| ObjectivesA multi-center cross-sectional study was used to describe the current situation of post-traumatic growth,analyze the influencing factors of post-traumatic growth,and explore the path relationship between post-traumatic growth,resilience and social support in patients with breast cancer.The purpose of this study istoconstruct and empirically evaluate the effects of psychological group intervention based on PTG model on post-traumatic growth,resilience,family resilience,rumination and self-disclosure in patients with breast cancer.Methods1.The cross-sectional study on influencing factors of post-traumatic growth based on mediation model in patients with breast cancer A cross-sectional study was used.The self-designed general information questionnaire,Posttraumatic Growth Inventory(PTGI),Connor-Davidson Resilience Scale(CD-RISC)and Social Support Rating Scale(SSRS)were used as sssessment tools.A total of 180 breast cancer patients were selected from breast surgery or oncology of four Class III Grade A hospitals in Jiangsu Province.Correlation analysis was used to explore the correlation between post-traumatic growth,resilience and social support.Multivariate linear regression was used to analyze the independent influencing factors of post-traumatic growth.The regression coefficient method was used to investigate the relationship between the three variables of post-traumatic growth,resilience and social support and path analysis was performed.Boopstrap was used for the intermediary effect test.2.Construction of a psychological group intervention based on PTG model inpatients with breast cancer A phenomenological research was used to conduct in-depth one-on-one interviews with 12 medical staff from breast cancer multidisciplinary team to explore the psychological intervention strategies for post-traumatic growth in patients withbreast cancer.Based on the current situation investigation,qualitative research,and literature review,a framework of psychological group intervention based on PTG model was preliminarily constructed in patients with breast cancer.After the expert meeting,the final psychological group interventions were constructed.3.Application of a psychological group intervention based on PTG model in patients with breast cancer Breast cancer patients were enrolled from the Breast Diagnosis and Treatment Center of Zhongda Hospital Affiliated to Southeast University and Breast Surgery of Jiangsu Provincial Cancer Hospital from March 2019 to August 2019.Patients who met the selection criteria were randomly divided into a experimental group or a control group.There were 44 participants in the experimental group.A psychological group intervention based on PTG model plus a six-session health education were used in the experimental group.Meanwhile,there were 43 participants in the controlgroup.A six-session health education provided by a multidisciplinary team was used in the control group.Data were collected at three points,including baseline,3 and6 weeks after the intervention.Repeated measures analysis of variance was used to compare the differences in post-traumatic growth,resilience,family resilience,rumination and selfdisclosure between the two groups.Results1.The cross-sectional study on influencing factors of post-traumatic growth based on mediation model in patients with breast cancer(1)The total PTGI score of 180 breast cancer patients in this study were(62.52± 17.59)points.The highest dimensional average score was the mental change dimension and the lowest dimensional average score was the new possibility dimension.The total CD-RISC score were(56.51 ± 18.33)points,and the total SSRS score were(35.15 ± 9.29)points.Correlation analysis showed that the total score of PTGI and the scores of each dimension were positively correlated with the total score of CD-RISC,SSRS and the scores of each dimension(P <0.01).(2)The univariate analysis results showed that the family’s average monthly income,disease detection method and treatment options were the influencing factors of post-traumatic growth,and the differences were statistically significant(P <0.01).Multiple linear regression analysis showed that resilience,disease detection methods,and treatment options were independent factors affecting PTG in patients with breast cancer.(3)The test of the mediating effect shows that social support and resilience have direct predictive effects on PTG and path factorswere 0.493 and 0.302respectively;meanwhile,social support indirectly affects PTG,and resilience is a mediating variable between the two variables and indirect effect was 0.080.2.Construction of a psychological group intervention based on PTG model Inpatients with breast cancer(1)Promoting emotional expression,transforming negative emotions,reducing the uncertainty of disease,and developing new values were refined by the qualitative research on psychological intervention strategies for post-traumatic growth from the perspective of a multidisciplinary team.(2)Based on the empirical basis of cross-sectional and qualitative research,literature review,and the results of expert meetings,a psychological group intervention based on PTG model was established in patients with breast cancer.The intervention mainly included the following:1)Preparation before intervention: The study subjects who entered the experimental group were grouped with 7-8 people in each group according to the address,age,tumor stage,and treatment plan and other factors.2)Intervention implementers: a multidisciplinary team in psychological group intervention for breast cancer included 13 members of a multidisciplinary team for breast cancer and 2 graduate students.3)Interventions: Thematic conferences were organized around six themes:transforming negative emotions,promoting emotional disclosure,adjusting self-stress,managing uncertainty,improving mental resilience,and developing new values.The conference content included:(1)topics related to theoretical elaboration of positive psychology;(2)cognitive-behavioral psychological strategies to help breast cancer patients achieve relevant goals of psychosocial adjustment;(3)encourage patients to participate in group discussions at thematic meetings.4)Intervention time: lasting 6 weeks,once a week for 90 minutes each time.5)Intervention method: Themed meetings were mainly used and We Chat group were supplemented.6)Intervention records: The members of the research group briefly recorded the content of the We Chat group,and regularly feeded back the collected information and communication records to the multi-disciplinary team,and the team members performed relevant processing and guidance if necessary.7)The evaluation tools of intervention effects: Posttraumatic Growth Inventory(PTGI),Connor-Davidson Resilience Scale(CD-RISC),Family Hardness Index(FHI)Event Related Rumination Inventory(ERRI),Distress Disclosure Index(DDI).8)The evaluation time of Intervention effects: before the intervention,3weeks after the intervention,6 weeks after the intervention.3.Application of a psychological group intervention based on PTG model in patients with breast cancer In this study,two groups of 87 patients were collected,including 44 patients in the exerimental group and 43 patients in the control group.There were statistically sinificant differences in treatment options between the two groups of study subjects(P<0.05);there was no significant difference in other baseline data between the two grups(P> 0.05).(1)post-traumatic growth: The results showed that the interaction between the total scores of post-traumatic growth and the time term were statistically significant(P<0.05),indicating that the change trend of the total scores of post-traumatic growth were different with time between the experimental group and the control group and the scores improved in the experimental group were significantly higher than those in the control group.(2)resilience : The results showed that there were no statistical significance in the interaction between the total scores of resilience and the time term between the two groups(P> 0.05),indicating that there were no difference in the level of resilience between the experimental group and the control group.(3)family resilience:The results showed that the interaction between the total scores of family resilience and the time term were statistically significant(P <0.05),indicating that the change trend of the total scores of family resilience were different with time between the experimental group and the control group and the scores improved in the experimental group were significantly higher than those in the control group.(4)rumination : The results showed that there were no statistical significance in the interaction between the total scores of rumination and the time term between the two groups(P> 0.05),indicating that there were no difference in the level of rumination between the experimental group and the control group.(5)self disclosure: The results showed that the interaction between the total scores of self disclosure and the time term were statistically significant(P <0.05),indicating that the change trend of the total scores of self disclosure were different with time between the experimental group and the control group and the scores improved in the experimental group were significantly higher than those in the control group.Conclusions1.The total score of post-traumatic growth was at a moderately high level in patients with breast cancer;resilience,the methods of disease detection and treatment options were independent factors affecting breast cancer patients.2.Social support and resilience have a direct predictive effect on post-traumatic growth in patients withbreast cancer.Meanwhile,resilience is an intermediary variable between social support and post-traumatic growth.3.Promoting emotional expression,transforming negative emotions,reducing the uncertainty of disease,and developing new values were refined by thequalitative research on psychological intervention strategies for post-traumatic growth from the perspective of a multidisciplinary team.4.A psychological group intervention based on PTG model can significantly improve the post-traumatic growth,family resilience,and self disclosure in patients with breast cancer.However,the effects of resilience and rumination were not obvious. |
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