance patient activation at different time points. |
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