Objective  To analyze the mediating effect of psychological resilience and family support on perioperative fear and anxiety disorders of lung cancer patients.

Methods  225 perioperative lung cancer patients admitted to Sun Yat-sen Memorial Hospital from January 2021 to April 2023 were included as the study subjects. The general information questionnaire, Connor Davidson Resilience Scale (CD-RISC), Perceived Social Support Scale (PSSS), Surgical Fear Questionnaire (SFQ), State-Trait Anxiety Inventory (STAI) were used to conduct a questionnaire survey. Pearson correlation analysis was used to analyze the correlation between psychological resilience, family support, fear of surgery and anxiety symptoms. Model 6 of Process was used to analyze the mediating effect of psychological resilience and family support on perioperative fear and anxiety disorders of lung cancer patients.

Results  220 patients with lung cancer were included in the study, and the score of anxiety symptoms was (49.22±10.17). There were statistically significant differences in anxiety symptoms scores among patients with different ages, educational levels, tumor stages, psychological resilience and family support scores (P<0.05). The scores of anxiety symptoms were positively correlated with the scores of fear (r=0.85, P<0.05), and negatively correlated with the scores of psychological resilience (r=-0.90, P<0.05) and family support (r=-0.81, P<0.05). The chain-mediated effect analysis showed that the effect value of perioperative fear→psychological resilience→anxiety symptoms was 0.36, accounting for 63.54% of the total effect and 75.30% of the total indirect effect, indirect effect 1 was established (P=0.021 4); the effect value of perioperative fear→ family support→anxiety symptoms was 0.06, accounting for 11.21% of the total effect and 13.29% of the total indirect effect, and indirect effect 2 was established (P=0.001 3); the effect value of perioperative fear→psychological resilience→family support→anxiety disorders was 0.05, accounting for 9.63% of the total effect and 11.41% of the total indirect effect, indirect effect 3 was established (P=0.002 5).

Conclusion Patients with lung cancer showed significant anxiety symptoms during perioperative period. The chain mediation effect of psychological resilience and family support between perioperative fear and anxiety disorders of lung cancer patients is established. Clinical medical staff should take intervention measures based on the path of adjusting the influence of perioperative fear on anxiety disorders, so as to improve the anxiety disorders symptom of lung cancer patients and promote their early recovery.

1.中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南（2023版)[J]. 中华医学杂志, 2023,103(27) : 2037-2074. [Oncology Society of Chinese Medical Association, Chinese Medical Association Publishing House. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2023 edition)[J]. National Medical Journal of China, 2023,103(27) : 2037-2074.] DOI: 10.3760/cma.j.cn112137-20230510-00767.

2.田艳涛, 康文哲. 全球癌症发病情况研究新进展[J]. 中国医药, 2021, 16(10): 1446-1447. [Tian YT, Kang WZ. New progress in global cancer incidence [J]. China Medicine, 2021, 16(10): 1446-1447.] DOI: 10.3760/j.issn.1673-4777.2021.10.002.

3.王燕玲, 李领, 李文, 等. 极量肝切除术对肝癌患者生活质量、心理状态及社会功能的影响[J]. 中国医药导报, 2020, 17(4): 184-188. [Wang YL, Li L, Li W, et al. Influence of extreme hepatectomy on quality of life, psychological state and social function of patients with liver cancer[J]. China Medical Herald, 2020, 17(4): 184-188.] DOI: CNKI:SUN:YYCY.0.2020-04-046.

4.乐霄, 赵体玉, 旷婉. 术前焦虑测评量表的研究进展[J]. 护理学报, 2017, 24(9): 26-30. [Le X, Zhao TY, Kuang W. Research progress of preoperative anxiety scale[J]. Journal of Nursing, 2017, 24(9): 26-30.] DOI: 10.16460/j.issn1008-9969.2017.09.026.

5.Alodaibi FA, Minick KI, Fritz JM. Do preoperative fear avoidance model factors predict outcomes after lumbar disc herniation surgery? A systematic review[J]. Chiropr Man Therap, 2013,21(1): 40. DOI: 10.1186/2045-709X-21-40.

6.孙恒文, 杨艳珍, 刘婷, 等. 癌症复发恐惧心理现状调查及其影响因素分析[J]. 循证医学, 2018, 18(5): 298-303. [Sun HW, Yang YZ, Liu T, et al. Investigation of cancer recurrence fear and analysis of its influencing factors[J]. The Journal of Evidence-Based Medicine, 2018, 18(5): 298-303.] DOI: 10.12019/j.issn.1671-5144.2018.05.011.

7.寇晓敏. 某综合性三甲医院护理人员焦虑状态与社会支持相关性研究[J]. 成都医学院学报, 2018, 13(3): 364-367. [Kou XM. Study on the correlation between anxiety and social support of nurses in a comprehensive 3A hospital[J]. Journal of Chengdu Medical College, 2018, 13(3): 364-367.] DOI: 10.3969/j.issn.1674-2257.2018.03.030.

8.石远凯, 孙燕, 于金明, 等. 中国晚期原发性肺癌诊治专家共识(2016年版)[J]. 中国肺癌杂志, 2016, 19(1): 1-15. [Shi YK, Sun Y, Yu JM, et al. Expert consensus on diagnosis and treatment of advanced primary lung cancer in China (2016 edition)[J]. Chinese Journal of Lung Cancer, 2016, 19(1): 1-15.] DOI: 10.3779/j.issn.1009-3419.2016.01.01.

9.Papini N, Kang M, Ryu S, et al. Rasch calibration of the 25-item connor-davidson resilience scale[J]. J Health Psychol, 2021 ,26(11): 1976-1987. DOI: 10.1177/1359105320904769.

10.Zimet GD, Powell SS, Farley GK, et al. Psychometric characteristics of the Multidimensional Scale of Perceived Social Support[J]. J Pers Assess, 1990, 55(3-4): 610-617.DOI: 10.1080/00223891.1990.9674095.

11.Theunissen M, Peters ML, Schouten EG, et al. Validation of the surgical fear questionnaire in adult patients waiting for elective surgery[J]. PLoS One, 2014, 9(6): e100225. DOI: 10.1371/journal.pone.0100225.

12.吴军, 朱俊玲. 外科手术恐惧问卷的汉化及其在武汉市某三甲医院乳甲外科择期手术患者中的信效度检验[J]. 医学与社会, 2019, 32(11): 65-68. [Wu J, Zhu JL. Sinicization of surgical fear questionnaire and its reliability and validity test in patients undergoing elective surgery of breast nail surgery in a 3A hospital in Wuhan[J]. Medicine and Society, 2019, 32(11): 65-68.] DOI: 10.13723/j.yxysh.2019.11.016.

13.Spielberger CD. Manual for the state-trait anxiety inventory[J]. Self Evaluation Questionnaire, 1970. https://xueshu.baidu.com/usercenter/paper/show?paperid=82ed6500b487ec534d69af52c0e7d0f3.

14.杨芳, 周静茹, 宋晓艳, 等. 学龄期哮喘患儿父母照顾负担对父母生存质量的影响: 应对方式的中介作用[J]. 医学新知, 2023, 33(6): 429-437. [Yang F, Zhou JR, Song XY, et al. The influence of parents' care burden on parents' quality of life of school-age children with asthma: the mediating role of coping style[J]. Yixue Xinzhi Zazhi, 2023, 33(6): 429-437.] DOI: 10.12173/j.issn.1004-5511.202303004.

15.王丹, 何爽, 丁倩. 聚焦解决模式联合放松训练在老年肺癌患者围术期中的应用效果[J]. 护理实践与研究, 2022, 19(21): 3251-3255. [Wang D, He S, Ding Q. The application effect of focused solution mode combined with relaxation training in elderly patients with lung cancer during perioperative period[J]. Nursing Practice and Research, 2022, 19(21): 3251-3255.] DOI: 10.3969/j.issn.1672-9676.2022.21.018.

16.Aust H, Eberhart L, Sturm T, et al. A cross-sectional study on preoperative anxiety in adults[J]. J Psychosom Res, 2018, 111(1): 133-139. DOI: 10.1016/j.jpsychores.2018.05.012.

17.Theunissen M, Jonker S, Schepers J, et al. Validity and time course of surgical fear as measured with the Surgical Fear Questionnaire in patients undergoing cataract surgery[J]. PLoS One, 2018, 13(8): e0201511. DOI: 10.1371/journal.pone.0201511.

18.李云, 李军娜, 刘倩, 等. 平顶山市肺癌初诊患者心理应激、焦虑抑郁现状及相关因素调查[J]. 国际精神病学杂志, 2022, 49(2): 288-290, 294. [Li Y, Li JN, Liu Q, et al. Investigation on psychological stress, anxiety and depression and related factors of newly diagnosed lung cancer patients in Pingdingshan[J]. Journal of International Psychiatry, 2022, 49(2): 288-290, 294.] http://qikan.cqvip.com/Qikan/Article/Detail?id=7107169804.

19.Madani H, Pourmemari M, Moghimi M, et al. Hopelessness, perceived social support and their relationship in Iranian patients with cancer[J]. Asia Pac J Oncol Nurs, 2018 , 5(3): 314-319. DOI: 10.4103/apjon.apjon_5_18.

20.赵倩倩, 杨智慧, 张立力. 肺癌患者心理韧性形成过程的质性研究[J]. 护士进修杂志, 2018, 33(1): 74-77. [Zhao QQ, Yang ZH, Zhang LL. Qualitative study on the formation of psychological resilience in patients with lung cancer[J]. Journal of Nurses Training, 2018, 33(1): 74-77.] DOI: 10.16821/j.cnki.hsjx.2018.01.026.

21.马静, 朱爱玉, 李丽, 等. 共情疲劳在军队护理人员心理韧性与职业认同之间的中介效应分析[J]. 山西医药杂志, 2020, 49(18): 2448-2451. [Ma J, Zhu AY, Li L, et al. Analysis of the mediating effect of empathic fatigue between psychological resilience and professional identity of military nurses[J]. Shanxi Medical Journal, 2020, 49(18): 2448-2451.] DOI: 10.3969/j.issn.0253-9926.2020.18.011.

22.滕跃, 李圣洁, 尚美玲, 等. 护士工作压力与广泛性焦虑: 心理韧性的中介效应[J]. 济宁医学院学报, 2021, 44(6): 403-406. [Teng Y, Li SJ, Shang ML, et al. Nurses' work stress and generalized anxiety: the mediating effect of psychological resilience[J]. Journal of Jining Medical University, 2021, 44(6): 403-406.] DOI: 10.3969/j.issn.1000-9760.2021.06.006.

23.樊瑞, 景鹏宇, 郅晓燕. 自我效能和家庭支持在经外周静脉置入中心静脉导管患者疾病恐惧与护理依从性的中介效应分析[J]. 实用医院临床杂志, 2023, 20(1): 96-99. [Fan R, Jing PY, Zhi XY. Mediating effect of self-efficacy and family support on disease fear and nursing compliance of patients with central venous catheter via peripheral vein[J]. Practical Journal of Clinical Medicine, 2023, 20(1): 96-99.] DOI: 10.3969/j.issn.1672-6170.2023.01.026.

24.Xu J, Wang X, Chen M, et al. Family interaction among young Chinese breast cancer survivors[J]. BMC Fam Pract, 2021, 22(1): 122. DOI: 10.1186/s12875-021-01476-y.

25.孙文泽, 张莹冰, 王琳. 卡瑞利珠单抗联合参芪扶正注射液治疗晚期非鳞非小细胞肺癌患者的疗效和安全性评价[J]. 中国药师, 2023, 26(11): 241-248. [Sun WZ, Zhang YB, Wang L. Efficacy and safety evaluation of Karelizumab combined with Shenqi Fuzheng injection in the treatment of advanced non-squamous non-small cell lung cancer[J]. China Pharmacist, 2023, 26(11): 241-248.] DOI: 10.12173/j.issn.1008-049X.202311011.

26.张湘香, 彭乙聆, 胡天琼. 家庭支持和家庭韧性对妇科肿瘤术后复发恐惧的影响分析[J]. 肿瘤代谢与营养电子杂志, 2022, 9(5): 609-615. [Zhang XX, Peng YL, Hu TQ. Analysis of the influence of family support and family resilience on postoperative recurrence fear of gynecological tumors[J]. Electronic Jourmal of Metabolism and Nutrition of Cancer, 2022, 9(5): 609-615.] DOI: 10.16689/j.cnki.cn11-9349/r.2022.05.011.

27.郭冀丹, 李巧平, 宫敏. 复发性流产孕妇的焦虑、抑郁状况与社会支持、家庭功能的关系[J]. 海南医学, 2020, 31(20): 2651-2654. [Guo JD, Li QP, Gong M. Relationship between anxiety and depression, social support and family function of pregnant women with recurrent abortion[J]. Hainan Medical Journal, 2020, 31(20): 2651-2654.] DOI: 10.3969/j.issn.1003-6350.2020.20.018.

28.李燕妮, 杨少梅, 张丽华. 家庭支持在脑卒中后遗症患者应对方式、心理健康间的中介效应[J]. 齐鲁护理杂志, 2021, 27(9): 42-44. [Li YN, Yang SM, Zhang LH. Mediating effect of family support on coping style and mental health of patients with stroke sequelae[J]. Journal of Qilu Nursing, 2021, 27(9): 42-44.] DOI: 10.3969/j.issn.1006-7256.2021.09.013.

29.王薇姣, 曲衍清, 张月琴, 等. 喉癌术后患者癌症复发恐惧现状与心理韧性、应对方式的关系[J]. 中华生物医学工程杂志, 2023, 29(3): 306-309. [Wang WJ, Qu YQ, Zhang YQ, et al. The relationship between cancer recurrence fear, psychological resilience and coping style in postoperative patients with laryngeal cancer[J]. Chinese Journal of Biomedical Engineering , 2023, 29(3): 306-309.] DOI: 10.3760/cma.j.cn115668-20221223-00264.