【作者】 王萍；

【导师】 孙秀杰；

【作者基本信息】 青岛大学 ， 护理学， 2024， 硕士

【摘要】 目的明确影响乳腺癌术后患者重返工作准备度的相关因素,分析其重返工作准备度与社会支持、疾病感知和希望的相关性。探讨疾病感知、希望在社会支持与重返工作准备度之间的中介效应,以期为未来提高乳腺癌术后患者的重返工作准备度、进行职业康复提供干预思路借鉴。方法研究类型为横断面研究,抽样方法为便利抽样,选取三所青岛市三甲医院的290例乳腺癌术后患者为研究对象。采用一般资料调查表、社会支持评定量表、简化版疾病感知问卷、Herth希望量表、重返工作准备度量表开展调查。采用SPSS 25.0和Amos24.0进行数据分析。统计方法:对一般资料、社会支持、疾病感知、希望、重返工作准备度进行描述性分析;使用非参数秩和检验分析一般资料在患者重返工作准备度的差异;采用Spearman相关性分析明确社会支持、疾病感知、希望和重返工作准备度之间的关系;应用多元有序logistic回归分析明确重返工作准备度的影响因素;采用中介效应分析疾病感知、希望在社会支持和重返工作准备度之间的中介效应并构建结构方程模型。结果1.社会支持得分42.33±4.78分,处于一般水平。疾病感知得分为57.07±7.42分,处于中等水平。希望得分为36.53±3.38分,处于高水平。重返工作准备度中,患者多处于行动准备-自我评估阶段(34.14%)及前意向阶段(31.72%)。2.单因素方差分析:重返工作准备度在不同职业、文化程度、家庭月收入、医保类型、组织学分级、手术类型、乳腺手术后天数中具有统计学差异(P<0.05)。3.相关性分析:社会支持与重返工作准备度呈正相关,与希望呈正相关,与疾病感知呈负相关;希望与重返工作准备度呈正相关、与疾病感知呈负相关;疾病感知与重返工作准备度呈负相关。4.多元logistic回归分析:职业、文化程度、医保类型、手术类型、乳腺手术后天数、社会支持和希望是重返工作准备度的正向影响因素,组织学分级、疾病感知是重返工作准备度的负向影响因素。5.中介效应分析:疾病感知在社会支持与重返工作准备度间起部分中介效应,效应值占比40.44%。希望在社会支持与重返工作准备度间起部分中介效应,效应值占比37.82%。结论1.当前乳腺癌术后患者具有一般水平的社会支持、中等水平的疾病感知,高水平的希望,且重返工作准备度处于中等水平。乳腺癌术后患者的社会支持、疾病感知、希望、重返工作准备度仍有待进一步提升。2.社会支持、希望与职业、文化程度、家庭月收入、医保类型、手术类型、手术后天数是重返工作准备度的正向影响因素;疾病感知、组织学分级是重返工作准备度的负向影响因素。3.社会支持、希望与重返工作准备度呈正相关,疾病感知与重返工作准备度呈负相关,即患者社会支持水平越高、负性疾病感知越低、希望水平越高,重返工作准备度越高。4.疾病感知、希望在社会支持与重返工作准备度之间发挥中介作用,二者为并行中介,通过改变疾病感知、希望可间接改变重返工作准备度阶段。社会支持对重返工作准备度产生直接作用。更多还原

【Abstract】 ObjectiveTo identify the factors affecting the readiness for return to work among postoperative breast cancer patients,analyze the correlation between their readiness for return to work and social support,illness perception,and hope.Exploring the mediating effects of illness perception and hope between social support and readiness for return to work,with a view to improving the readiness for return to work for postoperative breast cancer patients and providing intervention ideas for vocational rehabilitation in the future.MethodsThe type of study was cross-sectional,used convenience sampling method,to select290 postoperative breast cancer patients from three tertiary-level hospitals in Qingdao as study subjects.Used General Information Questionnaire,Social Support Rating Scale,Brief Illness Perception Questionnaire,Herth Hope Index,and Readiness for Return-ToWork Scale to research.Used SPSS 25.0 and Amos 24.0 to analysis.Statistical methods:Used descriptive analyses to describe general information,social support,illness perceived,hope,and readiness for return to work;Used nonparametric rank sum test to analyze the difference about general information on patient readiness for return to work;Used Spearman correlation analysis to clarify the relationship between social support,illness perception,hope,and readiness for return to work;Used Multiple ordered logistic regression to analyze the factors influencing readiness for return to work;Used Mediation effects analysis to analyze the mediation effects between perception,hope in social support,and readiness for return to work and to construct structural equation modeling.Results1.The social support score was 42.33±4.78,which is at an average level.Illness perception score was 57.07±7.42,which is in the middle level.The hope level score is36.53±3.38,which is in the high level.In the readiness for return to work,patients were mostly in the preparation for action-self assessment stage(34.14%)and the pre-intentional stage(31.72%).2.ANOVA: Readiness for return to work was statistically different by occupation,education level,monthly household income,type of health insurance,histologic grading,type of surgery,and number of days after breast surgery(P<0.05)3.Correlation Analysis: Social support was positively correlated with readiness to return to work,positively correlated with hope,and negatively related to illness perception;Hope was positively related to readiness for return to work and negatively related to illness perception;Illness perception was negatively related to readiness for return to work.4.Multiple Logistic Regression Analysis: Occupation,education level,type of health insurance,type of surgery,number of days after breast surgery,social support and hope were positive influences on readiness for return to work,and histologic grading,illness perception were negative influences on readiness for return to work.5.Mediation Effects Analysis: Illness perceived partially mediated the effect between social support and readiness to return to work,with an effect value of 40.44%;Hope partially mediated the effect between social support and readiness for return to work,with an effect value of 37.82%.Conclusions1.Currently,postoperative breast cancer patients have a general level of social support,a moderate level of illness perception,a high level of hope,and a moderate level of readiness for return to work.The social support,illness perception,hope,and readiness for return to work of postoperative breast cancer patients still need to be further improved.2.Social support,hope and occupation,education level,monthly household income,type of health insurance,type of surgery,and number of days after breast surgery were positive influences on readiness for return to work;Illness perception and histologic grading were negative influences on readiness for return to work.3.Social support and hope were positive correlated with readiness for return to work,and illness perception was negatively correlated with readiness for return to work,the higher the patient’s social support level,the lower the negative illness perception,and the higher level of hope,the higher readiness for return to work.4.Illness perceived levels and hope level mediate the relationship between social support and readiness for return to work,they are parallel mediation,and the stage of readiness for return to work can be indirectly altered by changing perceived illness and hope.Social support has a direct effect on readiness to return to work.更多还原