| Objective(s):To understand the status of dignit in patients with colorectal cancer,analyze the influencing factors of dignity in patients with colorectal cancer,explore the correlation between dignity and anxiety,depression and quality of life in patients with colorectal cancer,and further explore the dignity experience of patients with colorectal cancer,so as to provide a reference for formulating targeted dignity interventions in the next step.Methods:This study was explanatory sequential mixed mehod,which consisting of 2 parts:a cross-sectional study and a phenomenological study.1.A cross-sectional survey: Convenience sampling method was used to select patients with colorectal cancer who met the inclusion and exclusion criteria in the Department of Colorectal Surgery of a Class3 Grade A cancer hospital in Yunnan Province from March to October 2022 as the research objects.The general information questionnaire,Patient Dignity Inventory(PDI),Hospital Anxiety and Depression Scale(HADS)and Functional Assessment of Cancer Therapy-General(FACT-G)were used for the questionnaire survey.Data were double-entered using Epidata 3.1 software,and data were analyzed using SPSS 20.0 statistical software.Patients’ general data were described by frequencies and percentages,and the scores of each scale were described by mean ± standard deviation,t-test or ANOVA was used for single factors,multiple linear regression analysis was used for multiple factors,and Person correlation analysis was used for correlations.2.Phenomenological approach: Colorectal cancer patients with moderate or above dignity impairment(PDI > 50)who were treated in the Department of Colorectal Surgery of a Class 3 Grade A cancer hospital in Yunnan Province from November 2022 to January 2023 were selected as the research objects by purposive sampling method.Data were collected through face-to-face semi-structured interviews.Noivo12 software was used to code and organize the interview data,and Colaizzi 7-step method was used to analyze the text and extract the theme.Results:1.A total of 320 questionnaires were distributed and 320 questionnaires were collected,with a questionnaire recovery rate of 100%.After 11 invalid questionnaires were eliminated,309 valid questionnaires were collected,with an effective rate of96.5%.The male to female ratio of colorectal cancer patients participating in the survey was 1.62:1,and the average age was(58.67±12.20)years.2.The dignity score of colorectal cancer patients was(49.08±8.50),the average score of each dimension from high to low was independence dimension(2.13 ± 0.49),symptom disturbance dimension(2.07 ± 0.42),survival disturbance dimension(2.05 ±0.45),peace of mind dimension(1.86 ± 0.54),and social support dimension(1.29 ±0.44).Among them,203 patients(65.5%)had mild impairment of dignity,103patients(33.3%)had moderate impairment of dignity,and 3 patients(1.0%)had severe impairment of dignity.3.The anxiety score of colorectal cancer patients was(7.22±2.75),among which251 patients(81.2%)had no symptoms of anxiety and 58 patients(18.8%)had symptoms of anxiety.The depression score was(8.50±3.36),among which 188patients(60.8%)had no depressive symptoms and 121 patients(39.2%)had depressive symptoms.4.The quality of life score of colorectal cancer patients was(51±7.56),and the average score of each dimension was divided from high to low into physiological status dimension(3.38±0.38),emotional status dimension(2.76±0.39),social and family status dimension(1.14±0.45),and functional status dimension(0.48±0.46).5.The results of univariate analysis showed that different residence(t=-3.147,P=0.002),occupation(F=-4.574,P=0.004),monthly per capita household income(F=10.919,P<0.001),type of medical insurance(F=6.595,P<0.001),family harmony(F=8.40,P<0.001),self-care status(F=29.809,P<0.001),with or without surgery(t=-2.218,P=0.027),with or without stoma(t=-3.855,P<0.001)were statistically different in dignity scores of colorectal cancer patients.6.The results of multiple linear regression analysis showed that place of residence,with or without stoma,type of medical insurance,monthly per capita household income,family harmony,and self-care status were included in the final regression model(P < 0.001).7.The results of person correlation analysis showed that dignity was positively correlated with anxiety(r=0.314,P<0.01)and depression(r=0.241,P<0.01)and negatively correlated with quality of life(r=-0.233,P<0.01)in colorectal cancer patients.8.Semi-structured interviews were conducted with 10 colorectal cancer patients with moderate to severe dignity impairment until data saturation was reached.Through analysis of the interview data,3 main themes and 11 subthemes were identified,including dignity threats(symptom distress,disease stigma,economic worries,self-perceived burden,negative coping),dignity protection factors(good social support,self-esteem and respect,positive coping),and dignity needs(need for privacy protection,social support,and respect for personal wishes).Conclusions:1.The overall dignity of patients with colorectal cancer is at a moderate level,and the impairment of dignity is mainly mild to moderate.2.Place of residence,with or without stoma,type of medical insurance,monthly per capita household income,family harmony,and self-care statusare were the main factors affecting the dignity of colorectal cancer patients.Health care workers should focus on the dignity of colorectal cancer patients in rural areas,with stoma,selfpayment,low per capita monthly family income,poor family harmony,and poor selfcareand formulate reasonable,and effective interventions to enhance the dignity level of patients.3.The dignity of patients with colorectal cancer was correlated with anxiety,depression and quality of life,meaning that the more severe the impairment of a patient’s dignity,the more apparent their symptoms of anxiety and depression,and the worse their quality of life.It was suggested that clinical medical staff should evaluate the emotional status of patients early,promptly alleviate their negative emotions,and intervene when necessary to reduce their anxiety and depression and improve their quality of life while maintaining their dignity.4.Semi-structured interviews further analyzed the factors affecting the dignity of patients with colorectal cancer,supplemented their dignity needs,and made up for information that could not be explored through the questionnaire survey.A more comprehensive understanding of the factors influencing the dignity of patients with colorectal cancer was obtained.Clinical medical staff should consider these factors comprehensively and adopt a comprehensive,multi-perspective,and targeted intervention approach to meet patients’ multidimensional dignity needs and actively guide them in coping with the disease. |
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