Ziner Kim Wagler, Sledge George W, Bell Cynthia J, Johns Shelley, Miller Kathy D, Champion Victoria L
School of Nursing, Indiana University, Indianapolis, IN, USA.
Oncol Nurs Forum. 2012 May 1;39(3):287-95. doi: 10.1188/12.ONF.287-295.
PURPOSE/OBJECTIVES: To determine the effect that age at diagnosis has on fear of breast cancer recurrence and to identify the predictors of fear of recurrence using self-efficacy as a mediator.
Cross-sectional survey.
Two university cancer centers and one cooperative group in the midwestern United States.
1,128 long-term survivors.
Survivors were eligible if they were aged 18-45 years (younger group) or 55-70 years (older group) at cancer diagnosis, had received chemotherapy, and were three to eight years postdiagnosis. Fear of recurrence was compared between younger and older groups. Multiple regression analyses were used to test variables' prediction of fear of recurrence and breast cancer survivor self-efficacy, as well as breast cancer survivor self-efficacy mediation effects.
Fear of recurrence, breast cancer survivor self-efficacy, and age at diagnosis.
Survivors diagnosed at a younger age had significantly higher fear of recurrence, as well as health, role, womanhood, death, and parenting worries. Perceived risk of recurrence, trait anxiety, and breast cancer reminders explained significant variance in fear of recurrence and breast cancer survivor self-efficacy. Breast cancer survivor self-efficacy partially mediated the effects of variables on fear of recurrence.
The findings suggest that breast cancer survivor self-efficacy may have a protective effect for survivors who are younger at diagnosis and have higher perceived risk of recurrence, higher trait anxiety, and more breast cancer reminders. Oncology nurses already use the skills required to support self-efficacy. Additional research is needed to define and test breast cancer survivor self-efficacy interventions.
Oncology nurses are in a key role to assess fear of recurrence and provide self-efficacy interventions to reduce it in breast cancer survivors. Strategies to efficiently address fear of recurrence to reduce psychological distress in survivorship follow-up care are warranted.
目的/目标：确定确诊年龄对乳腺癌复发恐惧的影响，并以自我效能感作为中介变量，找出复发恐惧的预测因素。
横断面调查。
美国中西部的两个大学癌症中心和一个协作组。
1128名长期幸存者。
如果幸存者在癌症确诊时年龄在18 - 45岁（较年轻组）或55 - 70岁（较年长组），接受过化疗，且确诊后3至8年，则符合条件。比较较年轻组和较年长组之间的复发恐惧情况。采用多元回归分析来检验各变量对复发恐惧和乳腺癌幸存者自我效能感的预测作用，以及乳腺癌幸存者自我效能感的中介效应。
复发恐惧、乳腺癌幸存者自我效能感和确诊年龄。
较年轻确诊的幸存者有显著更高的复发恐惧，以及对健康、角色、女性特质、死亡和为人父母方面的担忧。感知到的复发风险、特质焦虑和乳腺癌提示因素解释了复发恐惧和乳腺癌幸存者自我效能感的显著差异。乳腺癌幸存者自我效能感部分介导了各变量对复发恐惧的影响。
研究结果表明，乳腺癌幸存者自我效能感可能对确诊时较年轻、感知到更高复发风险、特质焦虑水平更高且有更多乳腺癌提示因素的幸存者具有保护作用。肿瘤学护士已经具备支持自我效能感所需的技能。需要进一步研究来定义和测试乳腺癌幸存者自我效能感干预措施。
肿瘤学护士在评估复发恐惧并为乳腺癌幸存者提供自我效能感干预措施以降低恐惧方面起着关键作用。有必要制定策略来有效应对复发恐惧，以减轻 survivorship 随访护理中的心理困扰。
