Self-efficacy, post-traumatic growth, and quality of life of pediatric cancer survivors: A cross-sectional study

Temporal Relationships Between General Self-Efficacy, Social Support and Health-Related Quality of Life Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A 9-Year Follow-Up Study

BACKGROUND

Acute lymphoblastic leukemia (ALL) is the most prevalent childhood malignancy. To improve long-term health-related quality of life (HRQOL) in adult survivors of childhood ALL, more longitudinal studies are needed to assess outcomes and risk factors throughout treatment and survivorship. The aim of this study was to examine the long-term changes in HRQOL, self-efficacy, and social support among adult survivors of childhood ALL and to explore the temporal relationship between HRQOL, self-efficacy, and social support.

PROCEDURE

The study includes 148 adult childhood ALL survivors who responded to a questionnaire assessing HRQOL (SF36), self-efficacy (General Self-Efficacy Scale, GSE), and quantitative and qualitative social support (AVSI and AVAT in SS13) in 2012 and 2021. Changes in the HRQOL, GSE, and social support were calculated using paired t-tests. Bayesian path models were specified, and separate models were estimated for each relationship between GSE and AVSI, and AVAT and HRQOL. Cross-sectional associations, autoregressive effects within constructs over time, and cross-lagged effects between two variables over time were specified within each model.

RESULTS

The mean of six of the eight HRQOL dimensions, as well as quantitative and qualitative social support, deteriorated during the 9-year follow-up. Self-efficacy was unchanged. Temporal positive relationships were found between baseline GSE and the HRQOL dimension of social functioning, as well as between social support and the HRQOL dimensions of physical functioning, vitality, and mental health at follow-up.

CONCLUSION

The findings highlight the importance of self-efficacy and social support as potential buffering factors for HRQOL in adult survivors of childhood ALL over time.

A study of the relationship and mediating effects of perceived stress and post-traumatic growth in patients undergoing postoperative chemotherapy for breast cancer

OBJECTIVE

The traumatic experience of cancer, in addition to its negative impact on breast cancer patients, can also bring about positive change, i.e., post-traumatic growth (PTG). PTG can help boost patients' confidence in their fight against the disease and improve their adherence to treatment, thereby facilitating their recovery. The study aimed to investigate the effect of perceived stress on the PTG of patients undergoing postoperative chemotherapy for breast cancer and to examine the roles of rumination and self-efficacy between two.

METHODS

The data was collected using a cross-sectional design. From December 2021 to October 2022, a total of 306 breast cancer patients who had undergone chemotherapy following surgery and met the inclusion and exclusion criteria were selected from three tertiary-level A hospitals in Henan Province, China. We conducted descriptive analysis, Pearson correlation analysis, and a regression analysis using PROCESS Macro Model 80 to explore the relationships among perceived stress, rumination, self-efficacy, and PTG.

RESULTS

Perceived stress of patients undergoing postoperative chemotherapy for breast cancer had a negative predictive effect on PTG (r = -0.340, P < 0.01); Rumination and self-efficacy played a partial mediating effect between perceived stress and PTG, accounting for 45.25% of the total effect.

CONCLUSIONS

Clinical nursing staff could promote PTG by strengthening psychological assessment and timely psychological intervention for patients with high perceived stress levels, encourage patients to adopt a positive way of thinking about illness and improve their self-efficacy level, so as to improve their PTG level.

Psychometric properties of the Turkish Version General Self-Efficacy Scale in children and adolescents with cancer

OBJECTIVES

The study aimed to evaluate the validity and reliability of the Turkish version of the General Self-Efficacy Scale in children and adolescents aged 8-18 undergoing cancer treatment.

METHODS

The sample of this methodological and descriptive study consisted of 128 children and adolescents between the ages of 8 and 18 in the pediatric hematology-oncology wards and outpatient units of a university hospital. The study was implemented in a university hospital in Turkey between March 2023 and November 2023. Data were collected through face-to-face interviews with children and adolescents attending the clinic or outpatient clinic. Data were collected using the information form and General Self-Efficacy Scale psychometric tests, Cronbach's alpha, Test-retest, validity and reliability analysis). Item-total score correlation was used.

RESULTS

In the exploratory factor analysis, Kaiser Meyer Olkin was p 0.77, for which Bartlett's test of sphericity was significant (p < 0.001). Exploratory factor analysis revealed a ten-item unidimensional structure with satisfactory representation. Item-total score correlations of the scale ranged between 0.32 and 0.52. In the confirmatory factor analysis, the model fit indices of this scale were obtained as follows: χ2/sd = 1.36, Goodness-of-Fit Index = 0.94, Comparative Fit Index = 0.92, Adjusted Goodness-of-Fit Index = 0.90, and Cronbach alpha value, indicating the internal consistency of the entire scale, was 0.76.

CONCLUSIONS

The scale is a valid and reliable tool for assessing self-efficacy in children and adolescents between the ages of eight and eighteen undergoing cancer treatment.

PRACTICE IMPLICATIONS

The study will provide precious information for experimental interventions and follow-up studies to assess the self-efficacy of children and adolescents with cancer.

The Mediating Role of Self-efficacy and Coping Mode Between Powerlessness and Quality of Life in Patients with Venous Leg Ulcers

OBJECTIVE

To explore the mediating effect of self-efficacy and coping mode between powerlessness and quality of life in patients with a venous leg ulcer (VLU).

METHODS

The authors used a convenience sampling method to select 208 patients with a VLU in four tertiary grade A hospitals in Qingdao and Tianjin from June 2021 to August 2022. Instruments included the Powerlessness Assessment Tool, Venous Leg Ulcer Self-efficacy Tool, Medical Coping Modes Questionnaire, and Venous Leg Ulcer Quality of Life Questionnaire. The authors used descriptive statistics, Pearson correlation, and PROCESS macros for data analysis.

RESULTS

The powerlessness score was significantly negatively associated with self-efficacy and confrontation coping mode scores and positively associated with patients' quality-of-life scores. In addition, self-efficacy and confrontation coping modes separately and sequentially mediated the relationship between powerlessness and quality of life.

CONCLUSIONS

Self-efficacy and confrontation coping mode play important mediating roles between powerlessness and quality of life in patients with VLUs. By decreasing patients' sense of powerlessness, boosting their self-efficacy, and encouraging them to adopt confrontation coping mode, health professionals can improve patients' quality of life.

Relationships Between Socio-behavioral Factors and the Symptoms Among Asian American Breast Cancer Survivors: A Structural Equation Modeling

BACKGROUND

Despite increased research on breast cancer survivors, little is known about how socio-behavioral factors influence the symptoms among racial/ethnic minority breast cancer survivors, particularly Asian American breast cancer survivors (AABCS).

OBJECTIVE

This study examined the relationship between multiple socio-behavioral factors in AABCS, including attitudes, perceived barriers, and social influences, and their symptom experiences, with an emphasis on the mediating effect of self-efficacy.

METHODS

This secondary analysis used data collected from 195 AABCS women recruited through online and offline communities from January 2017 to June 2020. Study variables were measured using validated instruments such as the Questions on Attitudes, Self-Efficacy, Perceived Barriers, and Social Influences; the Cancer Behavior Inventory; and the Memorial Symptom Assessment Scale-Short Form. For structural equation modeling based on Bandura's self-efficacy theory, mediation analysis was performed using SPSS version 26.0 and AMOS 28.

RESULTS

The overall fitness of the hypothetical model to the data is acceptable (χ2 = 51.36, P < .001; goodness-of-fit index = 0.95, adjusted goodness-of-fit index = 0.89, comparative fit index = 0.96, Tucker-Lewis index = 0.94, normed fit index = 0.94, and root-mean-square error of approximation index = 0.08). Both attitudes and social influences indirectly influenced symptom distress through self-efficacy (β = -0.054, P = .019, and β = -0.053, P = .017, respectively). Perceived barriers had indirect effects through self-efficacy (β = 0.121, P = .024) and significant direct effects (β = 0.605, P = .003) on symptom distress.

CONCLUSIONS

Our findings supported that the self-efficacy for coping mediated their symptom experience among AABCS. In addition, there were significant relationships among attitudes, perceived barriers, social influences, and symptom experience.

IMPLICATIONS FOR PRACTICE

Future theory-driven interventions need to consider self-efficacy and socio-behavioral factors in symptom management among AABCS.

Empowerment and quality of life: the mediating role of self-efficacy and health literacy among spousal caregivers in China

The aim of this study was to explore the chain mediation model of self-efficacy and health literacy between empowerment and quality of life among spousal caregivers of disabled elderly based on 'Marriage Binding'. From December 2020 to June 2022, the cross-sectional study was conducted in hospitals and communities, in Guangdong, Fujian, Sichuan, Hunan, Jiangxi, Guangxi and Yunnan provinces, China. Descriptive statistics were used to describe the demographic data and four main variables, including empowerment, self-efficacy, health literacy and quality of life. Spearman correlation analysis was used to analyze the correlation between the four main research variables. Multiple Linear Regression and bootstrap analysis were used to analyze the direct and indirect effects among them. Any two variables of spousal caregivers were correlated among empowerment, self-efficacy, health literacy and quality of life. Self-efficacy and health literacy can separately and sequentially mediate the relationship between empowerment and quality of life. To improve the quality of life of spousal caregivers of disabled elderly, the mediating role of self-efficacy, the mediating role of health literacy and the chain mediating role of self-efficacy and health literacy should take effect. In the future, some intervention studies should be taken to enhance the effects of those variables that may be beneficial for improving quality of life of spousal caregivers of disabled elderly.

Posttraumatic growth in children aged 8-18 years with malignancies in China

OBJECTIVE

To establish a nomogram prediction model for posttraumatic growth (PTG) in children aged 8-18 years with malignancies in China and to convenient intuitively judge psychological tendencies.

METHODS

We recruited 358 children aged 8-18 years with malignancies in China as the study participants. Data from 250 cases collected from June 2019 to November 2019 were used as the model group, data from 108 cases collected from December 2019 to January 2020 were used as the validation group. Logistic regression was used to analyze the influencing factors of PTG in the model group. A prediction model was then established using a nomogram. The centrality measurement index(C-index) and receiver operating characteristic curves (ROC) were used to verify the model.

RESULTS

Among the 250 children in the model group, 65 children with malignancies had PTG, with an occurrence of 26%. The model showed that the child's age, diagnosis, coping style and self-efficacy level and the educational level of the caregiver were core predictors of PTG (P < 0.05). The ROC of the model was 0.837, the best cutoff value was 0.566. The C-indexes of the internal and external validation were 0.837 (95% CI: 0786 ~ 0.886) and 0.813 (95% CI: 0732 ~ 0.894), respectively.

CONCLUSIONS

The prediction model of PTG in children aged 8-18 years with malignancies in China has good discrimination and consistency and can accurately predict PTG. It can be used to clinically assess the psychological status of children in the future.

Psychometric validation of the Chinese version of the Adolescent Asthma Self-Efficacy Questionnaire

Background

Self-efficacy was considered as a promising target for the self-management of symptoms for adolescents with asthma. The measurement of self-efficacy in adolescents with asthma requires effective self-report tools, which have not been met with at present. So, the aim of this study was to cross-culturally validate the Adolescent Asthma Self-Efficacy Questionnaire (AASEQ).

Methods

As many as 408 adolescents with asthma were invited to take up the psychometric properties test between July 2021 and June 2022. We conducted the confirmatory factor analysis (CFA) to determine the structure of the AASEQ. The relationship between the AASEQ and General Self-Efficacy Scale was tested to evaluate the construct validity. The reliability was evaluated by retest reliability, internal consistency, and interfactor correlation.

Results

The results of the present study showed that the confirmatory factor analysis indicated a significantly good fit for a four-factor model, which explained 62.697% of the total variance. The fit indices of the four-factor model were acceptable, and the standardized factor loading ranged from 0.631 to 0.880. The C-AASEQ showed an acceptable internal consistency (Cronbach's α = 0.810-0.927) and test-retest reliability (intraclass correlation coefficient = 0.64-0.89). Content validity index at the scale level was 0.96, and content validity index at the item level was 0.86 to 1.

Conclusion

The Chinese version of Adolescent Asthma Self-Efficacy Questionnaire showed consistently acceptable positive psychometric properties and can be used as an instrument to assess the self-efficacy of adolescents with asthma in China, as corroborated in the present study.

Posttraumatic growth and rumination among parents of children with autism spectrum disorder: The mediating role of social support

Although rumination and social support are regarded as essential predictors of posttraumatic growth (PTG), few studies have explored the associations among PTG, rumination, and social support in parents of children with autism spectrum disorder (ASD). This study examined whether social support mediates the relationship between rumination and PTG. Cross-sectional questionnaire data were collected from 385 parents of children with ASD from September 2019 to November 2020 by convenience sampling. Participants completed the Posttraumatic Growth Inventory, Event Related Rumination Inventory, and Social Support Rating Scale. Path analyses showed that subjective support partially mediates the relationship between deliberate rumination and PTG (β = 0.073, P &lt; 0.001), and indirect effects account for 15.30% of the total effects. In addition, a negative direct path was found between intrusive and PTG because of the suppression effect of subjective support (β = -0.110, P &lt; 0.01), and indirect effects accounted for 80% of the direct effects. For future studies, it underscores the essential role of subjective support and rumination in promoting PTG in parents of children with ASD.

Posttraumatic stress and growth in adolescent childhood cancer survivors: Links to quality of life

Pediatric cancer can be considered an event potentially leading to posttraumatic stress symptoms (PTSS) as well as posttraumatic growth (PTG). While clinically significant levels of PTSS are rare in childhood cancer survivors, PTG is common in this population. However, the relationship of PTG to overall adaptation and quality of life (QOL) in pediatric cancer patients is not clear. Therefore, our study aims to analyse the relationships of PTSS and PTG with QOL in childhood cancer survivors. In this study, 172 childhood cancer survivors completed measures of quality of life (Minneapolis-Manchester Quality of Life Scale; child and adolescent version), posttraumatic stress (UCLA PTSD Reaction Index for DMS-IV) and posttraumatic growth (Benefit Finding Scale for Children). Correlation analyses were carried out separately for the child (up to 13 years, N = 47) and adolescent (more than 13 years, N = 125) groups and each QOL dimension. In the adolescent group, the relationship of PTSS and PTG with QOL was further verified by regression analyses while controlling for age, gender, and time off treatment. In children, negative relationships between PTSS and QOL were found, but the relationships between QOL and PTG were not significant. In adolescents, significant relationships were found for all dimensions of QOL and PTSS and also for several dimensions of QOL and PTG. The relationships between PTSS and QOL dimensions were negative in both groups, and the relationships between PTG and QOL in the adolescent group were weakly positive. In adolescents, regression analyses controlling for age, gender and time off treatment were performed and confirmed a negative relationship of PTSS with all QOL dimensions except for social functioning. For PTG, regression analyses revealed a significant positive relationship with QOL dimensions of social functioning, outlook on life and intimate relations. While the relationship between PTSS and QOL is negative for almost all QOL dimensions in children and adolescents, the nature of the relationship between PTG and QOL appears to be more complex and changing over time. PTG in children may reflect different processes with different outcomes than PTG in adolescents.

The Correlation Between Quality of Life and Positive Psychological Resources in Cancer Patients: A Meta-Analysis

Purpose

This study aimed to assess the evidence of the association between positive psychological resources and quality of life in patients with cancer.

Methods

Electronic searching was performed to retrieve articles from PubMed, Web of Science, Embase, CNKI, and CBM (from inception to 7 April 2022). Summary correlation coefficient (r) values were extracted from each study, and 95% CIs were calculated by the random-effect model. Subgroup and sensitivity analyses were performed to investigate potential heterogeneity.

Results

In total, sixty-six articles were included in the present study. The pooled r for resilience was 0.71 (95%CI: 0.55, 0.87), hope 0.50 (95%CI: 0.43, 0.56), self-efficacy 0.53 (95%CI: 0.46, 0.61), self-esteem 0.46 (95%CI: 0.28, 0.63), and optimism 0.30 (95%CI: 0.19, 0.40). For subgroup analysis, no significant differences were found between minors and adults.

Conclusion

This study indicated that resilience, hope, optimism, self-esteem, and self-efficacy were positively correlated with quality of life in patients with cancers. Therefore, intervention programs should be focused on increasing state-like positive psychological resources to improve the quality of life in patients with cancer.

Mediating Role of Entrepreneurial Self-Efficacy and Prosocial Tendency in the Relation Between College Students' Post-traumatic Growth and Entrepreneurial Intention in the Post-COVID-19 Era

In this study, we explore the psychological mechanisms underlying the relation between college students' post-traumatic growth and their entrepreneurial intentions in the post-COVID-19 era. Using the post-traumatic growth, entrepreneurial self-efficacy, prosocial tendency, and entrepreneurial intention scales, we tested 690 valid samples of Chinese undergraduates (including 445 men and 245 women). The results revealed that post-traumatic growth of college students in the post-COVID-19 era will have a significant and positive effect on their entrepreneurial intentions. Additionally, the results indicated that students' entrepreneurial self-efficacy and prosocial tendencies play a partial mediation role between post-traumatic growth and entrepreneurial intentions in the post-COVID-19 era and that there is a chain mediating effect between students' entrepreneurial self-efficacy and prosocial tendencies. This study provides valuable insights into the influence of post-traumatic growth on entrepreneurial intentions among college students in the post-COVID-19 era and suggests that colleges and universities can improve students' entrepreneurial intentions by adopting measures to foster their post-traumatic growth, entrepreneurial self-efficacy, and prosocial tendencies.

Influence of Self-Efficacy on Cancer-Related Fatigue and Health-Related Quality of Life in Young Survivors of Childhood Cancer

This study aims to elucidate how self-efficacy influences cancer-related fatigue and health-related quality of life (HRQoL) in young survivors of childhood cancer. Forty-six young survivors (age range, 8–18 years) of childhood cancer who were currently in complete remission completed measures for self-efficacy (Pediatric General Self-Efficacy Scale (PedsSE)), cancer-related fatigue (Cancer-related Fatigue Score (CRFS)), and HRQoL (Pediatric Quality of Life Inventory 4.0 Generic Core Scale, Pediatric Quality of Life Inventory (PedsQL)). Structural relationships between the PedsSE and CRFS or PedsQL, including the effects of potential demographic or clinical confounders, were examined by machine learning random forest algorithms and structural equation modeling. According to the distribution of the PedsQL, six survivors with PedsQL < 70 were determined to have compromised HRQoL (referred to as “low-PedsQL survivors”). The random forest model identified six variables for the prediction of the CRFS, with the PedsSE being the most important, and eight variables for the distinction of low-PedsQL survivors, with the CRFS being the most and the PedsSE the third most important variable. The structural equation model indicated that a direct influence of the PedsSE on the PedsQL was less detectable (β = −0.049), whereas an indirect influence of the PedsSE on the PedsQL via the CRFS was evident (β = 0.333). The model explained 51% of the variation of the CRFS and 28% of the variation of the PedsQL. The PedsSE was strongly correlated with “altered mood” in the subclass of the CRFS (r = −0.470), and “altered mood” was strongly correlated with the PedsQL (r = 0.737). In conclusion, self-efficacy is a major determinant of cancer-related fatigue and influences HRQoL via cancer-related fatigue in survivors of childhood cancer. The main pathway from self-efficacy to HRQoL is thought to be via the emotional aspect of cancer-related fatigue. However, unlike adult survivors of cancer, self-efficacy for young survivors may not contribute much to self-management behaviors that maintain HRQoL.