J Korean Acad Nurs.  2016 Jun;46(3):327-337. 10.4040/jkan.2016.46.3.327.

The Structural Equation Model on Resilience of Breast Cancer Patients Receiving Chemotherapy

• Yang JH
• Kim OS

• KMID: 2413340
• DOI: http://doi.org/10.4040/jkan.2016.46.3.327

Abstract

PURPOSE
The purpose of this study was to construct and test a structural equation model on resilience of breast cancer patients receiving chemotherapy.
METHODS
Participants were 204 patients with breast cancer who received chemotherapy treatment. They participated in a structured interview, which included social support, depression, symptom experience, self-efficacy, hope, resilience, and infection prevention behaviors. Data were analyzed using SPSS/WIN 20.0 and AMOS 18.0.
RESULTS
Lower depression (γ=-.33, p=.020) and symptom experience (γ=-.31, p=.012) and higher self-efficacy (γ=.32, p=.005) and hope (γ=.48, p=.016) were influenced by higher social support. Greater resilience was influenced by lower symptom experience (β=-.18, p=.016), higher self-efficacy (β=.49, p=.023), and higher hope (β=.46, p=.012), and these predictors explained 66.7% of variance in resilience. Greater resilience (β=.54, p=.009) made an impact on greater infection prevention behaviors. Resilience mediated the relations of symptom experience (β=-.10 p=.013), self-efficacy (β=.27, p=.006) and hope (β=.25, p=.009) with infection prevention behaviors. These predictors explained 24.9% of variance in infection prevention behaviors.
CONCLUSION
The findings of the study suggest that breast cancer patientsw ith greater resilience who are receiving chemotherapy participate in increased infection prevention behaviors. Further research should be conducted to seek intervention strategies that improve breast cancer patients' resilience.

Keyword

Psychological resilience; Breast neoplasms; Chemotherapy adjuvant; Infection control; Social support

MeSH Terms

Adult
Antineoplastic Agents/*therapeutic use
Breast Neoplasms/*drug therapy/nursing/pathology
Chemotherapy, Adjuvant
Depression
Female
Hope
Humans
Middle Aged
*Models, Theoretical
Resilience, Psychological
Self Efficacy
Social Support
Antineoplastic Agents

Figure

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  Figure 1 Conceptual framework based on ARM (Adolescent Resilience Model).

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  Figure 2 Path diagram for the hypothetical model.

Reference

1. Jung KW, Won YJ, Kong HJ, Oh CM, Cho H, Lee DH, et al. Cancer statistics in Korea: Incidence, mortality, survival., and prevalence in 2012. Cancer Res Treat. 2015; 47(2):127–141. DOI: 10.4143/crt.2015.060.

2. Schelenz S, Giles D, Abdallah S. Epidemiology, management and economic impact of febrile neutropenia in oncology patients receiving routine care at a regional UK cancer centre. Ann Oncol. 2012; 23(7):1889–1893. DOI: 10.1093/annonc/mdr520.

3. Lee YR, Kwon IS. The relationship between infection prevention behaviors and barriers among cancer patients undergoing chemotherapy. J Korean Oncol Nurs. 2007; 7(2):150–161.

4. Waugh CE, Fredrickson BL, Taylor SF. Adapting to life's slings and arrows: Individual differences in resilience when recovering from an anticipated threat. J Res Pers. 2008; 42(4):1031–1046. DOI: 10.1016/j.jrp.2008.02.005.

5. Nizamli F, Anoosheh M, Mohammadi E. Experiences of Syrian women with breast cancer regarding chemotherapy: A qualitative study. Nurs Health Sci. 2011; 13(4):481–487. DOI: 10.1111/j.1442-2018.2011.00644.x.

6. Kwak SY, Byeon YS. Factors influencing resilience of patients with hematologic malignancy. Korean J Adult Nurs. 2013; 25(1):95–104. DOI: 10.7475/kjan.2013.25.1.95.

7. Choi KS, Park JA, Lee J. The effect of symptom experience and resilience on quality of life in patients with colorectal cancers. Asian Oncol Nurs. 2012; 12(1):61–68. DOI: 10.5388/aon.2012.12.1.61.

8. Strauss B, Brix C, Fischer S, Leppert K, Füller J, Roehrig B, et al. The influence of resilience on fatigue in cancer patients undergoing radiation therapy (RT). J Cancer Res Clin Oncol. 2007; 133(8):511–518. DOI: 10.1007/s00432-007-0195-z.

9. Li Y, Cao F, Cao D, Wang Q, Cui N. Predictors of posttraumatic growth among parents of children undergoing inpatient corrective surgery for congenital disease. J Pediatr Surg. 2012; 47(11):2011–2021. DOI: 10.1016/j.jpedsurg.2012.07.005.

10. Lee EK. A study on factors affecting cancer patients. J Korean Acad Soc Nurs Educ. 2007; 13(1):52–58.

11. Ho SM, Ho JW, Bonanno GA, Chu AT, Chan EM. Hopefulness predicts resilience after hereditary colorectal cancer genetic testing: A prospective outcome trajectories study. BMC Cancer. 2010; 10:279. DOI: 10.1186/1471-2407-10-279.

12. Burton NW, Pakenham KI, Brown WJ. Evaluating the effectiveness of psychosocial resilience training for heart health, and the added value of promoting physical activity: A cluster randomized trial of the READY program. BMC Public Health. 2009; 9:427. DOI: 10.1186/1471-2458-9-427.

13. Perfect MM, Jaramillo E. Relations between resiliency, diabetes-related quality of life, and disease markers to school-related outcomes in adolescents with diabetes. Sch Psychol Q. 2012; 27(1):29–40. DOI: 10.1037/a0027984.

14. Lee EK, Ryu EJ, Kim KH. Structual equation modeling on adjustment of cancer patients receiving chemotherapy. J Korean Oncol Nurs. 2011; 11(2):101–107. DOI: 10.5388/jkon.2011.11.2.101.

15. Haase JE. The adolescent resilience model as a guide to interventions. J Pediatr Oncol Nurs. 2004; 21(5):289–299. DOI: 10.1177/1043454204267922.

16. Popoola AO, Adewuya AO. Prevalence and correlates of depressive disorders in outpatients with breast cancer in Lagos, Nigeria. Psychooncology. 2012; 21(6):675–679. DOI: 10.1002/pon.1968.

17. Bellury L, Pett MA, Ellington L, Beck SL, Clark JC, Stein KD. The effect of aging and cancer on the symptom experience and physical function of elderly breast cancer survivors. Cancer. 2012; 118(24):6171–6178. DOI: 10.1002/cncr.27656.

18. DiSipio T, Hayes S, Newman B, Janda M. What determines the health-related quality of life among regional and rural breast cancer survivors? Aust N Z J Public Health. 2009; 33(6):534–539. DOI: 10.1111/j.1753-6405.2009.00449.x.

19. Zhang J, Gao W, Wang P, Wu ZH. Relationships among hope, coping style and social support for breast cancer patients. Chin Med J (Engl). 2010; 123(17):2331–2335.

20. Hoelter JW. The analysis of covariance structures: Goodness-of-fit indices. Sociol Methods Res. 1983; 11(3):325–344. DOI: 10.1177/0049124183011003003.

21. Distefano M, Riccardi S, Capelli G, Costantini B, Petrillo M, Ricci C, et al. Quality of life and psychological distress in locally advanced cervical cancer patients administered pre-operative chemoradiotherapy. Gynecol Oncol. 2008; 111(1):144–150. DOI: 10.1016/j.ygyno.2008.06.034.

22. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988; 52(1):30–41. DOI: 10.1207/s15327752jpa5201_2.

23. Hahn HM, Yum TH, Shin YW, Kim KH, Yoon DJ, Chung KJ. A standardization study of Beck Depression Inventory in Korea. J Korean Neuropsychiatr Assoc. 1986; 25(3):487–500.

24. Fu MR, McDaniel RW, Rhodes VA. Measuring symptom occurrence and symptom distress: Development of the symptom experience index. J Adv Nurs. 2007; 59(6):623–634. DOI: 10.1111/j.1365-2648.2007.04335.x.

25. Chen G, Gully SM, Eden D. Validation of a new general self-efficacy scale. Organ Res Methods. 2001; 4(1):62–83. DOI: 10.1177/109442810141004.

26. Miller JF, Powers MJ. Development of an instrument to measure hope. Nurs Res. 1988; 37(1):6–10.

27. Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. J Trauma Stress. 2007; 20(6):1019–1028. DOI: 10.1002/jts.20271.

28. Centers for Disease Control and Prevention. Preventing infections in cancer patients [Internet]. Atlanta, GA: Author;2012. cited 2013 October 28. Available from: http://www.cdc.gov/cancer/preventinfections/.

29. Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. 7th ed. Upper Saddle River, NJ: Pearson Prentice Hall;2010.

30. Rud OP. Data mining cookbook: Modeling data for marketing, risk, and customer relationship management. New York, NY: John Wiley & Sons, Inc;2001.