Study on the Correlation Between Disease Acceptance, Marital Adjustment and Psychosocial Adaptation of Cervical Cancer Patients After Operation
Purpose: To examine psychosocial adaptation and its associated factors among postoperative cervical cancer patients, and to assess the relationships between disease acceptance, marital adjustment, and psychosocial adaptation. Methods: A cross-sectional study was conducted using convenience sampling. From April to July 2024, 231 postoperative cervical cancer patients attending their first postoperative follow-up visit at gynecology oncology outpatient clinics were recruited. Data were collected using the Psychosocial Adjustment to Illness Scale - Self-Report (PAIS-SR), the Acceptance of Illness Scale (AIS), and the Lock - Wallace Marital Adjustment Test (MAT). Pearson correlation analysis and multiple linear regression were used to examine associations and identify factors independently associated with psychosocial adaptation. Results: The mean PAIS-SR score was 47.29 ± 7.90. Psychosocial adaptation was negatively correlated with disease acceptance (r = -0.510, P-value < 0.01) and marital adjustment (r = −0.551, P-value < 0.01). Disease acceptance was positively correlated with marital adjustment (r = 0.541, P-value < 0.01). In multiple linear regression, disease acceptance, marital adjustment, age, monthly family income, and disease stage were significant predictors of psychosocial adaptation, explaining 46.3% of the variance (adjusted R² = 0.463). Conclusion: Postoperative cervical cancer patients reported a moderately low level of psychosocial adaptation. Higher disease acceptance and greater marital adjustment were associated with better psychosocial adaptation. Interventions that strengthen disease acceptance and couple-based support may help improve psychosocial adaptation during postoperative recovery.
[1] Alay, I., Kaya, C., Karaca, I., Yildiz, S., Baghaki, S., Cengiz, H., ... & Yasar, L. (2020). The effect of being diagnosed with human papillomavirus infection on women’s sexual lives. Journal of Medical Virology, 92 (8), 1290-1297. https://doi.org/10.1002/jmv.25623
[2] Bae, H., & Park, H. (2016). Sexual function, depression, and quality of life in patients with cervical cancer. Supportive Care in Cancer, 24(3), 1277-1283. https://doi.org/10.1007/s00520-015-2918-z
[3] Bergmark, K., Åvall-Lundqvist, E., Dickman, P. W., Henningsohn, L., & Steineck, G. (1999). Vaginal changes and sexuality in women with a history of cervical cancer. New England Journal of Medicine, 340(18), 1383-1389. https://doi.org/10.1056/NEJM199905063401802
[4] Bhatla, N., Aoki, D., Sharma, D. N., & Sankaranarayanan, R. (2021). Cancer of the cervix uteri: 2021 update. International Journal of Gynecology & Obstetrics, 155, 28-44. https://doi.org/10.1002/ijgo.13865
[5] Chabowski, M., Polański, J., Jankowska-Polanska, B., Lomper, K., Janczak, D., & Rosinczuk, J. (2017). The acceptance of illness, the intensity of pain and the quality of life in patients with lung cancer. Journal of Thoracic Disease, 9(9), 2952. https://doi.org/10.21037/jtd.2017.08.70
[6] Cheng, F., Meng, A. F., Yang, L. F., & Zhang, Y. N. (2013). The correlation between ostomy knowledge and self-care ability with psychosocial adjustment in Chinese patients with a permanent colostomy: a descriptive study. Ostomy/Wound Management, 59(7), 35-38. Retrieved from https://europepmc.org/article/med/23846005
[7] Cipora, E., Konieczny, M., & Sobieszczanski, J. (2018). Acceptance of illness by women with breast cancer. Annals of Agricultural and Environmental Medicine, 25(1). https://doi.org/10.26444/aaem/75876
[8] Derogatis, L. R. (1986). The psychosocial adjustment to illness scale (PAIS). Journal of Psychosomatic Research, 30(1), 77-91. https://doi.org/10.1016/0022-3999(86)90069-3
[9] Felton, B. J., Revenson, T. A., & Hinrichsen, G. A. (1984). Stress and coping in the explanation of psychological adjustment among chronically ill adults. Social Science & Medicine, 18(10), 889-898. https://doi.org/10.1016/0277-9536(84)90158-8
[10] Feng, Q., Huang, Y., Huang, Y., Fang, J., Yang, Y., & Huang, L. (2018). Study on the effect of sexual health education on the satisfaction of sexual life of cervical cancer radical radiotherapy patients. Journal of Guangxi Medical University, 35(4), 572-574. https://doi.org/10.16190/j.cnki.45-1211/r.2018.04.037
[11] Gao, W., Zhang, Q., & Han, J. (2024). Meta-integration of qualitative research on couple intimacy in breast cancer patients. Chinese Journal of Nursing, 59(5), 618-626. https://doi.org/10.3761/j. issn.0254-1769.2024.05.016
[12] He, W. Q., & Li, C. (2021). Recent global burden of cervical cancer incidence and mortality, predictors, and temporal trends. Gynecologic Oncology, 163(3), 583-592. https://doi.org/10.1016/j.ygyno.2021.10.075
[13] Hsu, Y. Y., Wang, W. M., Fetzer, S. J., Cheng, Y. M., & Hsu, K. F. (2018). Longitudinal psychosocial adjustment of women to human papillomavirus infection. Journal of Advanced Nursing, 74(11), 2523-2532. https://doi.org/10.1111/jan.13725
[14] Jankowska-Polańska, B., Blicharska, K., Uchmanowicz, I., & Morisky, D. E. (2016). The influence of illness acceptance on the adherence to pharmacological and nonpharmacological therapy in patients with hypertension. European Journal of Cardiovascular Nursing, 15(7), 559-568. https://doi.org/10.1177/1474515115626878
[15] Jiang, X., Leng, Y., Li, C., Xie, R., Nie, Z., & Wang, G. (2024). Meta-analysis of the current status and influencing factors of psychosocial adaptation in stoma patients. Modern Medicine and Health, 40(18), 3160-3167. http://dx.chinadoi.cn/10.3969/j.issn.1009-5519.2024.18.021
[16] Jiang, Y., Zhang, X., Ma, Y., & Wang, R. (2023). Analysis of the correlation between perceived psychosocial adaptation and quality of life in patients undergoing modified radical mastectomy for breast cancer. General Nursing, 21(7), 869-873. Retrieved from http://kns.cnki.net.https.gzlib.99885.net/kcms2/article/abstract?v=JITlTmCwHjJClBfvqdwAQtsAKGSC1XXO4z_hWC-210PCKsAJj6isz9117g7aH6WBPVgwJgFJCOmS1e3lQ7aYRMpL-ehDZq13OwEw36ZVjbA1QWwjLR6CoL6RTrdsO7kNSVPVpl5f4EH1dUF-iz060FeP9864cD9BGOGUhdNqtdMPpv2u5doeGw==&uniplatform=NZKPT&language=CHS
[17] Kołtuniuk, A., & Rosińczuk, J. (2021). The levels of depression, anxiety, acceptance of illness, and medication adherence in patients with multiple sclerosis-descriptive and correlational study. International Journal of Medical Sciences, 18(1), 216. https://doi. org/10.7150/ijms.51172
[18] Leite, V., Santos, B. D., & Pereira, M. G. (2019). Psychosocial impact of human papillomavirus on women’s sexual dissatisfaction and quality of life. Journal of Psychosomatic Obstetrics & Gynecology, 40(3), 232-238. https://doi.org/10.1080/0167482X.2018.1470164
[19] Li, Y., Tang, H., & Hu, Y. (2023). The impact of nursing intervention based on transcendence theory on the disease acceptance and cancer-related fatigue in patients with cervical cancer who are receiving intravenous chemotherapy. Clinical Medical Research and Practice, 8(29), 138-141. https://doi. org/10.19347/j. cnki. 2096-1413.202329035
[20] Liu, B., Zheng, S., & Wang, J. (2020). Investigation on cervical cancer screening women's awareness of cervical cancer and its influencing factors. Chinese Community Physicians, 36(9), 166-167. http://dx.chinadoi. cn/10.3969/j.issn.1007-614x.2020.09.102
[21] Locke, H. J., & Wallace, K. M. (1959). Short maritaladjustment and prediction tests: Their reliability and validity. Marriage and Family Living, 21(3), 251-255. https://doi.org/10.2307/348022
[22] Mercan, R., Mercan, S., Durmaz, B., Sur, H., Kilciksiz, C. M., Kacar, A. S., ... & Ata, B. (2019). Sexual dysfunction in women with human papilloma virus infection in the Turkish population. Journal of Obstetrics and Gynaecology, 39(5), 659-663. https://doi.org/10.1080/01443615.2018.1547694
[23] National Health and Family Planning Commission of the Peoples Republic of China. (2013) Standardized guidelines for the diagnosis and treatment of cervical cancer and pre-cancerous lesions (Trial). China Medical Frontier Journal (Electronic Edition), 8(8):40-49.
[24] Ni, P., Chen, J., & Liu, N. (2010). Sample size estimation of quantitative research in nursing care. Chinese Journal of Nursing, 45(4), 378-380.
[25] Nichols, T. R., & Riemer, M. (2008). The impact of stabilizing forces on postsurgical recovery in ostomy patients. Journal of Wound Ostomy & Continence Nursing, 35(3), 316-320. https://doi.org/10.1097/01.WON.0000319131.52348.7a
[26] Obiegło, M., Uchmanowicz, I., Wleklik, M., JankowskaPolańska, B., & Kuśmierz, M. (2016). The effect of acceptance of illness on the quality of life in patients with chronic heart failure. European Journal of Cardiovascular Nursing, 15(4), 241-247. https://doi.org/10.1177/1474515114564929
[27] Pan, Z. (2023). Relationship between self-expression of breast cancer patients after surgery and marital intimacy and psychosocial adaptation. (Master’s thesis). Nanchang University. https://doi.org/10.27232/d.cnki.gnchu.2023.001127
[28] Pearman, T. (2003). Quality of life and psychosocial adjustment in gynecologic cancer survivors. Health and Quality of life Outcomes, 1(1), 33. https://doi.org/10.1186/1477-7525-1-33
[29] Reese, J. B., Zimmaro, L. A., McIlhenny, S., Sorice, K., Porter, L. S., Zaleta, A. K., ... & Gorman, J. R. (2022). Coping with changes to sex and intimacy after a diagnosis of metastatic breast cancer: Results from a qualitative investigation with patients and partners. Frontiers in Psychology, 13, 864893. https://doi.org/10.3389/fpsyg.2022.864893
[30] Shi, G., Huang, Y., Jiang, Z., Gao, X., & Yu, L. (2021). The impact of bivariate coping interventions on disease coping strategies and intimate relationships of cervical cancer patients and their spouses. Guangxi Medical Journal, 43(17), 2133-2137. https://doi.org/10.11675/j.issn.0253-4304.2021.17.23
[31] Shi, Y., Zhuang, J., Zhang, Q., & Ma, L. (2019). The mediating effect of marital intimate relationship between psychological resilience and post-traumatic growth for patients after breast cancer surgery. Journal of Qilu Nursing, 25(20), 16-19. https://doi.org/10.3969/j.issn.1006-7256.2019.20.005
[32] Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209-249. https://doi.org/10.3322/caac.21660
[33] Suo, R., Zhang, L., Tao, H., Ye, F., Zhang, Y., & Yan, J. (2021). The effects of dyadic coping and marital satisfaction on posttraumatic growth among breast cancer couples. Supportive Care in Cancer, 29(9), 5425-5433. Retrieved from https://doi. org/10.1007/s00520-021-06121-z
[34] Szpilewska, K., Juzwiszyn, J., Bolanowska, Z., Milan, M., Chabowski, M., & Janczak, D. (2018). Acceptance of disease and the quality of life in patients with enteric stoma. Polish Journal of Surgery, 90, 13-17. https://doi.org/10.5604/01.3001.0011.5954
[35] Wang, R., Xu, L., Yang, X., & Dong, J. (2024). Investigation and nursing research on the factors affecting the psychological and social adaptability of middle-aged and young patients with nasopharyngeal cancer. Contemporary Nurse (Mid-term Edition), 31(1), 87-91. https://doi.org/10.19792/j.cnki.1006-6411.2024.02.021
[36] Wright, T. M., & Kiropoulos, L. A. (2017). Intimate relationship quality, elf-concept and illness acceptance in those with multiple sclerosis. Psychology, Health & Medicine, 22(2), 212-226. https://doi. org/10.1080/13548506.2016.1238492
[37] Xie, F., & Sui, L. (2020). Current status and reflections on cervical cancer screening. Journal of Practical Ostetrics and Gynecology, 36(10), 721-723. Retrieved from http://d.wanfangdata.com.cn.https.muc.99885.net/periodical/CiBQZXJpb2RpY2FsQ0hJU29scjkyMDI2MDMwNjE2NTI1NxIQc3lmY2t6ejIwMjAxMDAwMRoIMmN2MjdtM24%3D
[38] Yao, J. J. (2013). Cross-sectional survey of cancer patients’ adaptation level and analysis of its predictive factors. Second Military Medical University. https://doi.org/10.7666/d.Y2339996
[39] Zhao, W. (2018). Evaluation of the reliability and validity of the Chinese version of the disease acceptance scale. Chinese Journal of Modern Nursing, 24(22), 2652-2655. https://doi. org/10.3760/cma. j. issn. 1674-2907.2018.22.012
