Asian Nursing Research

Mediation Effects of Self-care Self-efficacy and Health-promoting Behaviors on Fear of Cancer Recurrence and Posttraumatic Growth in Postoperative Patients With Cervical Cancer: A Cross-sectional Study

High recurrence risks significantly contribute to poor health outcomes among postoperative cervical cancer patients. This study aimed to determine the impact of fear of cancer recurrence (FCR) on the posttraumatic growth (PTG) in postoperative cervical cancer patients and to investigate the mediating effects of self-care self-efficacy and health-promoting behaviors within this relationship. A total of 334 cervical cancer patients who had undergone surgery in three tertiary hospitals in Liaoning Province, China, were recruited using a convenience sampling method. Data were collected using the general information questionnaire, the Fear of Progression Questionnaire (FCR), the Post-traumatic Growth Inventory (PTG), the Strategies Used by People to Promote Health (self-care self-efficacy), and the Health-Promoting Lifestyle Profile (health-promoting behaviors). Data analysis was performed using descriptive analysis, Pearson's correlations, and multiple linear regression analysis. A structural equation model was conducted using Amos 24.0 software. PTG of cervical cancer patients after surgery was significantly and negatively associated with FCR (r = -.54, p < .001), while positively correlated with self-care self-efficacy (r = .51, p < .001) and health-promoting behaviors (r = .59, p < .001). The mediation model revealed that self-care self-efficacy (Boots 95% CI 0.39 ∼ 0.15) and health-promoting behaviors (Boots 95% CI 0.51 ∼ 0.24) independently served as mediating factors, respectively. Self-care self-efficacy and health-promoting behaviors played a significant chain mediating effect between FCR and PTG (Boots 95% CI 0.19 ∼ 0.07), with an indirect effect of 11.6%. This study demonstrated that self-care self-efficacy and health-promoting behaviors partially mediated the relationship between FCR and PTG in cervical cancer survivors after surgery. Implementing tailored interventions that focus on enhancing self-care self-efficacy and health-promoting behaviors among cervical cancer survivors may help alleviate concerns about cervical cancer recurrence and enhance PTG following surgery.

Risk Prediction Model for Radiation-induced Dermatitis in Patients with Cervical Carcinoma Undergoing Chemoradiotherapy

Radiation-induced dermatitis (RD) is a common side-effect of therapeutic ionizing radiation that can severely affect patient quality of life. This study aimed to develop a risk prediction model for the occurrence of RD in patients with cervical carcinoma undergoing chemoradiotherapy using electronic medical records (EMRs). Using EMRs, the clinical data of patients who underwent simultaneous radiotherapy and chemotherapy at a tertiary cancer hospital between 2017 and 2022 were retrospectively collected, and the patients were divided into two groups: a training group and a validation group. A predictive model was constructed to predict the development of RD in patients who underwent concurrent radiotherapy and chemotherapy for cervical cancer. Finally, the model's efficacy was validated using a receiver operating characteristic curve. The incidence of radiation dermatitis was 89.5% (560/626) in the entire cohort, 88.6% (388/438) in the training group, and 91.5% (172/188) in the experimental group. The nomogram was established based on the following factors: age, the days between the beginning and conclusion of radiotherapy, the serum albumin after chemoradiotherapy, the use of single or multiple drugs for concurrent chemotherapy, and the total dose of afterloading radiotherapy. Internal and external verification indicated that the model had good discriminatory ability. Overall, the model achieved an area under the receiver operating characteristic curve of .66. The risk of RD in patients with cervical carcinoma undergoing chemoradiotherapy is high. A risk prediction model can be developed for RD in cervical carcinoma patients undergoing chemoradiotherapy, based on over 5 years of EMR data from a tertiary cancer hospital.

Analysis of the Incidence and Risk Factors Influencing Postoperative Complications in Patients with Gynecological Malignancies: A Retrospective Study

Perioperative patient complications are a global concern for patient safety. Few studies have systematically evaluated the factors associated with complications during the perioperative period of gynecologic malignancies from a nursing or caregiving perspective. Therefore, this study aimed to investigate the incidence and risk factors of postoperative complications in patients with gynecological malignancies from a holistic care perspective. This retrospective study included 3,372 patients from the information system of a university-affiliated teaching hospital in China, with data collected from October 1, 2018, to September 30, 2023. A nomogram was constructed based on the predictive factors. Its goodness-of-fit was examined using the Hosmer-Lemeshow test, and calibration curves were used for internal evaluation. The clinical utility of the nomogram was quantified using clinical decision curve analysis. The incidence of postoperative complications in patients with gynecological malignancies was 13.0%. Nomograms constructed based on employment status, intraoperative warming, blood and fluid loss, cancer type, and cancer stage were bootstrap-corrected with a consistency index of .63. The calibration curves showed good agreement between predicted and actual probabilities. The net benefit of screening all patients based on the nomogram was greater than no screening when the risk of complications was 5.0-30.0%. Gynecological malignancies are associated with a high incidence of postoperative complications. Employment status, intraoperative warming, bleeding and rehydration fluid, cancer type, and cancer stage are independent risk factors for these complications, and their incidence can be predicted using the nomogram. The results of this study highlight the important role of nursing strategies in preventing complications. These findings have important implications for clinical nursing intervention and decision-making.