Effect Of Stigma On Quality Of Life In Patients With Oral Cancer After Flap Surgery And Its Mediating Effect

ObjectiveThis study was aimed to understand the current situation of quality of life of patients after oral cancer flap operation,explore its influencing factors,and study the path effects of disease shame,coping style,social support,family function on quality of life,as well as to pave roads for clinical medical workers to improve the quality of life of patients after oral cancer flap operation.MethodsUsing the convenient sampling method,403 patients with oral cancer flap were investigated in the Department of oral and maxillofacial surgery of three tertiary hospitals in Guangdong Province.The survey tools included general information questionnaire,quality of life measurement scale-head and neck（FACT-H＆n）,social impact scale（SIS）,social support scale（SSRs）,Medical Coping Style Questionnaire（mcmq）and family function scale（FAD）.The data of this study are analyzed by SPSS24.0 statistical analysis software and MPLUS7.4 structural equation model software.The statistical analysis methods:descriptive statistical analysis,independent sample t-test,one-way ANOVA,multiple linear regression analysis,Pearson correlation analysis.Finally,the structural equation model is constructed by mplus7.4 structural equation model software for analysis and calculation.Results1.A total of 430 questionnaires were distributed in this study.After removing the unqualified and invalid questionnaires,403 valid questionnaires were recovered,with an effective rate of 93.7%,the age of the patients with an average age of（56.64±10.99）years;260 males（64.5%）and 143 females（35.5%）;279（69.2%）people live in cities and towns and 124（30.8%）in rural areas;357（88.6%）were married;227（56.3%）students with junior high school education;Among the payment types,there are 147（36.3%）urban medical insurance and 234（58.3%）non local medical insurance;There were 230（57.1%）patients with a family per capita monthly income of 2000-5000 yuan and 83（20.6%）patients with a family per capita monthly income of 5001-8000 yuan.Disease related data showed that 252（62.5%）patients were treated with surgery alone;The lesions were located in 62（15.4%）of the cheeks,239（59.3%）of the tongue and 77（19.1%）of the gums;The disease stage was 188（46.7%）in stageⅡ,108（26.8%）in stage Ⅲ and 78（19.4%）in stage Ⅳ.2.The quality of life score of patients with oral cancer flap was（78.78 ± 9.06）,which was in the middle level.The score rate of additional attention dimension of head and neck was the lowest,which was（14.28 ± 4.27）.3.The results of independent difference analysis showed that the effects of treatment mode and disease stage on quality of life were statistically significant（P<0.05）.4.The score of stigma was（60.79±7.16）,which was at a high level.The score rate of social isolation dimension（20.62±2.80）was the highest:The total score of family function was（135.59 ± 7.23）,which was at the medium level;The score of social support was（41.72 ±5.53）,which was lower than the norm;The face score（15.18± 2.72）was lower than the norm,and the avoidance and yield scores were（14.92±2.46）and（11.05±1.93）respectively,which were higher than the norm（P<0.05）.5.Pearson correlation analysis showed that the total score of quality of life was negatively correlated with the total score of disease shame（r=-0.424,P<0.01）,social exclusion（r=0.132.P<0.01）,economic discrimination（r=-0.305,P<0.01）,internal shame（r=-0.21 1,P<0.01）and social isolation（r=-0.151,P<0.01）;It was positively correlated with the total score of social support（r=0.568,P<0.01）,subjective support（r=0.44,P<0.01）,objective support（r=0.358.P<0.01）and support utilization（r=0.479,P<0.01）;It was positively correlated with face（r=0.438,P<0.01）,negatively correlated with avoidance（r=-0.397,P<0.01）and yield（r=-0.56,P<0.01）;It was positively correlated with the total scores of family function（r=0.323,P<0.01）,problem solving（r=0.318,P<0.01）,communication（r=0.404,P<0.01）,role（r=0.511,P<0.01）,emotional response（r=0.268,P<0.01）,emotional intervention（r=0.308,P<0.01）,behavior control（r=0.317,P<0.01）and total function（r=0.204,P<0.01）.6.Multiple linear regression analysis showed that treatment style,internal shame,social exclusion,total score of disease shame,total score of social support,face,avoidance,submission and total score of family function were the main predictors of quality of life,which explained 68.2%of the total variation.7.The analysis of mediating effect shows that stigma plays a partial mediating role between coping style,family function,social support and quality of life,in which the mediating effect of and face accounts for 29.0%,and the 95%level confidence interval is[0.004-0.276];The mediating effect of and avoidance accounted for 27.2%,and the 95%level confidence interval was[-0.210-0.019];And yield mediating effect accounted for 28.3%,and the 95%level confidence interval was[-0.247-0.011];The mediating effect with family function accounted for 44.0%,and the 95%level confidence interval was[0.004-0.215];And social support accounted for 72.0%,and the 95%level confidence interval was[0.048-0.302].Conclusion1.The overall quality of life of patients with oral cancer flap is at a medium level;2.The patients with oral cancer after flap surgery have greater functional damage due to surgical resection,which leads to a higher level of negative psychology such as shame and lower social support,which seriously affects their quality of life.Therefore,clinical medical staff should take effective measures to improve patients’ quality of life after evaluating patients’quality of life;3.Medical staff should pay full attention to the intermediary role of disease shame,strengthen the education of patients’ peers,take positive and effective measures to reduce patients" disease shame,evaluate the impact of social support,family function and coping style on the quality of life,and strive to improve patients’ quality of life after sugery.