Analysis of latent profiles of stressors and their influencing factors in patients with breast cancer undergoing postoperative chemotherapy: a mixed-methods study.

OBJECTIVE: To explore the heterogeneity of stress experiences, identify latent stressor profiles, and analyze their influencing factors in patients with breast cancer undergoing postoperative chemotherapy, in order to provide evidence for implementing precise psychosocial interventions. METHODS: An explanatory sequential mixed-methods design was employed. A total of 232 patients with breast cancer undergoing postoperative chemotherapy at Nantong University Affiliated Hospital were conveniently sampled and participated in a cross-sectional survey using a general information questionnaire and the Chinese version of the Stressor Scale for Breast Cancer Patients. Latent profile analysis (LPA) was used to identify heterogeneous subgroups of stress experience, and multinomial logistic regression was conducted to analyze the influencing factors. Subsequently, 12 patients belonging to different stress profiles were purposively sampled for semi-structured interviews. Thematic analysis was performed on the interview transcripts using Colaizzi's phenomenological method to extract core themes. RESULTS: The stress experiences of patients with breast cancer undergoing postoperative chemotherapy presented four distinct latent profiles: 'Low-stress Adaptive Profile' (26.3%), 'Moderate-High Physio-Psychological Distress Profile' (38.4%), 'High Medical Concerns Profile' (20.3%), and 'High-Stress Across Domains Profile' (15.1%). Multinomial logistic regression analysis revealed that older age was a protective factor. For each one-year increase in age, the risk of belonging to the 'Moderate-High Physio-Psychological Distress Profile' (OR = 0.94, 95%CI: 0.90-0.98) and the 'High-Stress Across Domains Profile' (OR = 0.91, 95% CI: 0.86-0.96) decreased. Advanced clinical stage (Stage III) was an independent risk factor for belonging to the 'High Medical Concerns Profile'(OR=2.20, 95%CI: 1.02-4.75) and the 'High-Stress Across Domains Profile' (OR=4.80, 95%CI: 1.85-12.45). Furthermore, low monthly family income (≤5000 RMB, OR = 3.50,95%CI: 1.25-9.80) and the presence of treatment-related complications(OR=2.80, 95%CI: 1.15-6.82)significantly increased the risk of belonging to the 'High-Stress Across Domains Profile'. Qualitative interviews yielded three core themes: 'Intertwined and Impactful Multiple Stressors', 'Depletion and Dysregulation of Internal Psychological Resources', and the 'Double-Edged Sword Effect of External Support Systems'. CONCLUSION: The stress experiences of patients with breast cancer undergoing postoperative chemotherapy exhibit significant heterogeneity, with over 70% experiencing moderate to high levels of stress. Clinical practice should incorporate stress profile identification. Targeted support, such as enhanced information and decision-making aids for patients in the 'High Medical Concerns Profile' and multi-dimensional integrated interventions for those in the 'High-Stress Across Domains Profile', is recommended to achieve precise psychosocial support.