Department of Hepatobiliary and Pancreatic Surgery, First Hospital of China Medical University, No. 210, Baeta 1 Street, Hunnan District, Shenyang, Liaoning, 110001, China.
Operating Room, First Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, Liaoning, 110001, China.
BMC Womens Health. 2024 Jun 15;24(1):344. doi: 10.1186/s12905-024-03187-9.
Breast cancer patients undergoing chemotherapy via peripherally inserted central catheter often experience serious behavioral and psychological challenges, with uncertainty and cancer-related fatigue being prevalent issues that profoundly impact prognosis. Therefore, this study aimed to investigate the relationship between uncertainty and cancer-related fatigue by employing a chain mediation model to examine the potential mediating roles of psychological resilience and self-care.
A cross-sectional study was conducted with 223 breast cancer patients receiving peripherally inserted central catheter chemotherapy at two tertiary affiliated hospitals of China Medical University in Liaoning, China, from February 2021 to December 2022. Participants completed self-reported questionnaires to assess uncertainty, psychological resilience, self-care, and cancer-related fatigue. The collected data were subsequently analyzed using Pearson's correlation analysis, hierarchical regression analysis, and mediation analysis.
Uncertainty exhibited a significant positive correlation with cancer-related fatigue (p < 0.01) and a negative correlation with psychological resilience (p < 0.01) and self-care (p < 0.01). Uncertainty was found to impact cancer-related fatigue through three pathways: psychological resilience mediated the relationship between uncertainty and cancer-related fatigue (mediating effect = 0.240, 95% confidence interval: 0.188 to 0.298, effect ratio = 53.22%); self-care also mediated this relationship (mediating effect = 0.080, 95% confidence interval: 0.044 to 0.121, effect ratio = 17.74%); furthermore, there was a significant joint mediating effect of psychological resilience and self-care on the association between uncertainty and cancer-related fatigue (mediating effect = 0.042, 95% confidence interval: 0.021 to 0.068, effect ratio o = 9.31%).
The findings of this study revealed that uncertainty not only directly influenced cancer-related fatigue, but also operated through the mediating effect of psychological resilience, self-care, and sequential mediation of psychological resilience and self-care. Interventions tailored for breast cancer patients receiving peripherally inserted central catheter chemotherapy should target these factors to help alleviate uncertainty, enhance psychological resilience, and improve self-care practices, thereby ameliorating cancer-related fatigue.
接受外周置入中心静脉导管化疗的乳腺癌患者常经历严重的行为和心理挑战，不确定性和与癌症相关的疲劳是普遍存在的问题，对预后有深远影响。因此，本研究旨在通过链式中介模型探讨不确定性与与癌症相关的疲劳之间的关系，以检验心理弹性和自我护理的潜在中介作用。
本研究采用横断面研究方法，于 2021 年 2 月至 2022 年 12 月在辽宁中国医科大学的两家三级附属医院，共纳入 223 例接受外周置入中心静脉导管化疗的乳腺癌患者。参与者完成自我报告问卷，以评估不确定性、心理弹性、自我护理和与癌症相关的疲劳。收集的数据采用 Pearson 相关分析、分层回归分析和中介分析进行分析。
不确定性与与癌症相关的疲劳呈显著正相关（p<0.01），与心理弹性（p<0.01）和自我护理（p<0.01）呈负相关。不确定性通过三条途径影响与癌症相关的疲劳：心理弹性中介了不确定性与与癌症相关的疲劳之间的关系（中介效应=0.240，95%置信区间：0.188 至 0.298，效应比=53.22%）；自我护理也介导了这种关系（中介效应=0.080，95%置信区间：0.044 至 0.121，效应比=17.74%）；此外，心理弹性和自我护理对不确定性与与癌症相关的疲劳之间的关联具有显著的联合中介作用（中介效应=0.042，95%置信区间：0.021 至 0.068，效应比 o=9.31%）。
本研究结果表明，不确定性不仅直接影响与癌症相关的疲劳，还通过心理弹性、自我护理的中介效应以及心理弹性和自我护理的顺序中介效应起作用。针对接受外周置入中心静脉导管化疗的乳腺癌患者的干预措施应针对这些因素，以帮助减轻不确定性、增强心理弹性和改善自我护理实践，从而改善与癌症相关的疲劳。
