其他摘要 | The fear of disease progression is commonly expressed in gynecological tumor patients as a psychological pain. It greatly impacts the mental and physical health and quality of life of the tumor patients. Clinical professionals are not very clear about how to understand and support patients to handle their fear of disease progression. Chinese and foreign showed that somatic symptoms are the main internal stimuli that lead to fear of disease progression for the patient. However, it is still unclear how somatic symptoms affect the fear of disease progression. Previous theoretical models have been focused on the important role of meta-worry in the fear of disease progression, and the relationship between somatic symptoms, meta-worry, and fear of disease progression needs to be explored. Doctor-patient empathy is the main solution to provide psychological support for patients. Research on the association between doctor-patient empathy and patients' fear of disease progression is still at early stage, and the role of doctor-patient empathy in patients' meta-worry has not been determined yet. Based on this, the study aims to provide new insights for clinical healthcare professionals to understand patients' fear of disease progression, and provide solid psychological support for patients in clinical work.
Study I tested the mediating effect of meta-worry between somatic symptoms and fear of disease progression. A total of 208 patients with gynecological tumors were surveyed, using the demographic and disease data questionnaire, Somatic Symptom Scale, Metacognition Questionnaire(including positive beliefs about worry, negative beliefs about worry, cognitive confidence, cognitive self-consciousness and the need to control thoughts)and Fear of Disease Progression Questionnaire. SPSS software 25.0 and PROCESS were used to data analysis. The results showed that there was a significant positive correlation between somatic symptoms, fear of disease progression, and meta-worry in gynecological tumor patients. Somatic symptoms, positive beliefs about worry, negative beliefs about worry, cognitive self-awareness, occupational status and understanding of the disease were predictive factors of fear of disease progression in gynecological tumor patients. Meta-worry partially mediated somatic symptoms and fear of disease progression.
Study II explored the moderating role of perceived doctor-patient empathy in the relationship between somatic symptoms, meta-worry, and fear of disease progression from the perspective of doctor-patient communication. A questionnaire survey was conducted on 241 gynecological tumor patients, and the research tool added Consultation and Relational Empathy Measure on the basis of Study I.The results showed perceived doctor-patient empathy was significant negatively correlated with somatic symptoms and fear of disease progression. Perceived doctor-patient empathy could negatively predict the fear of disease progression. The moderating effects of perceived doctor-patient empathy on somatic symptoms, meta-worry and fear of disease progression were not significant.
Based on the results of Study II, Stu即III explored the content of perceived doctor-patient empathy through qualitative research,and explored the factors that affect the relationship between perceived doctor-patient empathy,patients' fear of disease progression and meta-worry. A total of 12 gynecological tumor patients were interviewed, and the interview recordings were transcribed and manually encoded. Theme analysis was used to analyze and summarize the following three themes:(1) Patients' perceived doctor-patient empathy includes cognitive empathy,emotional empathy,practical assistance, and continuous attention. (2) The factors that affect the relationship between doctor-patient empathy and patient fear of disease progression include doctor-patient relationship, treatment satisfaction, doctor-patient communication satisfaction, disease perception, and social support. (3) The factors that affect the relationship between doctor-patient empathy and patient's meta-worry include personal traits, disease perception, treatment satisfaction, and perceptions of doctor-patient communication.
Conclusions: Somatic symptoms not only directly affect the fear of diseases progression, but also indirectly affect the fear of disease progression through the mediation of meta-worry. Perceived doctor-patient empathy has a significant protective effect on patients' fear of disease progression, but its protective effect on meta-worry is not significant. Perceived doctor-patient empathy does not moderate the association between somatic symptoms, meta-worry, and fear of disease progression. Psysicians and nurses need to improve their communication skills with patients, and reduce patients' concerns during communication, enhance recognition of negative emotions and worry, and better benefit patients through combined medical treatment and psychological support. |
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