| BACKGROUNDBreast cancer is the most common malignant tumor in women.Breast cancer is usually treated by surgery.Although the survival rate of patients will be significantly improved after surgery,patients will have a series of adverse psychological stress reactions after mastectomy,which will make patients suffer from both physical and psychological barriers for a long time,seriously affect their quality of life.In order to reduce inferiority,maintain self-esteem as well as normal working and living conditions,patients show emotional or emotional depression,unwilling or not good at expressing their own emotions.By avoiding communication with others,concealing illness experience and closing inner world,patients aggravate self-concealment and produce obvious stigma.In recent years,some scholars have adopted group psychotherapy,narrative medical intervention,peer education to psychological intervention on breast cancer,and achieved good results,but some studies have found that its intervention effect is not significant,the difference vary from different studies.Expressive writing is a kind of writing behavior to disclose and express feelings and thoughts related to personal important experiences or positive events,emphasizing writing of emotions in a written way,which in turn promotes emotional regulation or social sharing for the purpose of relieving psychological stress and releasing emotions.Expressive writing is considered to be an effective intervention and is extended to populations,including college students,patients with infertility and liver cancer.Expressive writing is a low-cost,convenient and overcoming the barrier of language intervention.There is a great demand to develop all kinds of intervention.The purpose of this study is to investigate the current situation of stigma in patients with breast cancer after operation,analyze the relevant influencing factors,and explore the application effect of expressive writing in patients with breast cancer after operation,so as to provide reference for psychological intervention to reduce stigma of patients after breast cancer surgery.SUBJECTS and METHODS1.By the convenience sampling,210 patients were selected to the study.After obtained the informed consent and the relevant requirements of the questionnaire,they were investigated with a series of scales.The scales were including:the general information questionnaire,Social Impact Scale,The European Organization for Research and Treatment of Cancer breast cancer-specific quality of life questionnaire(EORTC QLQ-BR23),Self-Concealment Scale.To investigate the status and influence factors of stigma in patients with postoperative breast cancer.SPSS 22.0 was used for statistical analysis.Data analysis was performed by descriptive statistics,one-way ANOVA,Spearman correlation and multiple regression analyses.2.Research method:total of 91 patients with breast cancer after mastectomy and axillary lymph node dissection were randomly divided into two groups according to the order of admission time.The single number was the control group,and the even number was the intervention group,with 40 cases in each group.The control group was given routine psychological nursing and health education;the intervention group was given expressive writing intervention to guide the patients to express their worries,feelings of surgery,adverse effects of the disease on their work or life,positive emotional experience and beautiful imagination of the future by writing for at least 20 minutes each time and at least 1 writing per week The intervention lasted for 3-4 weeks.A total of 4 writing sessions were completed.The contents of each writing could be the same or inconsistent.The intervention was completed and patients were delivered to the researchers by mail or in person.If the researcher found that the patient’s writing content had serious psychological problems or dangerous tendency,the researcher should report to the doctor in charge or communicate with the patient to suggest psychiatric treatment.The changes of stigma,quality of life and self concealment of the two groups before intervention,1 month,6month and 9 months after intervention were investigated to test the feasibility and effectiveness of the intervention scheme.Spss22.0 was used for statistical analysis,mainly including chi square test and two independent sample t-test to compare the differences of the observation indexes between the two groups,and repeated measurement analysis of variance was used to compare the longitudinal change trend of each observation index.Inspection level α=0.05.RESULTS1.The status and the influence factors of stigma in patients with post-operative breast cancer 205 valid questionnaires were collected and the recovery rate was 97.6%.The total score of stigma was(58.65±0.36).The results of multiple regression analysis showed that age,family per capita monthly income,operation method,postoperative time,self concealment and future view field of quality of life were the influencing factors of stigma.2.The effect of expressive writing intervention on stigma in post-operative breast cancer patientsIn the end,38 cases were obtained in the intervention group and 39 cases in the control group.There was no significant difference in general information,stigma,self concealment and quality of life between the two groups before intervention(P>0.05).The results of repeated measurement equation analysis showed that there were significant differences in the scores of stigma between groups(F=6.624,P<0.001),time effect(F=19.697,P<0.001)and interaction between time and group(F=38.987,P<0.001).The scores of stigma in intervention group decreased significantly with time,while those in control group decreased first and then rised.The inter group effect of self concealment score(F=3.101,P=0.002),time effect(F=6.726,P=0.011)and interaction between time and group were significant(F=3.230,P=0.029).The score of self concealment in intervention group decreased significantly with time.The inter group effect(F=3.192,P=0.002),time effect(F=3.955,P=0.049)and interaction between time and group were significant(F=7.382,P=0.001)in future view.The score of future view increased significantly with time.CONCLUSION1.There is a prevalence of stigma in postoperative breast cancer patients.2.It is shown that age,monthly income levels,operation methods,postoperative time,self-concealment and future perceptions had an effect on breast cancer patients’stigma levels.Patients with younger age,lower monthly income,longer postoperative time,adopted total mastectomy,axillary lymph node dissection,higher self-concealment and lower future view would perceive more serious stigma.3.Expressive writing can obviously reduce the level of stigma and self-concealment of breast cancer patients after surgery,improve future view and quality of life. |
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