The Causal Relationship Among Elements Comprising Laryngectomized Patients' Psychological Adjustment at 3 and 6 Months after Discharge

Kotake, Kumiko

Wednesday, 24 July 2013

Kumiko Kotake, PhD, RN, MSN
Faculty of Health care and Nursing, Graduate school of Health Care and Nursing, Juntendo University, Urayasu, Japan
Yoshimi Suzukamo, PhD
Department of Physical Medicine and Rehabilitation, Tohoku University, Graduate School of Medicine, Sendai, Japan
Ichiro Kai, MD, MPH
Social GerontologySchool of Public Health, The University of Tokyo, Tokyo, Japan
Kazuyo Iwanaga, RN, MS
School of Nursing, Fukuoka-University, Fukuoka, Japan
Aya Takahashi, RN, PHN, MSN
Faculty of Health SciencesCDepartment of Nursing, Saitama Prefectural University, Koshigaya, Japan
Yuki Nagamatsu, RN, MSN
Department of Adult Health Nursing, Kurume University School of Nursing, Kurume, Japan
Kaori Haba, RN, PHN, MSN
Faculty of Health and Nursing, Juntendo University, Urayasu, Japan
Rieko Kawamoto, PhD, RN
Depatment of health Sciences, Kyushu University, Fukuoka, Japan

Learning Objective 1: The learner will be able to used as fundamental materials for cancer nursing care in this sutdy.

Learning Objective 2: The learner will be able to know the psychological adjustment component for the laryngectmized patients.

Purpose: A 3-layer structure of psychological adjustment among laryngectomized patients was reported in a previous cross-sectional study (Kotake et al., 2008): Increased recognition of the self as a voluntary agent led to increased acceptance of one’s disability. However, this study did not verify a causal relationship. Therefore, the current study attempts to determine a causal relationship between elements comprising psychological adjustment among laryngectomized patients at 3 months and 6 months after discharge.

Methods: One hundred and twenty-eight laryngectomized patients (followed-up at 3 and 6 months after discharge) completed 6 subscales of the Nottingham Adjustment Scale: anxiety, depression, attitude, positive affirmation (acceptance of disability), self-efficacy, and self-esteem. Structural equation modeling was used for analysis. Synchronous effects models (models 1 and 2) and a cross-lagged model (model 3) were used to validate the causal relationship observed in the longitudinal data, which was followed by hypothesis generation.

Results: Mean age at 3 months after discharge was 63.1 ± 7.2 years and 63.7 ± 6.8 years at 6 months. Values were as follows: model 1: chi squared = 88.0, GFI = .909, AGFI = .831; model 2: chi squared = 76.8, GFI = .917, AGFI = .833; model 3: chi squared = 71.2, GFI = .917, AGFI = .922. All 3 models had relatively good fit (ps < 0.05), supporting our hypothesis.

Conclusion: A causal relationship was verified from our longitudinal data: Laryngectomized patients’ psychological adjustment was initiated by the recognition of oneself as a voluntary agent, followed by the acceptance of one’s disability and internal value as a human being.

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