Construction of a psychological intervention program to support fear of recurrence in patients with cervical cancer

Table 1 Basic information questionnaire for experts

Basics		Quorum	Composition ratio (%)
Distinguishing between the sexes	Male	9	69.23
	Female	4	30.77
Work experience	10-20 years	7	53.85
	> 20 years	6	46.15
Age	30-40 years old	2	15.39
	40-50 years old	7	53.85
	> 50 years old	4	30.76
Title	High ranking	6	46.15
	Deputy high ranking	5	38.46
	Middle level (in a hierarchy)	2	15.39

Table 2 Experts’ recommendations and revisions

Number of communications	Suggestion		Content of the modification
Round 1	Mission approach	Innovative mission approaches	Add synchronized Tencent video live streaming on top of the regular lectures
	Forms of mission	Traditional board books are more outdated	Prepare synchronized videos for health promotion in advance
	Intervention time	Clear and harmonized timing of interventions	One-to-one opportunity for 30 minutes week by appointment
	Psychological intervention modalities	Is there some variation in psychological problems from patient to patient and is there a graded intervention?	Those at low risk are interviewed by a psychiatric nurse; those at medium risk are interviewed by a counselling clinic; and those at high risk are interviewed by a psychologist
	Psychological intervention content	Are there more factors that contribute to patients’ fear of relapse and are the intervention programs targeted?	A multidisciplinary approach is used to target interventions to patients presenting with fear of relapse through consultation
	Intervention	There are more measures to help patients relieve psychological stress, what are the specific stress reduction measures taken	Instruct patients in skills related to stress reduction tools and guide them to learn to reduce stress on their own
Round 2	Decompression schedule	What specifically are the stress reduction tools?	Stress relieving tools include stress reducing ball/stress reducing flip stick/fingertip blocks/BIG ENTER key stress reducer/ferrofluid magnetic fluid/stress reducing Rubik’s cube and so on
	Implementation	How to implement psychological interventions for postoperative cervical cancer patients?	A psychological intervention workshop for fear of relapse was set up, “HengYi Oasis”, with the head nurse of the ward as the person in charge, a nurse specialized in psychology as the leader of the team, supplemented by a nurse specialized in oncology and a nurse specialized in nutrition to provide guidance on oncology and nutrition
	Intervention	What interventions are available in addition to stress reduction tools?	Organize interventions such as positive thinking stress reduction (e.g., body scanning, meditation stress reduction method), music stress reduction (method), music sleep exercise, stress reduction breathing exercise, confiding stress reduction (method), etc.; popularize Chinese medicine meridian health exercise: Ba Duan Jin, Green Valley Wu Chun meridian exercise, clapping health exercise, taijiquan, five-step boxing, neck and shoulder exercise, tendon and muscle clapping exercises, etc.

Table 3 Authority coefficient and coordination factor for expert correspondence

Number of communications	Indicator level	Number of experts	Total number of indicators	Authority coefficient	Coefficient of coordination	χ2	P value
Round 1	First class	13	3	0.811	0.821	25.134	< 0.001
	Category B	13	4	0.834	0.893	62.439	< 0.001
Round 2	First class	13	3	0.819	0.827	26.935	< 0.001
	Category B	13	4	0.856	0.889	65.341	< 0.001

Table 4 Relapse fear supportive psychological intervention program

Level 1 indicators	Secondary indicators	Goal	Forms of intervention	Time	Intervener	Location
Health education	Basic education	Produce and distribute a paper version of the “Health Promotion Manual on Cervical Cancer Disease” to give patients a basic knowledge of cervical cancer	Focused preaching	Week 1 (5-10 minutes)	Physiotherapists	Study room or ward
		Producing and distributing synchronized videos for health education on cervical cancer to enrich the form of education and stimulate patients’ interest in learning	Focused preaching	Week 1 (5-10 minutes)	Physiotherapists	Study room or ward
		Synchronizing health education content with Internet + Nursing Services to provide patients with education services that are not limited by time or location	Focused preaching	Week 1 (15-20 minutes)	Physiotherapists	Study room or ward
	Professional guidance	The department carries out weekly centralized teaching lectures and synchronized Tencent video live broadcasts, and adopts online and offline interaction to communicate and interact with patients and mobilize their learning enthusiasm	Focused preaching	Weeks 2 to 8 (15-30 minutes)	Physiotherapists	Learning room
		Provide patients with the opportunity to book a 30-minute one-on-one exchange and communication with the nurse, who is in charge of the whole process by the psychiatric nurse, giving professional assessment and guidance, and providing professional and standardized psychological interventions for the patients	Individual interventions	Weeks 1 to 8 (30 minutes)	Psychological nurse specialists	Learning room
Intervention assessment	Classified interventions	Multidisciplinary co-operation and graded interventions based on the Fear of Relapse Scale score to ensure that each patient has access to scientific and appropriate intervention management	Individual interventions	Week 1 (5-10 minutes)	Psychological intervention team	Business premises
		Low risk is intervened by psychiatric nurses, medium risk is intervened by psychological counseling clinics, and high risk is intervened by psychologists (specialists from tertiary care hospitals) in consultation, who give individualized intervention plans and put them into practice	Individual interventions	Weeks 1 to 8 (10-15 minutes)	Psychiatric nurses, physicians, psychologists	Learning room
Interventions	Forms of implementation of the intervention	Distribute stress-reducing tools (stress-reducing artefacts), such as stress-reducing ball/stress-reducing flip stick/fingertip blocks/BIG ENTER key stress-reducing artefacts/Ferrofluid magnetic fluid/stress-reducing Rubik’s cube, etc., to patients, and guide them to learn how to reduce stress on their own	Focused preaching	Week 2 (15-20 minutes)	Physiotherapists	Learning room
		Organize patients to carry out positive stress reduction (e.g., body scanning, meditation stress reduction method), music stress reduction (method), music sleep exercise, stress reduction breathing exercise, and confiding stress reduction (method) to help patients relax physically and mentally	Focused preaching	Week 3 (30-40 minutes)	Physiotherapists	Learning room
		Popularize Chinese medicine meridian health exercises, such as Ba Duan Jin, Green Valley Wu Chun meridian exercise, hand clapping health exercise, Taijiquan, Five-Step boxing, neck and shoulder exercise, and tendon slapping exercise, etc., to help the patients to maintain a healthy physical and mental state	Focused preaching	Week 4 (30-40 minutes)	Physiotherapists	Learning room

Table 5 Comparison of general information between the two groups, n (%)

Groups	n	Age (years)	Educational level (n)		Tumor stage (n)		Treatment (n)
			Junior high school and below	High school and above	Phase I-II	Phase III	Surgeries	Surgery + combination therapy
Research group	40	51.23 ± 4.28	26 (65.00)	14 (35.00)	22 (55.00)	18 (45.00)	6 (15.00)	34 (85.00)
Control subjects	40	52.31 ± 5.16	21 (52.50)	19 (47.50)	25 (62.50)	15 (37.50)	11 (27.50)	29 (72.50)
χ2/t	-	1.019	1.290		0.464		1.867
P value	-	0.311	0.256		0.496		0.172

Table 6 Comparison of intervention effects between the two groups (score, mean ± SD)

Groups	Research group	Control subjects	t	P value
n	40	40
FCRI score
T1	131.26 ± 6.43	129.9 ± 7.11	0.845	0.401
T2	88.46 ± 5.96	93.47 ± 6.17	3.694	0.001
T3	70.13 ± 5.24	83.62 ± 6.38	10.334	0.001
K-10 rating
T1	32.43 ± 2.84	33.23 ± 3.17	1.189	0.238
T2	25.13 ± 3.34	27.58 ± 3.65	3.132	0.002
T3	15.43 ± 2.96	17.18 ± 3.37	2.468	0.016
DT score
T1	7.12 ± 0.57	7.03 ± 0.68	0.642	0.523
T2	5.01 ± 0.47	5.63 ± 0.88	3.931	0.001
T3	2.27 ± 0.39	3.11 ± 0.43	9.152	0.001
HADS score
T1	16.84 ± 1.27	17.01 ± 1.38	0.573	0.568
T2	10.25 ± 1.05	11.87 ± 1.18	6.487	0.001
T3	6.89 ± 1.33	8.01 ± 1.58	3.430	0.001
EORTC QLQ-C30 ratings
T1	54.76 ± 4.38	55.02 ± 5.13	0.244	0.808
T2	68.96 ± 4.76	64.47 ± 5.28	3.995	0.001
T3	80.26 ± 5.24	76.34 ± 5.49	3.267	0.002
PSSS score
T1	43.26 ± 3.95	42.74 ± 3.59	0.616	0.540
T2	55.69 ± 2.46	51.85 ± 3.61	5.559	0.001
T3	67.59 ± 3.81	64.13 ± 3.84	4.045	0.001

FCRI: Fear of Cancer Recurrence Inventory; K-10: Kessler Psychological Distress Inventory; DT: Distress Thermometer; HADS: Hospital Anxiety and Depression Scale; EORTC QLQ-C30: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30; PSSS: Perceived Social Support Scale.

Table 7 Effect sizes (Cohen’s d) for between-group differences at T2 and T3

	Time	Cohen’s d1
FCRI	T2	-0.84
	T3	-2.31
K-10	T2	-0.70
	T3	-0.56
DT	T2	-0.92
	T3	-2.07
HADS	T2	-1.45
	T3	-0.76
EORTC QLQ-C30	T2	0.88
	T3	0.73
PSSS	T2	1.30
	T3	0.92

¹Cohen’s d for between-group comparisons.

Negative d values indicate lower scores in the research group for Fear of Cancer Recurrence Inventory, Kessler Psychological Distress Inventory, Distress Thermometer, and Hospital Anxiety and Depression Scale. Positive d values indicate higher scores in the research group for European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Perceived Social Support Scale. FCRI: Fear of Cancer Recurrence Inventory; K-10: Kessler Psychological Distress Inventory; DT: Distress Thermometer; HADS: Hospital Anxiety and Depression Scale; EORTC QLQ-C30: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30; PSSS: Perceived Social Support Scale.