2.1 Participants and procedure
A total of 150 breast cancer survivors were recruited, which were selected from September 2019 to December 2020 in the breast surgery ward in the affiliated Hospital of Harbin Medical University. Inclusion criteria were: 1) diagnosed pathologically as breast cancer, and is undergoing postoperative chemotherapy for breast cancer, 2) female patients ≥18 years of age, 3) ability to read Chinese. Exclusion criteria were: 1) Past history of mental illness, severe mental or cognitive dysfunction, 2) accompanied by severe physical illness or past other malignant tumors and recurrence, 3) type of surgery patients who take breast-conserving conservative treatment. A total of 141 (94%) patients admitted to the hospital were eligible and agreed to participate in the study. 20.57% of the participants were under the age of 45. 60.99% were within 45-59 years and 18.44% were over 60 years old. Table 1 presents the detailed sample characteristics.
Ethical approval for this study was obtained from the Research Ethics Committee at Harbin Medical University (NO.KY2019-0118). Before the survey, the researchers were strictly trained. During the survey, the researchers explained the purpose and significance of the survey to the patients. After obtaining the patient's informed consent, they used a unified instruction to explain the questionnaire filling method and precautions to the patients. After the questionnaire is completed, it will be retrieved on the spot to check whether there are missing or invalid items, and if necessary, instruct patients to fill in or fill up again, and each participant was given a small gift after completed the study.
2.2 Measures
2.2.1 Personal information questionnaire
Designed by the researcher according to the research purpose and the characteristics of the disease, which including age, education, marital status and other demographic and sociological data.
2.2.2 Herth hope index
The Herth hope index (HHI) was used to measure hope about breast cancer. The Chinese version of the scale was introduced in 1999 by the translation of Zhao Haiping from China Medical University [24]. The 12-item scale has 3 subscales: temporality and future (T), positive readiness and expectancy (P), and interconnectedness (I). Using the Liket 4-level scoring method, each item is rated from 1 (strongly disagree) to 4 (strongly agree) and total score ranges from 12 to 48, with higher score reflecting greater hope. The internal consistency reliability of the scale Cronbach's α coefficient is 0.85.
2.2.3 Type C behavior scale
Designed by Temoshok and introduced to China by Yan Hua et al [25]. There are 16 items of C-type behavior pattern, and the score range is 0-16 points. The higher the score, the more obvious the type C personality behavior tendency, and the incidence, recurrence and metastasis rate of cancer are significantly increased. It has been widely used in patients after breast cancer surgery. The Cronbach's α coefficient of this questionnaire is 0.745 [25].
2.2.4 Medical coping modes questionnaire
The Medical Coping Modes Questionnaire (MCMQ) compiled by Feifei in 1987, the Chinese version was revised by Jiang Qianjin [26]. It has been widely used to assess patient coping patterns, including 19 items under the three dimensions of confrontation, avoidance, and acceptance-resignation. Each item is scored using a 4-point Likert rating that ranges from 1 = never to 4 = very much. The Cronbach's α coefficients of the three subscales in Chinese breast cancer patients are 0.803, 0.723, 0.7426, respectively [6].
2.2.5 Social relational quality scale
The Social Relational Quality Scale (SRQS) was designed by Hou [9] to assess the quality of social relationships in social processes. This 22-item scale is scored using a 4-point Likert scale that ranges from 1 = strongly disagree to 4 = strongly agree. It addresses the three dimensions of family intimacy, family commitment, and friendships, with higher scores representing higher levels of social relational quality. The Cronbach's α value was measured as 0.832 in Chinese breast cancer patients [6].
2.2.6 Acceptance of disability scale
Linkowski compiled the acceptance of disability scale (ADS) based on the theory of loss of acceptance in 1971 in order to describe the individual's attitude towards disability, and in 2007 it was revised by Darlene. The Chinese version of the scale was revised by Ni Chen et al [27]. The 32-item scale has 4 subscales: enlargement of scope of values, transformation from comparative values to asset values, containment of disability effect, and subordination of physique. The ADS is scored using a 4-point scale ranging from ‘strongly disagree’ (1) to ‘strongly agree’ (4), with higher scores indicating a higher level of ADS. The content validity index (CVI) of the total scale is 0.919, and the internal consistency reliability Cronbach's α value is 0.83.
2.3 Data analysis
Using Epidata 3.1 for single and double data entry can ensure the accuracy of data entry. The SPSS24.0 and AMOS24.0 statistical software packages are used to process and analyze the data. The measurement data is described by the mean and standard deviation (M±SD) is expressed. Perform descriptive statistics and correlation in SPSS24.0 to identify potential covariates. Examine the relationship between outcome variables ( SRQS and ADS), pre-variables (hope , type C personality), and medical coping styles. Path analyses were conducted using AMOS24.0 with maximum likelihood estimation. Model fit was accessed with the chi-square estimate, normed fit index (NFI), comparative fit index (CFI), Tucker-Lewis index (TLI), and the root mean square error of approximation (RMSEA). Model fit is deemed to be satisfactory if a CFI and TLI greater than 0.95 and an RMSEA less than 0.05 [28]. Indirect effects were assessed using the bootstrap procedure with bias-corrected 95% CIs.