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Limitations on participation and global quality of life among CRC survivors with permanent stomas: moderated mediation analysis of psychological distress and family functioning

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Abstract

Purpose

Although a cancer diagnosis and stoma creation leave colorectal cancer (CRC) survivors with significant limitations on participation in life activities that would impair their global quality of life (QoL), the underlying psychological mechanisms are understudied. The aim of this cross-section study was to examine whether psychological distress mediates the association of limitations on participation in life activity with global QoL, and whether family functioning moderated the indirect effects of limitations on participation in life activities on global QoL through psychological distress.

Methods

CRC survivors with permanent stomas (n = 282) completed questionnaires assessing socio-demographic and clinical characteristics, limitations on participation in life activities, psychological distress, family functioning, and global QoL. The mediation model and moderated mediation model were conducted using the PROCESS macro for SPSS.

Results

Mediation analysis showed that the association of limitations on participation in life activities with global QoL was partially mediated by psychological distress (indirect effect = −0.087, 95% CI = −0.135 to −0.041). Moderated mediation analysis indicated that the indirect effects of limitations on participation in life activities on global QoL through psychological distress were significantly moderated by family functioning. Specifically, the indirect effects decreased were significant as family functioning levels increased.

Conclusion

CRC survivors with permanent stomas experienced poor global QoL. The moderated mediation model provides a better understanding of how limitations on participation in life activities, psychological distress, and family functioning work together to affect global QoL. Interventions aiming to improve QoL among CRC survivors with permanent stomas should consider targeting these aspects.

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Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We are thankful for the generous contributions of the research participants and the staffs who assisted with data collection during the study.

Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 81773296 and No. 82272923).

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Authors and Affiliations

  1. Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, Shandong, 250012, People’s Republic of China

    Guopeng Li, Rui Qin, Xiangyu Zhao, Di Zhao & Ping Li

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  1. Guopeng Li
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  2. Rui Qin
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Contributions

All authors contributed to the study conception and design. Ping Li supervised the study implementation. Material preparation, data collection, and analysis were performed by Guopeng Li, Rui Qin, Xiangyu Zhao, and Di Zhao. The first draft of the manuscript was written by Guopeng Li and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ping Li.

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Ethics approval

The study was conducted in accordance with the Declaration of Helsinki, and approved by the University Human Research Ethics Committee (Approval No. 2020-R-053).

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Informed consent was obtained from all participants involved in the study.

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Li, G., Qin, R., Zhao, X. et al. Limitations on participation and global quality of life among CRC survivors with permanent stomas: moderated mediation analysis of psychological distress and family functioning. Support Care Cancer 31, 526 (2023). https://doi.org/10.1007/s00520-023-07993-z

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