Predictive Model Of Supportive Care Needs For Patients With Lung Cancer

To provide targeted supportive care for patients with lung cancer,studies on supportive care needs in cancer field have increasingly become a popular issue in recent years.Researches showed that meeting patients' needs can not only help the patient gain knowledge about the illness,but also develop a strong patient-clinician relationship,assist patients with decision making,and reduce patients' uncertainty which,in turn,can contribute to subjective well-being,improve functioning survival,and perception of health care as being of high quality.Patients with lung cancer have lower survival rate,suffer more physical hardship and psychosocial problems,thus the supportive care needs of patients with lung cancer are prominent.It is helpful to tailor supportive care program to meet the supportive care needs of patients with lung cancer by clarifying the supportive care needs,the predictive factors of supportive care needs and the relationship mechanism among these factors.Objectives(1)To describe the supportive care needs of patients with lung cancer;(2)To explore the predictive factors of supportive care needs among patients with lung cancer,analyze the path relationship among the variables,clarify the main predictive factors,and thus provide references to tailor targeted supportive care for patients with lung cancer clinically.Methods A descriptive,cross-sectional study of 370 patients with lung cancer were recruited from May 2016 to September 2016 in three tertiary teaching hospitals,using convenience sampling method.Patients were investigated using general information questionnaire,Nursing Professional Social Support Needs Scale(NPSSNS),Perceived Social Support Scale(PSSS),Distress Thermometer(DT),Chinese Version of the M.D.Anderson Symptom Inventory(MDASI-C),Type D Personality Scale(DS-14),Cataldo Lung Cancer Stigma Scale(CLCSS),Medical Coping Modes Questionnaire(MCMQ),The Impact of Events Scale-Revised(IES-R),The 36-item Medical Outcomes Study Short Form(SF-36),The Newcastle Satisfaction with Nursing Scale(NSNS),The Fear of Progression Questionnaire(Fo P-Q-SF).Epi Data3.1 software was used for double data entry,SPSS23.0 software for data description analysis,AMOS21.0 software for construction and validation of the structure equation model.Results The median score in general and specific module of supportive care needs was 3.06(1.16)and 2.60(1.50),respectively.The highest score was the technical needs,followed by information needs,and the lowest score was the psychological needs.Most of the top ten supportive care needs were technical needs.Patients who had type D personality,were female,younger,with lower economic income,longer time since diagnosis,cancer metastasis and stage ? of the cancer had higher level of supportive care needs,compared to the counterparts.Psychological distress,symptom distress,social support,fear of progression,intrusive thoughts,stigma,satisfaction with nursing,face coping were positively correlated with supportive care needs,and physical function was negatively correlated with supportive care needs.The direct significant predictive factors of supportive care needs were symptom distress,satisfaction with nursing,fear of progression about the disease,social support and face coping.The indirect significant predictive factors of supportive care needs were type D personality,surrender coping and stigma.Fear of progression had a positive effect to supportive care needs,path coefficient ?=0.403(t=6.180,P<0.001),further analyze the standardized effect of fear of progression to supportive care needs,the total effect was 0.427,the direct effect was 0.403,and the indirect effect through satisfaction with nursing and face coping was 0.024.Symptom distress had a positive effect to supportive care needs,path coefficient ?=0.158(t=2.607,P<0.01),the total effect was 0.302,the direct effect was 0.158,and the indirect effect through fear of progression was 0.144.Satisfaction with nursing had a positive effect to supportive care needs,path coefficient ?=0.135(t=2.553,P<0.05),the total effect was 0.159,the direct effect was 0.135,and the indirect effect through face coping was 0.024.Social support had a positive effect to supportive care needs,path coefficient ?=0.177(t=2.909,P<0.01),the total effect was 0.247,the direct effect was 0.177,and the indirect effect through face coping was 0.070.Face coping had a positive effect to supportive care needs,path coefficient ?=0.215(t=3.858,P<0.001).Type D personality had no direct effect to supportive care needs,while it was positively correlated with supportive care needs indirectly through fear of progression and social support,the indirect effect was 0.047.Stigma had no direct effect to supportive care needs,while it was positively correlated with supportive care needs indirectly through fear of progression and satisfaction with nursing,the indirect effect was 0.073.Surrender coping had no direct effect to supportive care needs,while it was negatively correlated with supportive care needs indirectly through face coping,the indirect effect was-0.034.The above variables explained33.0% total variance of the supportive care needs.Conclusion Patients with lung cancer had information,technology,psychology,care coordination and communication supportive care needs,and specific supportive care needs about lung cancer,mainly refers to technical needs.Fear of progression,symptom distress,satisfaction with nursing,social support and face coping had positive effect to supportive care needs.The fear of progression could also affect supportive care needs through satisfaction with nursing and face coping.The symptom distress could also affect supportive care needs through fear of progression.Satisfaction with nursing and social support could also affect supportive care needs through face coping.Type D personality was positively correlated with supportive care needs indirectly through fear of progression and social support.Stigma was positively correlated with supportive care needs indirectly through fear of progression and satisfaction with nursing.Surrender coping was negatively correlated with supportive care needs indirectly through face coping.It can provide reference for health care personnel to tailor supportive care program to meet the supportive care needs and improve the quality of life for patients with lung cancer by clarifying the predictive factors of supportive care needs and the path relationships among these factors.