Clinical practice and research on the psychological cognitive ability under the IKAP model in postoperative flap healing and psychological influencing factors in breast cancer
Abstract
Objective: To investigate the impact of psychological cognitive ability on flap healing and psychological factors in postoperative breast cancer (BC) individuals under the Information-Knowledge-Attitude-Practice (IKAP) model. Methods: A total of 123 postoperative BC individuals treated at our hospital between April 2022 and April 2023 were selected for the study. They were randomly assigned into a control group (CG, routine nursing model, n = 61) and an observation group (OG, IKAP model-based psychological cognitive ability intervention, n = 62) using a random number table method. The observation group, on the basis of routine care, combined the IKAP model for psychological and cognitive ability intervention. This included providing personalized health education information, enhancing the patients’ knowledge level, changing their attitudes towards the disease, and promoting the implementation of healthy behaviors through psychological counseling and practical training. The healing rates, healing times, and differences in cognitive ability, psychological status, and quality of life scores before and after the intervention were compared involving the two groupings. The impact of cognitive ability on flap healing and psychological factors was also analyzed. Results: After 2 weeks of intervention, the healing rate in the OG was higher than that of the CG [72.58% (45/62) vs. 54.10% (33/61)] (χ2 = 4.527, P = 0.033). The healing time in the OG was shorter than in the CG, but the difference was not considerable (P > 0.05). After 2 weeks of intervention, the two groups showed differences in their Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) scores [(7.73 ± 1.61) vs. (6.08 ± 1.53)], and Functional Assessment of Cancer Therapy-Breast (FACT-B) scores [(92.38 ± 6.43)], with the OG showing more significant improvements (P < 0.05). Compared to the unhealed group, the healed group had higher FACT-Cog and FACT-B scores, and lower HADS scores (P < 0.05). Cognitive ability directly predicted flap healing (β = 0.521, P < 0.001) and also influenced it indirectly through psychological factors (β = 0.537, P < 0.001). The mediating effect of psychological factors accounted for 69.17%, and the direct effect of cognitive ability accounted for 30.65%. This shows that cognitive ability affects flap healing both directly and indirectly through psychological changes. Conclusion: The IKAP model can significantly enhance patients’ cognitive ability and quality of life, shorten healing time, and, through the mediation of psychological factors, further promote flap healing. This provides a new perspective and method for comprehensive rehabilitation in postoperative BC patients.
Copyright (c) 2025 Author(s)
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
1. Katsura C, Ogunmwonyi I, Kankam HK, et al. Breast cancer: presentation, investigation and management. British Journal of Hospital Medicine. 2022; 83(2): 1-7. doi: 10.12968/hmed.2021.0459
2. Kashyap D, Pal D, Sharma R, et al. [Retracted] Global Increase in Breast Cancer Incidence: Risk Factors and Preventive Measures. BioMed Research International. 2022; 2022(1). doi: 10.1155/2022/9605439
3. Al-Hilli Z, Wilkerson A. Breast Surgery. Surgical Clinics of North America. 2021; 101(5): 845-863. doi: 10.1016/j.suc.2021.06.014
4. Aydin M, Kose E, Odabas I, et al. The Effect of Exercise on Life Quality and Depression Levels of Breast Cancer Patients. Asian Pacific Journal of Cancer Prevention. 2021; 22(3): 725-732. doi: 10.31557/apjcp.2021.22.3.725
5. Liu W, Liu J, Ma L, et al. Effect of mindfulness yoga on anxiety and depression in early breast cancer patients received adjuvant chemotherapy: a randomized clinical trial. Journal of Cancer Research and Clinical Oncology. 2022; 148(9): 2549-2560. doi: 10.1007/s00432-022-04167-y
6. Chiu A, Jia W, Sun Y, et al. Fibroblast-Generated Extracellular Matrix Guides Anastomosis during Wound Healing in an Engineered Lymphatic Skin Flap. Bioengineering. 2023; 10(2): 149. doi: 10.3390/bioengineering10020149
7. Ishii Y, Matsuki H, Uozumi N, et al. Latissimus dorsi musculocutaneous flap grafting to the infected recipient site in a patient with irradiated locally advanced breast cancer and multiple lung metastases. Surgical Case Reports. 2023; 9(1). doi: 10.1186/s40792-023-01711-x
8. Shi B, Lin Z, Shi X, et al. Effects of a lymphedema prevention program based on the theory of knowledge–attitude–practice on postoperative breast cancer patients: a randomized clinical trial[J]. Cancer Medicine, 2023, 12(14): 15468-15481. doi: 10.1002/cam4.6171
9. Qin Y, Lu J, Li S, et al. Knowledge, Attitude, and Practice of Breast Cancer Patients Toward Lymphedema Complications: Cross-Sectional Study[J]. Journal of Cancer Education, 2023, 38(6): 1910-1917. doi: 10.1007/s13187-023-02357-x
10. Hassan B, Mohammed AH, Alsammarraie AZA, et al. Knowledge, Attitude, and Practice of Oncologists toward Chemotherapy Resistance: A Questionnaire Development and Pilot Testing. Asian Pacific Journal of Cancer Prevention. 2022; 23(12): 4275-4284. doi: 10.31557/apjcp.2022.23.12.4275
11. Giuliano AE, Connolly JL, Edge SB, et al. Breast Cancer—Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA: A Cancer Journal for Clinicians. 2017; 67(4): 290-303. doi: 10.3322/caac.21393
12. Cheung YT, Chan A. Linguistic validation of Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog): methodological concerns. Supportive Care in Cancer. 2012; 21(3): 655-656. doi: 10.1007/s00520-012-1631-4
13. Brady MJ, Cella DF, Mo F, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. Journal of Clinical Oncology. 1997; 15(3): 974-986. doi: 10.1200/jco.1997.15.3.974
14. Smarr KL, Keefer AL. Measures of depression and depressive symptoms: Beck Depression Inventory‐II (BDI‐II), Center for Epidemiologic Studies Depression Scale (CES‐D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire‐9 (PHQ‐9). Arthritis Care & Research. 2011; 63(S11). doi: 10.1002/acr.20556
15. Rossi L, Mazzara C, Pagani O. Diagnosis and Treatment of Breast Cancer in Young Women. Current Treatment Options in Oncology. 2019; 20(12). doi: 10.1007/s11864-019-0685-7
16. Patel VL, Arocha JF, Diermeier M, et al. Cognitive psychological studies of representation and use of clinical practice guidelines. International Journal of Medical Informatics. 2001; 63(3): 147-167. doi: 10.1016/S1386-5056(01)00165-4
17. Decker SL, Hale JB, Flanagan DP. Professional practice issues in the assessment of cognitive functioning for educational applications. Psychology in the Schools. 2013; 50(3): 300-313. doi: 10.1002/pits.21675
18. Hausknecht JP, Halpert JA, Di Paolo NT, et al. Retesting in selection: a meta-analysis of coaching and practice effects for tests of cognitive ability. Journal of Applied Psychology. 2007; 92(2): 373. doi: 10.1037/0021-9010.92.2.373
19. Godefroy O, Gibbons L, Diouf M, et al. Validation of an integrated method for determining cognitive ability: implications for routine assessments and clinical trials. Cortex. 2014; 54: 51-62. doi: 10.1016/j.cortex.2014.01.016
20. Sartori AC, Vance DE, Slater LZ, et al. The impact of inflammation on cognitive function in older adults: implications for healthcare practice and research. Journal of Neuroscience Nursing. 2012; 44(4): 206-217. doi: 10.1097/JNN.0b013e3182527690
