Follow-up of health education based on WeChat platform on anxiety, depression and quality of life in patients with pulmonary nodules: a single-center study

Follow-up of health education based on WeChat platform on anxiety, depression and quality of life in patients with pulmonary nodules: a single-center study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Follow-up of health education based on WeChat platform on anxiety, depression and quality of life in patients with pulmonary nodules: a single-center study Jiang-Shan Huang, Zhen-yang Zhang, Yu-Kang Lin, Wen-wei Lin, Jia-fu Zhu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4232062/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 18 You are reading this latest preprint version Abstract Objective: The influence of health education based on WeChat platform on anxiety, depression and quality of life (QoL) of patients with indeterminate pulmonary nodules (IPNs). Method: IPNs from January 2020 to June 2022 were selected for follow-up. Self-questionnaire was used to subjectively evaluate patients' mental state, ASA and SDS questionnaires were used to objectively evaluate anxiety and depression, Fear of Progression Questionnaire-Short Form was used to evaluate patients' fear of disease, and SF-36 was used to evaluate patients' QoL. Results: After 6 months of follow-up, the WeChat group felt significantly less mental stress and sleep disturbance, fewer CT scans and multiple doctor visits than the traditional group; The anxiety, depression and fear of disease in the WeChat group was significantly less than that of the traditional group. The HRQoL of the two groups at 6 months of follow-up, the HRQoL of the WeChat group was lower than that of the traditional group. Conclusion: WeChat-based health education can effectively reduce anxiety and depression, improve disease fear, and improve HRQoL for patients with IPN; at the same time, it can reduce unnecessary radiation times. health education WeChat platform quality of life pulmonary nodules Background Pulmonary nodules (PNs) have been increasingly detected over the past decade due to the widespread use of low-dose computed tomography (LDCT) for screening or diagnostic purposes in the general population. Although less than 5% of patients are malignant [ 1 ], PNs are documented in up to approximately 30% of CT reports [ 2 ], leaving a substantial proportion of "indeterminate pulmonary nodules (IPNs). Due to the potential malignancy associated with IPN, a strict follow-up plan is usually required according to current clinical recommendations [ 3 ]. During follow-up, patients may require multiple CT scans and experience non-negligible psychological distress, such as anxiety or depression [ 4 ]. Since IPNs cannot be diagnosed immediately, patients must be monitored according to guidelines for months or even years before a final diagnosis, and this long wait places patients in a state of uncertainty [ 3 , 5 ], which is a powerful stressor and an important precursor to anxiety [ 6 ]. Fear of cancer was significantly associated with impaired health-related quality of life (HRQoL) [ 7 ], especially in patients who severely overestimated their lung cancer risk [ 8 ]. Several studies have investigated the psychological burden of lung cancer screening recipients [ 4 , 9 ]. However, in the Chinese expert consensus, severe anxiety or depression was proposed as one of the surgical indications for IPN, resulting in major differences in the management of IPN patients in China and Western countries [ 10 ]. Therefore, in China, trying to reduce the psychological pressure of patients and improve the HRQoL may reduce the overtreatment of IPNs. In the past, patients could only learn about IPNs through outpatient visits and online consultations. However, due to information asymmetry and the limitation of clinicians' energy, the psychological burden of patients cannot be effectively reduced. With advances in technology and the ubiquity of smartphones, WeChat has become one of the most popular social media and messaging apps in China for its low cost, speed and ease of face-to-face communication. It has become the main means for people to obtain and exchange information, and it is currently possible to provide medical and health services through WeChat [ 11 ]. WeChat can build a virtual social society among patients, clinicians and relatives. In this context, our platform based on smartphones and WeChat provides health education, professional knowledge popularization and follow-up services based on clinical experts. Therefore, this study explored the influence of health education based on WeChat platform on anxiety, depression and quality of life of patients with IPNs, and provided intervention strategies for the physical and mental health of patients with IPNs. Method Research object Patients with IPN found in the physical examination center from January 2020 to June 2022 were selected for follow-up. Inclusion criteria: 1) Patients > 18 years old; 2) Able to communicate well; 3) No visual or hearing impairment; 4) Can use WeChat smoothly; 5) Pulmonary nodules were first diagnosed by chest CT and the probability of malignancy was low as assessed by quantitative models (< 5%); 6) Willing to participate and sign informed consent. Exclusion criteria: 1) Patients with severe organ failure (such as liver and kidney failure), immune disease, history of other tumors, limb paralysis, cerebrovascular accident and other diseases that seriously affect the quality of life; 2) cognitive and mental dysfunction; 3) Did not participate in other psychological intervention at the same time; 4) No WeChat or unable to operate WeChat; 5) Refuse to participate in this study; 6) Data loss and loss of follow-up. Measurement methods Self-questionnaire The self-questionnaire consisted of 4 questions. Questions 1 and 2 were filled in at the first follow-up, which were mainly to evaluate the mental state of patients subjectively. Questions 3 and 4 were filled out during the 6-month follow-up, mainly to subjectively evaluate the actions the patient would take in the face of pulmonary nodules. Anxiety and Depression Assessment The evaluation tools used Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) [ 12 , 13 ]. Mental health assessments were carried out for all selected candidates. The assessors received professional training on mental assessment scales and were able to master them proficiently. The assessment time was the first visit to the doctor and the sixth month of follow-up, and the SDS and SAS scores of the patients were calculated respectively. HRQoL Assessment The standard Chinese translation version of the SF-36 score was used to evaluate the quality of life of patients after the operation. The SF-36 score consists of 36 standardization items. The results consist of eight scales: physical functioning (I), social functioning (II), role-physical (III), role-emotional (IV), mental health (V), vitality (VI), bodily pain (VII) and general health (VIII). We had specialized doctors help guide the patients in answering the questions. FoP-Q-SF Assessment Fear of Progression Questionnaire-Short Form (FoP-Q-SF), constructed by German scholar Mehnert in 2006, is used to measure the degree of fear of disease progression in patients diagnosed with chronic diseases and cancers [ 15 ]. The scale consists of 12 items and 2 dimensions, namely physical health and social and family dimensions. The physical health dimension mainly refers to patients' fear of their own disease and health; the social and family dimension mainly refers to their fear of their own disease and health. Each item is scored on a scale of 1–5 from "never" to "always", with a total score of 12–60 points. Intervention Patients in the WeChat group also received a 1-month WeChat-based follow-up service. We push relevant content to patients through the WeChat platform every week, including: 1) basic knowledge about pulmonary nodule disease, to help patients understand the relevant basic knowledge; 2) tertiary preventive measures for lung cancer; 3) reasonable nutrition and exercise, quit smoking and alcohol, stay away from related risk factors. The articles were written according to relevant guidelines and reviewed by at least two experts. At the same time, we will also send follow-up suggestions to the patients in the experimental group through the WeChat platform in the form of pictures, cartoons, videos, etc., including: 1) Standardized diagnosis and treatment and follow-up, avoid frequent CT in multiple hospitals in a short period of time; 2) Avoid over-treatment, regardless of benign, malignant, size, surgical resection is an over-treatment method. At the same time, patients can initiate communication requests on the WeChat platform at any time, and our team of professionals will answer patients' questions online from 18:00 to 20:00 every day and provide reasonable suggestions. Statistical method After recovering the survey data, review, collate, code and quantify it, and establish a database. After all the measurement data have passed the normal test, if they conform to the normal distribution, the t-test is used, and if they do not conform to the normal distribution, the non-parametric test (Mann-Whitney Test U test) is used for comparative analysis. Repeated measures analysis of variance was used to compare the quality of life between the two groups at different times. Count data were analyzed by chi-square test. The statistical software used is SPSS Statistics 26. Statistical data are expressed as mean ± standard deviation, and p < 0.05 is considered to have a significant statistical difference. Result After 1 month of intervention, 11 patients in the WeChat group were excluded, and 18 patients in the control group were excluded. The main reason for the exclusion was that they quit midway or did not complete the follow-up. In the end, 119 people were included in the WeChat group (average age 51.3 ± 6.1 years, 54 males and 65 females), and 112 people were included in the traditional group (average age 53.0 ± 8.7, 51 males and 61 females). There was no significant statistical difference between the two groups in the personal data of age, gender, marital status, smoking status, education level, nodule size, family history and tumor history. (See Table 1 for details) Table 1 Basic data of two groups of patients WeChat group traditional group P Gender (Male Female) 54/65 51/61 0.981 Age (years) 51.3 ± 6.1 53.0 ± 8.7 0.085 Marriage (married/divorced or widowed) 105/14 97/15 0.709 Smoking status (quit/not quit/no history) 19/16/20 22/12/22 0.670 Culture (elementary/junior high/high school) 23/24/12 25/20/11 0.814 nodule size 3.2 ± 0.9 3.3 ± 1.2 0.472 Family history of lung cancer (no/yes) 109/10 105/7 0.531 History of lung disease (no/yes) 101/18 98/14 0.564 In the self-questionnaire of the patients, 61.6% (69/112) of the patients in the control group felt obvious mental stress when they first found pulmonary nodules, while 59.7% (71/119) of the patients in the WeChat group felt mental stress, and there was no statistical difference in the distribution of the two groups (P = 0.978). The distribution of answers to the self-questionnaire is shown in Table 2 . Table 2 Patient Self-Questionnaire 1. Did you feel mentally stressed when you learned that you had pulmonary nodules? Answer very obvious obvious not obvious not at all P First discovered T group 24 45 31 12 0.978 W group 23 48 34 14 6 months later T group 21 38 36 17 0.011 W group 10 29 60 20 2. When you know pulmonary nodules, does pulmonary nodule affect your sleep? Answer very obvious obvious not obvious not at all P First discovered T group 16 30 41 25 0.935 W group 17 35 39 28 6 months later T group 12 23 44 38 0.044 W group 7 18 38 56 3. Have you reviewed CT since you learned about pulmonary nodules? Answer 2 or more times 1 time 0 times P T group 8 16 88 0.035 W group 4 7 108 4. During the period, did you visit other hospitals for further consultation? Answer 2 or more times 1 time 0 times P T group 11 21 80 0.046 W group 6 12 101 T group: Traditional group W group: WeChat group Table 3 Anxiety and depression in the two groups SAS SDS T group W group P T group W group P First discovered 64/55 59/53 0.867 60/59 58/54 0.836 6 months later 88/31 72/40 0.032 81/38 62/50 0.047 T group: Traditional group W group: WeChat group Table 4 Fear of Progression Questionnaire-Short Form in the two groups T group W group P First discovered 38.9 ± 5.8 37.8 ± 6.6 0.179 6 months later 29.1 ± 6.7 34.9 ± 7.8 0.000 Table 5 Evaluation of the HRQoL of the WeChat group and the traditional group First discovered 6 months later T group W group P T group W group P physical functioning 89 ± 12 88 ± 13 0.527 90 ± 19 91 ± 12 0.635 role-physical 92 ± 16 89 ± 17 0.168 89 ± 22 92 ± 19a 0.270 bodily pain 87 ± 15 88 ± 15 0.613 86 ± 18 89 ± 13 0.150 general health 88 ± 13 89 ± 15 0.588 87 ± 19 88 ± 15 0.659 vitality 75 ± 14 76 ± 17 0.625 82 ± 15 81 ± 21 0.613 social functioning 74 ± 16 73 ± 19 0.665 82 ± 17 77 ± 16 0.022 role-emotional 64 ± 11 66 ± 14 0.227 81 ± 18 75 ± 19 0.015 mental health 62 ± 17 64 ± 19 0.399 78 ± 21 72 ± 17 0.031 In terms of anxiety and depression, when pulmonary nodules were first discovered, there was no significant statistical difference between the traditional group and the WeChat group (P SAS =0.867; P SDS =0.836). After 6 months of follow-up, the number of anxiety and depression in the WeChat group decreased significantly, and there was a significant statistical difference compared with the traditional group (P SAS =0.032; P SDS =0.047). In terms of FoP-Q-SF, there was no significant difference in the scores of the two groups at the IPN were first discovered (P = 0.179); after 6 months of follow-up, the scores of the WeChat group were significantly lower than those of the traditional group, and statistically significance (P = 0.000). In terms of HRQoL, when IPN were first discovered, there was no statistical difference between the two groups in all aspects of quality of life, but the two groups had lower scores in role-emotional and mental health. After 6 months of follow-up, the HRQoL of the two groups has improved significantly in terms of emotional function and mental health, but the improvement of the WeChat group is more obvious than that of the traditional group, and there is a significant statistical difference. Discussion In recent years, with the popularization of CT scanning in annual physical examination, the prevalence of IPN in China has risen sharply. Numerous population-based studies have reported the psychological burden of IPN, and distress-related impairments in HRQoL may exceed nodule-specific impairments [ 4 , 9 , 16 ]. Psychological aspects are currently being considered in clinical work, but this requires shared decision-making that relies on patient-centered communication [ 10 ]. Therefore, in clinical work, we should try our best to reduce the psychological pressure of patients and improve the quality of life, which may reduce the overtreatment of benign nodules. However, in the face of a large number of patients in China, as a professional clinician, there is not enough time to reduce the psychological burden of patients. With the advancement of technology and the popularity of smartphones, WeChat has become the most popular social media and messaging application in China; it has the advantages of low cost, high speed, and convenient face-to-face communication, and has become the main way for people to obtain and exchange information means, and can also provide medical and health services through WeChat [ 11 ]. Due to the convenience of WeChat, the cost of health education is greatly reduced. Therefore, this article is the first time to intervene in patients with IPNs through health education on the WeChat platform, and to explore the impact on the psychological conditions and quality of life of patients with IPNs. It is initially found that WeChat-based health education can effectively reduce anxiety and depression, improve fear of disease, improve quality of life, and can effectively reduce unnecessary radiation times. Psychological burden, including anxiety, depression, and cancer-related distress, is common in patients with IPNs [ 17 ]. Clark et al reported that in the Netherlands-Belgium Randomized Lung Cancer Screening Trial (Nelson Trial), results showed increased cancer-specific distress in indeterminate patients [ 18 ].The author Rongxin Xiao believes that those with higher education levels are more prone to anxiety and depression, which may be related to differences in education systems and cultural backgrounds [ 19 ]. In this study, we found that our anxiety and depression levels are relatively high, which may be because our center, as a medical examination center of many public institutions, has a generally high level of education, but this requires further multi-center prospective research to identify relevant factors. Compared with facing physical pain, patients with IPN are far more tortured psychologically by the uncertain fear of disease progression to lung cancer. Fear of disease progression or recurrence is most common source of psychological distress among cancer survivors [ 20 ]. Nik et al. found that patients with head and neck cancer have a high level of fear of cancer progression, and interventions by health care providers for psychosocial supportive care of patients with head and neck cancer can effectively improve the fear of uncertainty [ 21 ]. This also tells us that psychological intervention can effectively improve the patient's sense of fear, and our research found that follow-up on WeChat can significantly reduce the sense of fear, and can also effectively reduce the number of patients' reexamination CT and reduce unnecessary radiation times. Cumulative radiation exposure from repeated CT scans has been reported to increase lung cancer risk, theoretically exceeding the risk associated with smoking [ 22 ]. Excessive radiation exposure may exacerbate psychological distress in some patients. In this study, the HRQoL of patients with IPN was assessed by using the SF-36 scale. The results showed that the patients scored lower on the mental total score (MCS), especially in the two domains of role-emotional and mental health. And after the intervention of WeChat group, the HRQoL in the spiritual aspect has been significantly improved. Therefore, interventions may be required to overcome psychological problems and improve HRQoL in patients with IPN. In other words, improvements in quality of life may be changes that lead to meaningful reductions in symptoms or improvements in functioning [ 23 ]. The Crosby RD scholar's study found that the HRQoL of IPN patients was significantly worse than that of the general population 6 months after the diagnosis process. Although one may think that IPN do not cause life disturbances, patients with such nodules have a lower HRQoL than the general population. Our study contributes to understanding the HRQoL of patients diagnosed with IPN and reveals possible targets for health education through WeChat to help such patients improve their HRQoL. Limitation Because our center is a physical examination center for multiple institutions, the research population is biased in terms of education, work, etc., and cannot represent most of the population. This is the biggest limitation of this study at present. At the same time, due to human and financial constraints, there is no long-term follow-up, and it is impossible to explore the anxiety and depression mental state and quality of life of patients with long-term nodules. This is also the direction of our future exploration. Finally, this study was conducted in a single center in southern China, and multi-center research will be adopted in the future. Conclusion WeChat-based health education can effectively reduce anxiety and depression, improve disease fear, and improve HRQoL for patients with IPN; at the same time, it can reduce unnecessary radiation times. Due to the convenience, wide application, and ease of use of the WeChat platform, WeChat health education can effectively improve the psychological state of patients with occasional pulmonary nodules, and is an effective strategy to improve physical and mental health. Declarations Funding: No. Competing interests All authors declared that they had no competing interests. Author Contribution Jiang-Shan Huang, Zhen-Yang Zhang, Yu-Kang Lin and Jiang-bo Lin wrote the main manuscript text and prepared the table. Wen-wei Lin and Jia-fu Zhu collected the clinical data. All authors reviewed the manuscript. Acknowledgments We highly acknowledge all the staff from our unit who participated in this study. Availability of Data and Materials: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request References National Lung Screening Trial Research Team; Church TR, Black WC, Aberle DR, Berg CD, Clingan KL, Duan F, Fagerstrom RM, Gareen IF, Gierada DS, Jones GC, Mahon I, Marcus PM, Sicks JD, Jain A, Baum S. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med. 2013 May 23;368(21):1980-91. Zheng C, Huang BZ, Agazaryan AA, Creekmur B, Osuj TA, Gould MK. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4232062","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":288606883,"identity":"aa74f835-3fea-427f-bb65-2fbeab03f24b","order_by":0,"name":"Jiang-Shan Huang","email":"","orcid":"","institution":"Fujian Medical University Union Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiang-Shan","middleName":"","lastName":"Huang","suffix":""},{"id":288606885,"identity":"edaefc57-a83d-4748-943e-534bfaffa80f","order_by":1,"name":"Zhen-yang Zhang","email":"","orcid":"","institution":"Fujian Medical University Union Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhen-yang","middleName":"","lastName":"Zhang","suffix":""},{"id":288606887,"identity":"836cefba-da5a-4718-9f42-d3fb299e97d7","order_by":2,"name":"Yu-Kang Lin","email":"","orcid":"","institution":"Fujian Medical University Union Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yu-Kang","middleName":"","lastName":"Lin","suffix":""},{"id":288606889,"identity":"9b8a15fd-cee4-4be1-98fe-21ac895a6878","order_by":3,"name":"Wen-wei Lin","email":"","orcid":"","institution":"Fujian Medical University Union Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wen-wei","middleName":"","lastName":"Lin","suffix":""},{"id":288606891,"identity":"ba24726f-bb01-4615-93f9-b434535283dd","order_by":4,"name":"Jia-fu Zhu","email":"","orcid":"","institution":"Fujian Medical University Union Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jia-fu","middleName":"","lastName":"Zhu","suffix":""},{"id":288606893,"identity":"817c57cb-3fa1-4dd8-81f9-ecf5fa8b1087","order_by":5,"name":"Jiang-bo Lin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYBACxmYQ0cAgw8bAfPDBBwMbO6K18LAxsCUbzihISybSKqAWBgYeM2meD4eAbAKAuZ352cOvO2x4+KR7zKRtDA4wM7AfProBv8PYzI1lz6TxsMkcK7bOMbjDx8CTlnaDgF/MpCXbDvOwSSRvvJ1j8IyZQYLHjIAW9m9QLQkG0hYGhxkbCGvhMZP8CNaSYiTNQKSWMmlGkF8k0pINewzSktkI+cWw//g2yZ87bOTkZyQffPDjj40dP/vhY/i1NAADmgdZhA2fchCQBznuByFVo2AUjIJRMLIBACO3Q80XQFgqAAAAAElFTkSuQmCC","orcid":"","institution":"Fujian Medical University Union Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jiang-bo","middleName":"","lastName":"Lin","suffix":""}],"badges":[],"createdAt":"2024-04-07 15:29:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4232062/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4232062/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54496066,"identity":"a1f33340-2089-4272-a823-da860b80792d","added_by":"auto","created_at":"2024-04-11 11:41:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":369848,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4232062/v1/1d2ef067-1466-4371-b42d-99fe399dda80.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Follow-up of health education based on WeChat platform on anxiety, depression and quality of life in patients with pulmonary nodules: a single-center study","fulltext":[{"header":"Background","content":"\u003cp\u003ePulmonary nodules (PNs) have been increasingly detected over the past decade due to the widespread use of low-dose computed tomography (LDCT) for screening or diagnostic purposes in the general population. Although less than 5% of patients are malignant [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], PNs are documented in up to approximately 30% of CT reports [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], leaving a substantial proportion of \"indeterminate pulmonary nodules (IPNs). Due to the potential malignancy associated with IPN, a strict follow-up plan is usually required according to current clinical recommendations [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. During follow-up, patients may require multiple CT scans and experience non-negligible psychological distress, such as anxiety or depression [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Since IPNs cannot be diagnosed immediately, patients must be monitored according to guidelines for months or even years before a final diagnosis, and this long wait places patients in a state of uncertainty [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], which is a powerful stressor and an important precursor to anxiety [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Fear of cancer was significantly associated with impaired health-related quality of life (HRQoL) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], especially in patients who severely overestimated their lung cancer risk [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Several studies have investigated the psychological burden of lung cancer screening recipients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, in the Chinese expert consensus, severe anxiety or depression was proposed as one of the surgical indications for IPN, resulting in major differences in the management of IPN patients in China and Western countries [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, in China, trying to reduce the psychological pressure of patients and improve the HRQoL may reduce the overtreatment of IPNs. In the past, patients could only learn about IPNs through outpatient visits and online consultations. However, due to information asymmetry and the limitation of clinicians' energy, the psychological burden of patients cannot be effectively reduced. With advances in technology and the ubiquity of smartphones, WeChat has become one of the most popular social media and messaging apps in China for its low cost, speed and ease of face-to-face communication. It has become the main means for people to obtain and exchange information, and it is currently possible to provide medical and health services through WeChat [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. WeChat can build a virtual social society among patients, clinicians and relatives. In this context, our platform based on smartphones and WeChat provides health education, professional knowledge popularization and follow-up services based on clinical experts. Therefore, this study explored the influence of health education based on WeChat platform on anxiety, depression and quality of life of patients with IPNs, and provided intervention strategies for the physical and mental health of patients with IPNs.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch object\u003c/h2\u003e \u003cp\u003ePatients with IPN found in the physical examination center from January 2020 to June 2022 were selected for follow-up. Inclusion criteria: 1) Patients \u0026gt; 18 years old; 2) Able to communicate well; 3) No visual or hearing impairment; 4) Can use WeChat smoothly; 5) Pulmonary nodules were first diagnosed by chest CT and the probability of malignancy was low as assessed by quantitative models (\u0026lt; 5%); 6) Willing to participate and sign informed consent. Exclusion criteria: 1) Patients with severe organ failure (such as liver and kidney failure), immune disease, history of other tumors, limb paralysis, cerebrovascular accident and other diseases that seriously affect the quality of life; 2) cognitive and mental dysfunction; 3) Did not participate in other psychological intervention at the same time; 4) No WeChat or unable to operate WeChat; 5) Refuse to participate in this study; 6) Data loss and loss of follow-up.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMeasurement methods\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eSelf-questionnaire\u003c/h2\u003e \u003cp\u003eThe self-questionnaire consisted of 4 questions. Questions 1 and 2 were filled in at the first follow-up, which were mainly to evaluate the mental state of patients subjectively. Questions 3 and 4 were filled out during the 6-month follow-up, mainly to subjectively evaluate the actions the patient would take in the face of pulmonary nodules.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eAnxiety and Depression Assessment\u003c/h2\u003e \u003cp\u003eThe evaluation tools used Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Mental health assessments were carried out for all selected candidates. The assessors received professional training on mental assessment scales and were able to master them proficiently. The assessment time was the first visit to the doctor and the sixth month of follow-up, and the SDS and SAS scores of the patients were calculated respectively.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eHRQoL Assessment\u003c/h2\u003e \u003cp\u003eThe standard Chinese translation version of the SF-36 score was used to evaluate the quality of life of patients after the operation. The SF-36 score consists of 36 standardization items. The results consist of eight scales: physical functioning (I), social functioning (II), role-physical (III), role-emotional (IV), mental health (V), vitality (VI), bodily pain (VII) and general health (VIII). We had specialized doctors help guide the patients in answering the questions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFoP-Q-SF Assessment\u003c/h2\u003e \u003cp\u003eFear of Progression Questionnaire-Short Form (FoP-Q-SF), constructed by German scholar Mehnert in 2006, is used to measure the degree of fear of disease progression in patients diagnosed with chronic diseases and cancers [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The scale consists of 12 items and 2 dimensions, namely physical health and social and family dimensions. The physical health dimension mainly refers to patients' fear of their own disease and health; the social and family dimension mainly refers to their fear of their own disease and health. Each item is scored on a scale of 1–5 from \"never\" to \"always\", with a total score of 12–60 points.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eIntervention\u003c/h2\u003e \u003cp\u003ePatients in the WeChat group also received a 1-month WeChat-based follow-up service. We push relevant content to patients through the WeChat platform every week, including: 1) basic knowledge about pulmonary nodule disease, to help patients understand the relevant basic knowledge; 2) tertiary preventive measures for lung cancer; 3) reasonable nutrition and exercise, quit smoking and alcohol, stay away from related risk factors. The articles were written according to relevant guidelines and reviewed by at least two experts. At the same time, we will also send follow-up suggestions to the patients in the experimental group through the WeChat platform in the form of pictures, cartoons, videos, etc., including: 1) Standardized diagnosis and treatment and follow-up, avoid frequent CT in multiple hospitals in a short period of time; 2) Avoid over-treatment, regardless of benign, malignant, size, surgical resection is an over-treatment method. At the same time, patients can initiate communication requests on the WeChat platform at any time, and our team of professionals will answer patients' questions online from 18:00 to 20:00 every day and provide reasonable suggestions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical method\u003c/h2\u003e \u003cp\u003eAfter recovering the survey data, review, collate, code and quantify it, and establish a database. After all the measurement data have passed the normal test, if they conform to the normal distribution, the t-test is used, and if they do not conform to the normal distribution, the non-parametric test (Mann-Whitney Test U test) is used for comparative analysis. Repeated measures analysis of variance was used to compare the quality of life between the two groups at different times. Count data were analyzed by chi-square test. The statistical software used is SPSS Statistics 26. Statistical data are expressed as mean ± standard deviation, and p \u0026lt; 0.05 is considered to have a significant statistical difference.\u003c/p\u003e \u003c/div\u003e "},{"header":"Result","content":"\u003cp\u003eAfter 1 month of intervention, 11 patients in the WeChat group were excluded, and 18 patients in the control group were excluded. The main reason for the exclusion was that they quit midway or did not complete the follow-up. In the end, 119 people were included in the WeChat group (average age 51.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1 years, 54 males and 65 females), and 112 people were included in the traditional group (average age 53.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7, 51 males and 61 females). There was no significant statistical difference between the two groups in the personal data of age, gender, marital status, smoking status, education level, nodule size, family history and tumor history. (See Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e for details)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBasic data of two groups of patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWeChat group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003etraditional group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender (Male Female)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54/65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51/61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarriage (married/divorced or widowed)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105/14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97/15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.709\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status (quit/not quit/no history)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19/16/20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22/12/22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCulture (elementary/junior high/high school)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23/24/12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25/20/11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.814\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003enodule size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.472\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history of lung cancer (no/yes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of lung disease (no/yes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101/18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98/14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.564\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIn the self-questionnaire of the patients, 61.6% (69/112) of the patients in the control group felt obvious mental stress when they first found pulmonary nodules, while 59.7% (71/119) of the patients in the WeChat group felt mental stress, and there was no statistical difference in the distribution of the two groups (P\u0026thinsp;=\u0026thinsp;0.978). The distribution of answers to the self-questionnaire is shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePatient Self-Questionnaire\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e1. Did you feel mentally stressed when you learned that you had pulmonary nodules?\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAnswer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003every obvious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eobvious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003enot obvious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enot at all\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFirst discovered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eW group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e6 months later\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eW group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e2. When you know pulmonary nodules, does pulmonary nodule affect your sleep?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAnswer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003every obvious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eobvious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003enot obvious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enot at all\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFirst discovered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eW group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e6 months later\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eW group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e3. Have you reviewed CT since you learned about pulmonary nodules?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eAnswer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2 or more times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1 time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0 times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eT group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eW group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e4. During the period, did you visit other hospitals for further consultation?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eAnswer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2 or more times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1 time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0 times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eT group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eW group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\"\u003eT group: Traditional group\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\"\u003eW group: WeChat group\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAnxiety and depression in the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eSAS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eSDS\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eW group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eW group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst discovered\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64/55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59/53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60/59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58/54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.836\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months later\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72/40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81/38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62/50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eT group: Traditional group\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eW group: WeChat group\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cstrong\u003eFear of Progression Questionnaire-Short Form in the two groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eW group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst discovered\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months later\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eEvaluation of the HRQoL of the WeChat group and the traditional group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eFirst discovered\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e6 months later\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eW group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eW group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ephysical functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90\u0026thinsp;\u0026plusmn;\u0026thinsp;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003erole-physical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92\u0026thinsp;\u0026plusmn;\u0026thinsp;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89\u0026thinsp;\u0026plusmn;\u0026thinsp;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92\u0026thinsp;\u0026plusmn;\u0026thinsp;19a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ebodily pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003egeneral health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u0026thinsp;\u0026plusmn;\u0026thinsp;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003evitality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81\u0026thinsp;\u0026plusmn;\u0026thinsp;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esocial functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74\u0026thinsp;\u0026plusmn;\u0026thinsp;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73\u0026thinsp;\u0026plusmn;\u0026thinsp;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u0026thinsp;\u0026plusmn;\u0026thinsp;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003erole-emotional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u0026thinsp;\u0026plusmn;\u0026thinsp;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emental health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u0026thinsp;\u0026plusmn;\u0026thinsp;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78\u0026thinsp;\u0026plusmn;\u0026thinsp;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIn terms of anxiety and depression, when pulmonary nodules were first discovered, there was no significant statistical difference between the traditional group and the WeChat group (P\u003csub\u003eSAS\u003c/sub\u003e=0.867; P\u003csub\u003eSDS\u003c/sub\u003e=0.836). After 6 months of follow-up, the number of anxiety and depression in the WeChat group decreased significantly, and there was a significant statistical difference compared with the traditional group (P\u003csub\u003eSAS\u003c/sub\u003e=0.032; P\u003csub\u003eSDS\u003c/sub\u003e=0.047). In terms of FoP-Q-SF, there was no significant difference in the scores of the two groups at the IPN were first discovered (P\u0026thinsp;=\u0026thinsp;0.179); after 6 months of follow-up, the scores of the WeChat group were significantly lower than those of the traditional group, and statistically significance (P\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e\n\u003cp\u003eIn terms of HRQoL, when IPN were first discovered, there was no statistical difference between the two groups in all aspects of quality of life, but the two groups had lower scores in role-emotional and mental health. After 6 months of follow-up, the HRQoL of the two groups has improved significantly in terms of emotional function and mental health, but the improvement of the WeChat group is more obvious than that of the traditional group, and there is a significant statistical difference.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn recent years, with the popularization of CT scanning in annual physical examination, the prevalence of IPN in China has risen sharply. Numerous population-based studies have reported the psychological burden of IPN, and distress-related impairments in HRQoL may exceed nodule-specific impairments [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Psychological aspects are currently being considered in clinical work, but this requires shared decision-making that relies on patient-centered communication [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, in clinical work, we should try our best to reduce the psychological pressure of patients and improve the quality of life, which may reduce the overtreatment of benign nodules. However, in the face of a large number of patients in China, as a professional clinician, there is not enough time to reduce the psychological burden of patients. With the advancement of technology and the popularity of smartphones, WeChat has become the most popular social media and messaging application in China; it has the advantages of low cost, high speed, and convenient face-to-face communication, and has become the main way for people to obtain and exchange information means, and can also provide medical and health services through WeChat [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Due to the convenience of WeChat, the cost of health education is greatly reduced. Therefore, this article is the first time to intervene in patients with IPNs through health education on the WeChat platform, and to explore the impact on the psychological conditions and quality of life of patients with IPNs. It is initially found that WeChat-based health education can effectively reduce anxiety and depression, improve fear of disease, improve quality of life, and can effectively reduce unnecessary radiation times.\u003c/p\u003e \u003cp\u003ePsychological burden, including anxiety, depression, and cancer-related distress, is common in patients with IPNs [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Clark et al reported that in the Netherlands-Belgium Randomized Lung Cancer Screening Trial (Nelson Trial), results showed increased cancer-specific distress in indeterminate patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].The author Rongxin Xiao believes that those with higher education levels are more prone to anxiety and depression, which may be related to differences in education systems and cultural backgrounds [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In this study, we found that our anxiety and depression levels are relatively high, which may be because our center, as a medical examination center of many public institutions, has a generally high level of education, but this requires further multi-center prospective research to identify relevant factors. Compared with facing physical pain, patients with IPN are far more tortured psychologically by the uncertain fear of disease progression to lung cancer. Fear of disease progression or recurrence is most common source of psychological distress among cancer survivors [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Nik et al. found that patients with head and neck cancer have a high level of fear of cancer progression, and interventions by health care providers for psychosocial supportive care of patients with head and neck cancer can effectively improve the fear of uncertainty [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This also tells us that psychological intervention can effectively improve the patient's sense of fear, and our research found that follow-up on WeChat can significantly reduce the sense of fear, and can also effectively reduce the number of patients' reexamination CT and reduce unnecessary radiation times. Cumulative radiation exposure from repeated CT scans has been reported to increase lung cancer risk, theoretically exceeding the risk associated with smoking [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Excessive radiation exposure may exacerbate psychological distress in some patients.\u003c/p\u003e \u003cp\u003eIn this study, the HRQoL of patients with IPN was assessed by using the SF-36 scale. The results showed that the patients scored lower on the mental total score (MCS), especially in the two domains of role-emotional and mental health. And after the intervention of WeChat group, the HRQoL in the spiritual aspect has been significantly improved. Therefore, interventions may be required to overcome psychological problems and improve HRQoL in patients with IPN. In other words, improvements in quality of life may be changes that lead to meaningful reductions in symptoms or improvements in functioning [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The Crosby RD scholar's study found that the HRQoL of IPN patients was significantly worse than that of the general population 6 months after the diagnosis process. Although one may think that IPN do not cause life disturbances, patients with such nodules have a lower HRQoL than the general population. Our study contributes to understanding the HRQoL of patients diagnosed with IPN and reveals possible targets for health education through WeChat to help such patients improve their HRQoL.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eBecause our center is a physical examination center for multiple institutions, the research population is biased in terms of education, work, etc., and cannot represent most of the population. This is the biggest limitation of this study at present. At the same time, due to human and financial constraints, there is no long-term follow-up, and it is impossible to explore the anxiety and depression mental state and quality of life of patients with long-term nodules. This is also the direction of our future exploration. Finally, this study was conducted in a single center in southern China, and multi-center research will be adopted in the future.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWeChat-based health education can effectively reduce anxiety and depression, improve disease fear, and improve HRQoL for patients with IPN; at the same time, it can reduce unnecessary radiation times. Due to the convenience, wide application, and ease of use of the WeChat platform, WeChat health education can effectively improve the psychological state of patients with occasional pulmonary nodules, and is an effective strategy to improve physical and mental health.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNo.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eAll authors declared that they had no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJiang-Shan Huang, Zhen-Yang Zhang, Yu-Kang Lin and Jiang-bo Lin wrote the main manuscript text and prepared the table. Wen-wei Lin and Jia-fu Zhu collected the clinical data. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eWe highly acknowledge all the staff from our unit who participated in this study.\u003c/p\u003e\u003ch2\u003eAvailability of Data and Materials:\u003c/h2\u003e \u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eNational Lung Screening Trial Research Team; Church TR, Black WC, Aberle DR, Berg CD, Clingan KL, Duan F, Fagerstrom RM, Gareen IF, Gierada DS, Jones GC, Mahon I, Marcus PM, Sicks JD, Jain A, Baum S. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med. 2013 May 23;368(21):1980-91.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eZheng C, Huang BZ, Agazaryan AA, Creekmur B, Osuj TA, Gould MK. Natural Language Processing to Identify Pulmonary Nodules and Extract Nodule Characteristics From Radiology Reports. Chest. 2021 Nov;160(5):1902-1914.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, Mehta AC, Ohno Y, Powell CA, Prokop M, Rubin GD, Schaefer-Prokop CM, Travis WD, Van Schil PE, Bankier AA. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017 Jul;284(1):228-243.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWu GX, Raz DJ, Brown L, Sun V. Psychological Burden Associated With Lung Cancer Screening: A Systematic Review. Clin Lung Cancer. 2016 Sep;17(5):315-324.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHarris RP, Sheridan SL, Lewis CL, Barclay C, Vu MB, Kistler CE, Golin CE, DeFrank JT, Brewer NT. The harms of screening: a proposed taxonomy and application to lung cancer screening. 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Transl Lung Cancer Res. 2021 May;10(5):2427-2440.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJiang G, Chen C, Zhu Y, Xie D, Dai J, Jin K, Shen Y, Wang H, Li H, Zhang L, Gao S, Chen K, Zhang L, Zhou X, Shi J, Wang H, Xie B, Jiang L, Fan J, Zhao D, Chen Q, Duan L, He W, Zhou Y, Liu H, Zhao X, Zhang P, Qin X. [Shanghai Pulmonary Hospital Experts Consensus on the Management of Ground-Glass Nodules Suspected as Lung Adenocarcinoma (Version 1)]. Zhongguo Fei Ai Za Zhi. 2018 Mar 20;21(3):147-159. Chinese.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eYang HL, Luan XR, Zhao LL, Wang JW, Chen YY. Design and Application of Health Education Apps Based on WeChat for Self-Management among Patients. Iran J Public Health. 2022 May;51(5):1020-1029.\u003c/li\u003e\n \u003cli\u003eZung WW. The Depression Status Inventory: an adjunct to the Self-Rating Depression Scale. J Clin Psychol. 1972 Oct;28(4):539-43.\u003c/li\u003e\n \u003cli\u003eZung WW. A rating instrument for anxiety disorders. 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Fear of cancer recurrence: a theoretical review and its relevance for clinical presentation and management. Psychooncology. 2017 Oct;26(10):1444-1454.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNik Jaafar NR, Hamdan NA, Abd Hamid N, Rajandram RK, Mahadevan R, Zakaria H, Mohamad Yunus MR, Leong Bin Abdullah MFI. Posttraumatic growth and its association with unmet supportive care needs and fear of cancer progression among head and neck cancer patients. PLoS One. 2022 Mar 15;17(3):e0265502.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMcCunney RJ, Li J. Radiation Risks in Lung Cancer Screening Programs. Chest. 2014 Mar;145(3):618-624.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCrosby RD, Kolotkin RL, Williams GR. Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol. 2003 May;56(5):395-407.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"health education, WeChat platform, quality of life, pulmonary nodules ","lastPublishedDoi":"10.21203/rs.3.rs-4232062/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4232062/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThe influence of health education based on WeChat platform on anxiety, depression and quality of life (QoL) of patients with indeterminate pulmonary nodules (IPNs).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e IPNs from January 2020 to June 2022 were selected for follow-up. Self-questionnaire was used to subjectively evaluate patients' mental state, ASA and SDS questionnaires were used to objectively evaluate anxiety and depression, Fear of Progression Questionnaire-Short Form was used to evaluate patients' fear of disease, and SF-36 was used to evaluate patients' QoL.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAfter 6 months of follow-up, the WeChat group felt significantly less mental stress and sleep disturbance, fewer CT scans and multiple doctor visits than the traditional group; The anxiety, depression and fear of disease in the WeChat group was significantly less than that of the traditional group. The HRQoL of the two groups at 6 months of follow-up, the HRQoL of the WeChat group was lower than that of the traditional group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eWeChat-based health education can effectively reduce anxiety and depression, improve disease fear, and improve HRQoL for patients with IPN; at the same time, it can reduce unnecessary radiation times.\u003c/p\u003e","manuscriptTitle":"Follow-up of health education based on WeChat platform on anxiety, depression and quality of life in patients with pulmonary nodules: a single-center study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-11 11:33:18","doi":"10.21203/rs.3.rs-4232062/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-29T16:42:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-29T19:25:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-29T03:07:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-27T23:36:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109668570610977782753013839002564024868","date":"2024-06-25T16:58:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-25T09:31:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"279043698092787915900137158436189950509","date":"2024-06-23T09:38:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"110671405969541314354645253641656076416","date":"2024-06-22T14:53:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132044361927024148459431192542028111779","date":"2024-06-21T03:30:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"190829435917038600287758238156400404439","date":"2024-06-20T17:16:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-07T12:35:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283818948296075134079504147207525912738","date":"2024-05-06T17:45:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115689504416540244113061063134704908170","date":"2024-05-01T20:06:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96590137565835172203410878646265565269","date":"2024-05-01T18:57:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-01T17:01:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-08T04:09:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-08T04:09:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2024-04-07T15:28:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"16bba9ed-38a7-4c0f-b7f2-b57b8a850de1","owner":[],"postedDate":"April 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-11-21T17:38:35+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-11 11:33:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4232062","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4232062","identity":"rs-4232062","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}