Fear of progression in patients with cervical precancerous lesions: a cross-sectional survey

Fear of progression in patients with cervical precancerous lesions: a cross-sectional survey | 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 Fear of progression in patients with cervical precancerous lesions: a cross-sectional survey Xiao-Hong Jin, Xiao-Man Liu, Hai-Yan Huang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4423438/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Sep, 2025 Read the published version in BMC Psychology → Version 1 posted 4 You are reading this latest preprint version Abstract Background FOP is a psychological experience of excessive fear that threatens the mental and physical health of patients, resulting in poor treatment outcomes and decreased quality of life. This study aimed at investigating the associations among anxiety, coping modes, and FOP in patients with cervical precancerous lesions. Methods This is a cross-sectional study that includes 167 patients with cervical precancerous lesions. Patients filled out the FOP Questionnaire, the Self‑Rating Anxiety Scale, and the Medical Coping Modes Questionnaire. The parallel mediation analysis was used to evaluate the mediating role of different coping styles in the relationship between anxiety and FOP. Results The scores of FOP in patients with precancerous cervical lesions was 27.84±10.51.. The potential predictors of FOP among patients were anxiety ( β =0.175, P =0.015), confrontation ( β =-0.188, P =0.009), avoidance ( β =0.229, P =0.002), resignation ( β =0.181, P <0.001), family history of cervical cancer ( β =0.221, P =0.001). Parallel mediation results show that confrontationand resignation played the mediating role in the relationship between anxiety and FOP. Conclusion As expected, Anxiety, confrontation, avoidance, resignation, and family history of cervical cancer are potential predictors of FOP in patients. The results of parallel mediation showed that confrontation and resignation played a mediating role in the relationship between anxiety and FOP.. The results suggest that medical staff need to give them professional medical knowledge and guide them to adopt appropriate and positive coping styles. Fear of progression Anxiety Coping Modes Cervical precancerous lesions Figures Figure 1 Figure 2 Introduction Cervical cancer is the fourth most common cancer in women, with about 570,000 new cases and 311,000 deaths worldwide in 2018. There are about 106,000 new cases of cervical cancer and 48,000 deaths, and cervical cancer remains an important public health problem affecting women's health[ 1 ]. Patients go through the process of HPV infection, to cervical precancerous lesions and then to cervical cancer. Most low-grade precancerous cervical lesions resolve spontaneously, but high-grade precancerous cervical lesions have the potential to become cancerous and can progress to cervical cancer[ 2 ]. Patients at different stages of the disease face different pressures, resulting in a lot of negative emotions that negatively affect their physical and mental health to varying degrees[ 3 , 4 ]. In recent years, with the improvement of people's awareness of the disease, more and more cervical cancer cases have been diagnosed and treated early. In the early stage of cervical intraepithelial lesions, patients can take interferon therapy, cervical conization and other methods to alleviate or relieve the deterioration of the disease. However, patients in the precancerous stage face a great risk of cancer, with a roughly 50% probability of becoming cancerous[ 5 ], which leads to negative emotions such as fear, anxiety, and stigma[ 6 , 7 ].. As a result, many patients with cervical precancerous lesions will be chronically ill and very fearful of the progression of the disease, because, cervical cancer implies a threat to the patient's life. Fear of progression (FOP) is a psychological state in which an individual feels extreme fear and concern about the possibility of further deterioration or worsening of his or her health status or that of others. From a psychological point of view, fear of progression is a common and normal psychological reaction in patients[ 8 , 9 ]. Previous studies have shown that FOP is one of the common distressing symptoms in cancer patients, with a prevalence of roughly 31%-82.5% in adolescents and adults with cancer[ 10 ]. Excessive concern or fear can lead to a range of inappropriate behavioral, cognitive, and emotional responses, such as avoidance of follow-up or screening, frequent visits to the doctor, and increased psychological distress, which can seriously affect the quality of survival of cancer patients[ 10 ]. It is also worth noting that fear of disease progression is a persistent negative emotion, and it has demonstrated that most patients reported FOP, and still suffer from it even years after their initial diagnosis[ 11 ].Studies have shown that FOP is closely related to death anxiety, and cancer patients with severe fear of progression suffer from severe death anxiety, which is a negative psychological state that will threaten the life safety of patients[ 12 ]. Previous studies have also confirmed that severe FOP can lead to sleep problems, causing patients to have difficulty falling asleep at night or to wake up frequently, which may have a negative impact on recovery and immune function[ 13 ]. FOP may be a psychological trigger for disease progression in patients with cervical precancerous lesions. Thus, the assessment of FOP in patients with precancerous lesions is necessary for improving their management and alleviate FOP in patients. Currently, more and more researchers are focusing on the negative effects of FOP on cervical cancer patients. The study noted that cervical cancer patients have severe fears about the pain caused by the disease, the impact of the disease on the family, and the deterioration of the disease, which results in poor quality of life for patients[ 13 ]. Thus, it is particularly important to analyze the causes of fear of disease progression in cervical cancer patients. In terms of demographic factors, previous investigations have suggested that a variety of factors associated with FOP in adult cancer survivors included younger age, marital status, residence, employment, duration since initial diagnosis, and stage of the disease [ 11 ]. Nagele followed the patients for one year, and FOP levels at one year were lower than at six months, meaning that the longer the disease lasted, the patients' FOP decreased slightly. Meanwhile, the results of this study showed that whether or not to take surgical treatment had no effect on patients' FOP[ 14 ].Previous studies have reported anxiety disorder and depression were identified as independent predictors for FOP[ 10 ].Many scholars have paid attention to the impact of coping styles on FOP, and found that patients who adopt avoidance coping mode have more severe FOP, and there is a mediating effect between anxiety, coping mode and FOP[ 15 ]. Mediating effects between anxiety, depression, sleep belief and FOP have also been confirmed[ 16 ].Likewise, several other associated factors such as social support, pathological worry, and quality of life have been suggested to act as predictors of FOP[ 10 , 17 , 18 ]. Based on these findings, we may be able to hypothesize that there may be a mediating effect between anxiety, coping style, and FOP. However, the associations among these variables in patients with cervical precancerous lesions remain to be elucidated. In summary, patients with precancerous cervical lesions face the unpredictable possibility of deterioration, treatment modalities, as well as unemployment and financial distress due to the deterioration of the disease. We need to investigate the FOP of patients in the period of precancerous cervical lesions and analyze the factors affecting it so that effective measures can be taken to alleviate the FOP, which is conducive to the mental health of patients. Previously, few studies have looked at FOP in patients with cervical precancerous lesions. Therefore, the present study was aimed to investigate the following:(i) the severity of FOP in patients with cervical precancerous lesions; (ii) predictors or risk factors of FOP in patients with cervical precancerous lesions and their mediating effects on FOP. Methods Design This was a single-center cross-sectional investigation with patients with cervical precancerous lesions. This study was approved by the local Hospital’s Ethics Committee(2021-K051). Patients were from the gynecological clinic or department of a large university hospital were sampled (i.e, from September, 2022 to July 2023). All patients were involved in the treatment and nursing process by the researchers themselves, and all understood the purpose and significance of this investigation. Self-reporting was utilized for patient socio-demographic information collection. Electronic medical records were accessed to obtain clinical data relating to hospitalization. Patients in this study meet the following inclusion criteria: (i) adult > 18 years of age; (ii) diagnosed with cervical precancerous lesions (CIN III)[ 19 ]; (iii) verbal communication and information technology skills to complete the questionnaire; (iv)who agreed with the participation scope and provided informed consent. Patients were excluded from the study if they met any of the following exclusion criteria: (i) abnormal or impaired communication;(ii) have a malignant tumor elsewhere;(iii) had undergone major surgery, or suffered severe cerebrovascular sequelae, acute heart failure, and/or acute infection;(iv) history of psychiatric disorders. Measures Fear of Progression, FOP The 12-item short version of the Fear of Progression Questionnaire-Short Form (FOP-Q-SF) was used to measure patient FOP in this study. It consists of 12 items, including two dimensions of physical and social/family well-being, which have been successfully applied to patients with chronic diseases such as cancer. The items are scored on a 5-point Likert Scale ranging from 1 to 5 (never to very often), with a total score ranging from 12 to 60. A higher score indicates a higher FOP for the patient. The Cronbach’s α value reported previously for the Chinese version of this scale is 0.883[ 20 ]. SelfRating Anxiety Scale, SAS The scale contains 20 items, and the higher the score SAS, the greater is the severity of anxiety. This scale contained 20 items, with each item scored from 1 (never) to 4 (always). The final evaluation score is obtained by multiplying the scores of each item by 1.25. In China, the standard score is 50, between 50 and 59 is mild anxiety, between 60 and 69 is moderate anxiety, and above 70 is severe anxiety. The Cronbach’s α value reported previously for the Chinese version of this scale is 0.850[ 21 ]. Medical Coping Modes Questionnaire, MCMQ The scale contains 20 items, and three dimensions, namely confrontation, avoidance, and resignation. The MCMQ was designed to assess disease-related cognitive and behavioral coping modes. The most frequently applied coping modes are measured through ratings of “never,” “sometimes,” “often,” and “always.” The dimension with the highest cumulative score indicated the particular coping strategy the patients likely to use. The Cronbach’s α value reported previously for the Chinese version of this scale ranged from 0.68 to 0.74[ 22 ]. Sociodemographic and Clinical Characteristics The demographic variables included: age, whether fertility, marriage status, occupation, educational level, residence, monthly per capita income. Medical records were assessed to extract the data on clinical characteristics. Clinical variables including course of disease, treatment method, family history of cervical cancer, and whether suffering from chronic diseases (e.g. gout, hypertension, diabetes, stroke, coronary heart disease, chronic lung disease). Statistical Analysis Data were statistically analyzed and presented by GraphPad Prism9.5.1, IBM SPSS26.0 and IBM AMOS 26.0. Kolmogorov-Smirnov was used to test whether the data was normal. Normal data distribution was represented as mean ± standard deviation (SD). Descriptive statistics were provided for skewed distributions, which were represented as medians (25th and 75th percentiles). Independent sample t test and one-way analysis of variance were used. Spearman correlation test was used to analyze continuous variables. The variable ( P < 0.1) in univariate analysis was considered the independent variable. Using the threshold of P < 0.1 as the screening criterion for entry into the multiple linear regression analysis, ensured that the variables were less likely to be omitted compared to the commonly used significance level of 0.05[ 23 ]. Multiple linear regression to identify the potential predictors of FOP. The results were regarded as significant when P < 0.05 (two-sided). Furthermore, parallel mediation analysis was used to evaluate the mediating role of different coping styles in the relationship between anxiety and FOP. 2000 bootstrap resamples were used to determine the role of coping styles as a moderator variable for anxiety and FOP. The confidence interval of the mediating effect was calculated by the Bootstrap method with bias correction. Results Study Sample We excluded 13 patients who filled out the questionnaire for a very short period of time and who filled it out incompletely. The mean age of the patients was M = 44.13 years (minimum–maximum: 23–75). All 167 patients in the study were diagnosed with CINIII and treated with conization of cervix. The mean course of disease was M = 41days (minimum–maximum: 7–180). Further sociodemographic and clinical characteristics are presented in Table 1 . Univariate analysis of the demographic, clinical characteristics of FOP in patients with cervical precancerous lesions The results of the univariate analysis of demographic and clinical variables are presented in Table 1 . Course of disease ( t =1.747, P =0.083) and family history of cervical cancer ( t =-2.398, P =0.018) were associated with FOP in patients with cervical precancerous lesions. Patients with long disease duration and a family history of cervical cancer have a more severe fear of disease progression. Psychological scale scores and correlation with FOP in patients with precancerous cervical lesions The scores of FOP in patients with precancerous cervical lesions was 27.84±10.51,which is in the medium severity range( Figure 1 ). The scores of SAS was 42.50(36.25,47.50). The scores of confront coping style was 18.00(16.00,20.00), and the average item score was 2.23. The scores of avoid coping style was 14.00(16.00,17.00), and the average item score was 2.21. The scores of resigned coping style was7.00(5.00,9.00), and the average item score was 1.53. MCMQ scores mean that the majority of patients adopt a confrontational or avoidant coping style, and a small percentage take resigned coping style. The results of the Spearman correlation test show a correlation between Anxiety and FOP ( r =0.235, P<0.01 ), Confrontation and FOP ( r =-0.184, P<0.05 ), Avoidance and FOP ( r =0.193, P<0.05 ), Resignation and FOP ( r =0.350, P<0.01 ) ( Table 2 ). Multivariate linear regression model of the factors associated with FOP in patients with precancerous cervical lesions To further investigate the potential predictors of the factors associated with FOP in patients with precancerous cervical lesions, a multiple linear regression analysis was conducted and the analysis results are presented in Table 3 . The potential predictors of FOP among patients with precancerous cervical lesions were Anxiety ( β =0.175, P =0.015), Confrontation ( β =-0.188, P =0.009), Avoidance ( β =0.229, P =0.002), Resignation ( β =0.181, P <0.001), Family history of cervical cancer ( β =0.221, P =0.001). These 5 factors explained 27.1% of FOP in patients with precancerous cervical lesions. In multiple linear regression analysis, the independent variables were tested for collinearity, normality, independence and homogeneity of variance. The variance inflation factor (VIF) ranged from 1.024 to 1.190, indicating that there was no multicollinearity among variables. Durbin-Watson value is 2.114, indicating that residuals are independent of each other. In this study, a false discovery rate (FDR) correction based on R Studio was performed to minimize false positive results. After FDR adjustment, the 5 influences of FOP remained significant. Pathway analysis for Anxiety , Medical Coping Modes , and FOP Anxiety was analyzed as the X variable, Confrontation and Resignation as mediating variables, and FOP as the Y variable. The results of the pathway analysis showed a significant direct correlation between the four variables. Medical Coping Mode played a mediating role in the relationship between anxiety and FOP. The direct effect of anxiety on FOP is 0.169, t =2.271,95%CI:0.026 to 0.383, P =0.023. Confrontation as a mediating variable mediates anxiety and FOP, with an indirect mediating effect of 0.032, 95%CI:0.001 to 0.093, P =0.041. Resignation as a mediating variable mediates anxiety and FOP, with an indirect mediating effect of 0.123, 95%CI:0.049 to 0.228, P =0.001. The total effect of anxiety on FOP is 0.360, 95%CI:0.146 to 0.531, P =0.003. Comparing the indirect effects of the two pathways, the results showed that Resignation was more likely to mediate the effect of anxiety on FOP than Confrontation ( P =0.051) (Table 4, Figure 2). Model summary of the Structural equation: χ 2 /df =2.556, RMSEA=0.097, GFI=0.992, AGFI=0.924, CFI =0.974, TLI=0.842. Discussion In the present study, using Fear of Progression Questionnaire-Short Form to measure fear of disease progression in patients with precancerous cervical lesions. Regression analysis found that anxiety, a family history of cervical cancer, avoidant and resigned coping style were risk factors for FOP, and confrontational coping style to disease was a protective factor for FOP. Additionally, confrontational and resigned coping styles mediate the effects of anxiety on FOP ( P = 0.003). Clinicians and nurses involved in patients’ treatment should focus on these factors and connection, so as to take effective psychological intervention measures timely. Interestingly, the FOP scores show that the higher scoring entries were “I become anxious at the thought that the disease may progress” (2.73 points), “I feel nervous before doctor's appointments and regular checkups” (2.70 points), “I am afraid of the pain caused by the disease” (2.60 points). It can be seen that the source of the patient's fearfulness is mainly the symptoms of the disease and stems from the social family dimension to a lesser extent. Similar to Nakata's findings[ 24 ], patients were concerned about the severity of their symptoms and the results of their tests. Moreover, patients with precancerous cervical lesions undergo frequent tests, and each time they face a change in the results, it is a psychological ordeal for them[ 13 ]. Several psychological interventions have been shown to be effective in reducing patients' FOP[ 25 , 26 ], and the results of the present study add to previous findings that healthcare professionals should pay more attention to patients' disease symptoms and reduce their excessive fear of medical visits and examinations. Firstly, patients in the study with a family history of cervical lesions were more fearful of progression compared to those without a family history of the disease. This is similar to the results of previous studies[ 27 ]. Most patients with a family history of the disease have witnessed the illness and treatment of their family members, they have clearly perceived the symptoms and pain of the disease, and they have empathized with the worry and anxiety brought about by the disease, so they are very afraid. The results of this study suggest that we should pay more attention to patients with a family history of cervical lesions. Healthcare professionals are aware of the family history of the patients during the health assessment of the patients, so we can start psychological counseling for these patients before they undergo the examination and treatment to alleviate their nervousness and fear. Furthermore, timely education of patients with specialized medical knowledge is also effective in alleviating FOP. Dissemination of knowledge about the disease aims to minimize excessive fear in patients so that they understand that having a family history of the disease does not mean a greater risk of death[ 28 ]. We may have better results if we give patients medical knowledge education and psychological counseling at the evaluation stage, just like a preventive shot, which can give patients time to do psychological construction. As a main result, our analysis revealed that anxiety was a mainly relevant determinant of FOP. Anxiety is an irritable emotion caused by excessive worry about one's life safety, future destiny[ 13 , 29 ]. The more anxious the patient with precancerous cervical lesions, the more severe the fear of disease progression. Anxiety in cervical cancer survivors was a risk factor for FOP in Hanprasertpong's study[ 13 ]. In this study, patients with precancerous cervical lesions faced great uncertainty, as it was difficult to determine whether there would be further deterioration and what future treatment would be required. The resulting anxiety further exacerbates the fear of progression. Therefore, alleviating patients' anxiety may be critical to improving their psychological state and reducing their fear in the face of the disease. Themes from some qualitative studies suggest that sources of patient anxiety may include: consequences of cancer: thoughts about death or impact on loved ones, higher perceived risk of cancer, stigma, and fertility worries (younger women)[ 4 , 30 ]. Healthcare professionals can address these aspects by providing patients with specialized knowledge about the disease thereby reducing their worries and rumination. Patients with precancerous cervical lesions certainly experience anxiety, which is normal, especially for women[ 31 – 33 ]. The results of previous studies have confirmed that measures such as knowledge education and mindfulness-based cognitive therapy are effective in relieving patients' anxiety[ 34 , 35 ]. We should learn from these effective psychological intervention measures to reduce the anxiety of patients and thereby alleviate their FOP. This study also investigated patients' coping styles with illness. Lazarus' theory points out that coping styles refer to the methods, means, or strategies that an individual employs to cope with the demands of the internal and external environments and their associated emotional distress, which are influenced by the stressful environment and personality traits[ 36 ]. Confrontation is the ability to confront the problem in a stressful situation and is considered a positive way of coping that is beneficial to the patient's physical and mental health. Avoidance and resignation coping styles are often perceived as negative and can weaken the patient's ability to self-regulate in the face of illness. The outcome of coping affects many aspects of an individual's outlook on life, attitude toward life, social adjustment, and mental and physical health[ 37 ]. The results of the study show that most of the patients will use confrontational coping style and only a small percentage of patients will use avoidance and resignation to cope with the disease. However, this is not encouraging because the way a patient copes with the disease can easily change, and it is difficult to determine if the patient will always be able to be positive about the disease[ 38 ]. The results of multiple linear regression in this study showed that avoidant and resigned coping style were risk factors for FOP, and confrontational coping style to disease was a protective factor for FOP. This result suggests that we should encourage patients with precancerous cervical lesions to face the disease positively, and that although avoidance coping may bring short-lived psychological comfort, it may cause serious FOP, which may jeopardize the patient's mental health status even more. As the results of this study show, anxiety and fear about health or disease are unavoidable. Previous studies have suggested a mediated effect relationship between FOP and psychological factors such as anxiety[ 10 , 15 , 39 ]; therefore, we conducted a preliminary mediated effect analysis of FOP, anxiety, and coping styles in patients with cervical precancerous lesions, which may help us to analyze in depth the role of the influence between psychological factors. We first analyzed the effects of confrontation, avoidance coping styles between anxiety and FOP, however the fit of the parallel mediator was poor, so we did not adopt a mediating role between this. We put confrontation and resignation into a parallel mediation effects model, and the results showed that confrontation and resignation mediated anxiety and FOP in each of the two pathways. Confrontation was a negative predictor between anxiety and FOP, implying that patients should be positive about the disease and thus reduce their internal fears. Additionally, the results showed that resignation was more likely to mediate the effect of anxiety on FOP than Confrontation, which means resignation may bring the patient severe anxiety and fears. As the results of previous studies have shown, confrontation can improve patients' mental health, which can lead to optimism about the disease[ 40 ]. Different coping styles will affect patients' FOP to different degrees, therefore, healthcare professionals should pay more attention to the psychological status of patients with precancerous cervical lesions in the course of treatment. It is necessary for healthcare professionals to give patients professional medical knowledge and psychological comfort, guide them to adopt the most appropriate coping styles, and help them build up confidence in treating the disease[ 41 ]. Clearly, this study has some limitations. Firstly, the data were collected through an online questionnaire, which may have some filling in errors, but these patients were seen in our hospital, we were familiar with the patients before collecting the questionnaire, and we continued to follow up with the patients by phone after collecting the questionnaire to minimize the data errors. Secondly, the Adjusted R 2 of the multiple linear regression equation is not ideal, but we used the FDR correction for statistical results. Thirdly, we need to conduct a qualitative study to further explore the causes and solutions of patients' fear of disease progression. Moreover, we only used parallel mediation modeling to analyze the relationship between psychological factors, and more complex structural equation modeling could be used in the next phase of the study to explore the influences of FOP. Conclusion This study is an important step toward exploring potential predictors of FOP in patients with cervical precancerous lesions and the role these predictors play in FOP, and provides preventive measures for delay in cervical precancerous lesions. The findings suggest that yielding is more likely to have an effect on FOP than confronting. It provides theoretical guidance for us to take effective methods to prevent the fear of progression in patients with cervical precancerous lesions. Abbreviations Cervical intraepithelial neoplasia, CIN human papilloma virus, HPV Fear of progression, FOP Self‑Rating Anxiety Scale, SAS Medical Coping Modes Questionnaire, MCMQ Declarations Authors’ contributions Xiao-Hong Jin: conception and design, administrative support, provision of study materials or patients, collection and assembly of data. Xiao-Man Liu: data analysis and interpretation. Hai-Yan Huang: review of manuscripts. Manuscript writing: All authors. Funding None Ethics approval : The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). This study was approved by the local Hospital’s Ethics Committee(2021-K051) and obtained signed informed consent from all patients. Consent for publication : Not applicable. Competing interests : All authors have completed the ICMJE uniform disclosure form. The authors have no conflicts of interest to declare. Acknowledgments We would like to extend our sincere gratitude to our patients who were willing to participate in our study, share their experience with us, and help and support people around. Data availability statement The datasets presented in this article are not readily available because participants did not provide consent for public availability of the data. References Arbyn M, Weiderpass E, Bruni L, de Sanjose S, Saraiya M, Ferlay J, Bray F: Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis . Lancet Glob Health 2020, 8 (2):e191-e203. Buskwofie A, David-West G, Clare CA: A Review of Cervical Cancer: Incidence and Disparities . J Natl Med Assoc 2020, 112 (2):229-232. Wang SM, Shi JF, Kang DJ, Song P, Qiao YL, Chinese HPVSG: Impact of human papillomavirus-related lesions on quality of life: a multicenter hospital-based study of women in Mainland China . Int J Gynecol Cancer 2011, 21 (1):182-188. McBride E, Marlow LAV, Bennett KF, Stearns S, Waller J: Exploring reasons for variations in anxiety after testing positive for human papillomavirus with normal cytology: a comparative qualitative study . Psychooncology 2021, 30 (1):84-92. Skare TL, Neppel A, Machoski MCC, Maestri CA, Messias-Reason I, Nisihara R: Antinuclear antibodies in patients with cervical lesions and invasive cervical cancer . Immunol Lett 2019, 208 :8-10. Nagele E, Reich O, Greimel E, Dorfer M, Haas J, Trutnovsky G: Sexual Activity, Psychosexual Distress, and Fear of Progression in Women With Human Papillomavirus-Related Premalignant Genital Lesions . J Sex Med 2016, 13 (2):253-259. Peterson CE, Silva A, Goben AH, Ongtengco NP, Hu EZ, Khanna D, Nussbaum ER, Jasenof IG, Kim SJ, Dykens JA: Stigma and cervical cancer prevention: A scoping review of the U.S. literature . Prev Med 2021, 153 :106849. Coutts-Bain D, Sharpe L, Pradhan P, Russell H, Heathcote LC, Costa D: Are fear of cancer recurrence and fear of progression equivalent constructs? Psychooncology 2022, 31 (8):1381-1389. Sharpe L, Michalowski M, Richmond B, Menzies RE, Shaw J: Fear of progression in chronic illnesses other than cancer: a systematic review and meta-analysis of a transdiagnostic construct . Health Psychol Rev 2023, 17 (2):301-320. Dinkel A, Marten-Mittag B, Kremsreiter K: Association Between Daily Worry, Pathological Worry, and Fear of Progression in Patients With Cancer . Front Psychol 2021, 12 :648623. Sun H, Yang Y, Zhang J, Liu T, Wang H, Garg S, Zhang B: Fear of cancer recurrence, anxiety and depressive symptoms in adolescent and young adult cancer patients . Neuropsychiatr Dis Treat 2019, 15 :857-865. Coutts-Bain D, Sharpe L, Russell H: Death anxiety predicts fear of Cancer recurrence and progression in ovarian Cancer patients over and above other cognitive factors . J Behav Med 2023. Hanprasertpong J, Geater A, Jiamset I, Padungkul L, Hirunkajonpan P, Songhong N: Fear of cancer recurrence and its predictors among cervical cancer survivors . J Gynecol Oncol 2017, 28 (6):e72. Nagele E, Trutnovsky G, Greimel E, Dorfer M, Haas J, Reich O: Do different treatment strategies influence women's level of psychosexual distress? Observational cohort study of women with premalignant HPV-associated genital lesions . Eur J Obstet Gynecol Reprod Biol 2019, 236 :205-209. Wu F, Howell D, Fang Q, Chen J, Yuan C: Trajectory Patterns and Factors Influencing Self-management Behaviors in Chinese Patients With Breast Cancer . Cancer Nurs 2020, 43 (2):E105-E112. Kim H, Cho IK, Lee D, Kim K, Lee J, Cho E, Park CHK, Chung S: Effect of Cancer-Related Dysfunctional Beliefs About Sleep on Fear of Cancer Progression in the Coronavirus Pandemic . J Korean Med Sci 2022, 37 (36):e272. Krok-Schoen JL, Naughton MJ, Bernardo BM, Young GS, Paskett ED: Fear of recurrence among older breast, ovarian, endometrial, and colorectal cancer survivors: Findings from the WHI LILAC study . Psychooncology 2018, 27 (7):1810-1815. Liu J, Peh CX, Simard S, Griva K, Mahendran R: Beyond the fear that lingers: The interaction between fear of cancer recurrence and rumination in relation to depression and anxiety symptoms . J Psychosom Res 2018, 111 :120-126. Peng G, Dong H, Liang T, Li L, Liu J: Diagnosis of cervical precancerous lesions based on multimodal feature changes . Comput Biol Med 2021, 130 :104209. Mehnert A, Herschbach P, Berg P, Henrich G, Koch U: [Fear of progression in breast cancer patients--validation of the short form of the Fear of Progression Questionnaire (FoP-Q-SF)] . Z Psychosom Med Psychother 2006, 52 (3):274-288. Li Q, Liu L, Gu Z, Li M, Liu C, Wu H: Sense of coherence mediates perceived social support and depressive and anxiety symptoms in cervical cancer patients: a cross-sectional study . BMC Psychiatry 2023, 23 (1):312. Jin R, Xie T, Zhang L, Gong N, Zhang J: Stigma and its influencing factors among breast cancer survivors in China: A cross-sectional study . Eur J Oncol Nurs 2021, 52 :101972. Li Y, Zhang X, Zhang J, Zhang D, Wang Y, Zhu Y, Xu X: Stigma and unhealthy psychological characteristics in patients with acromegaly: A cross-sectional study and identification of the associated factors . Acta Neurochir (Wien) 2022, 164 (8):2069-2081. Nakata H, Halbach S, Geiser F, Stock S, Kowalski C, Enders A, Pfaff H, Ernstmann N: Health literacy, mental disorders and fear of progression and their association with a need for psycho-oncological care over the course of a breast cancer treatment . Psychol Health Med 2021, 26 (7):818-831. Tauber NM, O'Toole MS, Dinkel A, Galica J, Humphris G, Lebel S, Maheu C, Ozakinci G, Prins J, Sharpe L et al : Effect of Psychological Intervention on Fear of Cancer Recurrence: A Systematic Review and Meta-Analysis . J Clin Oncol 2019, 37 (31):2899-2915. Lyu MM, Siah RC, Lam ASL, Cheng KKF: The effect of psychological interventions on fear of cancer recurrence in breast cancer survivors: A systematic review and meta-analysis . J Adv Nurs 2022, 78 (10):3069-3082. Yang Y, Qi H, Li W, Liu T, Xu W, Zhao S, Yang F, Humphris G, Chen Y, Sun H: Predictors and trajectories of fear of cancer recurrence in Chinese breast cancer patients . J Psychosom Res 2023, 166 :111177. Omidi Z, Kheirkhah M, Abolghasemi J, Haghighat S: Effect of lymphedema self-management group-based education compared with social network-based education on quality of life and fear of cancer recurrence in women with breast cancer: a randomized controlled clinical trial . Qual Life Res 2020, 29 (7):1789-1800. Dinkel A, Kremsreiter K, Marten-Mittag B, Lahmann C: Comorbidity of fear of progression and anxiety disorders in cancer patients . Gen Hosp Psychiatry 2014, 36 (6):613-619. O'Connor M, Costello L, Murphy J, Prendiville W, Martin CM, O'Leary JJ, Sharp L, Irish Screening Research C: 'I don't care whether it's HPV or ABC, I just want to know if I have cancer.' Factors influencing women's emotional responses to undergoing human papillomavirus testing in routine management in cervical screening: a qualitative study . BJOG 2014, 121 (11):1421-1429. McBride E, Marlow LAV, Forster AS, Ridout D, Kitchener H, Patnick J, Waller J: Anxiety and distress following receipt of results from routine HPV primary testing in cervical screening: The psychological impact of primary screening (PIPS) study . Int J Cancer 2020, 146 (8):2113-2121. Yang CM, Sung FC, Mou CH, Liao CH, Wang PH, Shieh SH: Anxiety and depression risk in Taiwan women with breast cancer and cervical cancer . Front Oncol 2022, 12 :946029. Yang YL, Liu L, Wang XX, Wang Y, Wang L: Prevalence and associated positive psychological variables of depression and anxiety among Chinese cervical cancer patients: a cross-sectional study . PLoS One 2014, 9 (4):e94804. Yang X, Huang L, Li C, Ji N, Zhu H: The effectiveness of mindfulness-based stress reduction intervention on alleviating anxiety and depression in postoperative patients with cervical cancer: A protocol for systematic review and meta-analysis . Medicine (Baltimore) 2022, 101 (5):e28706. Nissen ER, O'Connor M, Kaldo V, Hojris I, Borre M, Zachariae R, Mehlsen M: Internet-delivered mindfulness-based cognitive therapy for anxiety and depression in cancer survivors: A randomized controlled trial . Psychooncology 2020, 29 (1):68-75. Lazarus RS: Coping theory and research: past, present, and future . Psychosom Med 1993, 55 (3):234-247. Pfaendler KS, Wenzel L, Mechanic MB, Penner KR: Cervical cancer survivorship: long-term quality of life and social support . Clin Ther 2015, 37 (1):39-48. Shang M, Cai T, Meng Y, Wang Q, Cui Y, Zhang F: Dyadic coping in young and middle-aged women with gynecological cancer: a latent class analysis . Support Care Cancer 2022, 31 (1):47. Curran L, Sharpe L, MacCann C, Butow P: Testing a model of fear of cancer recurrence or progression: the central role of intrusions, death anxiety and threat appraisal . J Behav Med 2020, 43 (2):225-236. Li LR, Lin MG, Liang J, Hu QY, Chen D, Lan MY, Liang WQ, Zeng YT, Wang T, Fu GF: Effects of Intrinsic and Extrinsic Factors on the Level of Hope and Psychological Health Status of Patients with Cervical Cancer During Radiotherapy . Med Sci Monit 2017, 23 :3508-3517. Pradhan P, Sharpe L, Menzies RE: Towards a Stepped Care Model for Managing Fear of Cancer Recurrence or Progression in Cancer Survivors . Cancer Manag Res 2021, 13 :8953-8965. Tables Table 1 Results of univariate analysis on the factors of FOP in patients with cervical precancerous lesions ( n =167). Variables N (%) FOP t/F P Age a 0.416 0.660 <45 60 28.23±10.57 45-59 81 28.11±9.65 ≥60 26 26.11±10.94 Whether fertility b 1.379 0.170 yes 165 27.72±10.50 no 2 38.00±5.65 Marriage status b 0.155 0.877 divorced or widowed 6 28.50±11.99 married 161 27.81±10.49 Occupation b -1.243 0.215 unemployed 73 26.69±10.82 employed 94 28.73±10.22 Educational level a 0.284 0.753 secondary school or below 106 28.23±10.75 junior high school 30 26.60±10.71 college or above 31 27.70±9.65 Residence b -0.874 0.383 village 97 27.25±11.27 town or city 70 28.65±9.35 Monthly per capita income, RMB a 0.675 0.569 30 49 25.65±10.90 Chronic diseases b -0.661 0.542 yes 29 28.93±12.60 no 138 27.61±10.05 Family history of cervical cancer b -2.398 0.018 yes 13 34.46±9.28 no 154 27.28±10.44 Abbreviations: FOP, Fear of progression. Variables in bold are those considered statistically significant( P<0.1 ). Values are presented as number and mean ± standard deviation. a Values are analyzed by One Way ANOVA( F ). b Values are analyzed by Independent Sample Test( t ). Table 2 Results of correlation BETWEEN Psychological scale scores and FOP in patients with precancerous cervical lesions. Variables FOP Anxiety Confrontation Avoidance Resignation FOP - Anxiety 0.235** - Confrontation -0.184* -0.169* - Avoidance 0.193* -0.018 0.214** - Resignation 0.350** 0.286** -0.185* 0.128 - ** P<0.01 , * P<0.05. Table 3 Multivariate linear regression model of the factors associated with FOP in patients with precancerous cervical lesions. Variables B (SE) β t P -value P -FDR (95% CI) Anxiety 0.212(0.086) 0.175 2.459 0.015 0.015 (0.042,0.383) Confrontation -0.519(0.197) -0.188 -2.640 0.009 0.011 (-0.907, -0.131) Avoidance 0.887(0.275) 0.229 3.227 0.002 0.003 (0.344,1.430) Resignation 1.157(0.297) 0.181 3.890 <0.001 <0.001 (0.570,1.745) Family history of cervical cancer 8.630(2.624) 0.221 3.289 0.001 0.002 (3.448,13.812) Model summary: F =11.259, P <0.001, Adjusted R 2 =27.1%. Abbreviations: SE, standard error; FDR, false discovery rate. Table 4 Path analysis on the direct and indirect effects of anxiety on FOP in patients with precancerous cervical lesions. Effects Standardized estimator LLCI-ULCI P value Indirect effects Anxiety→Confrontation→FOP 0.032 0.001-0.093 0.041 Anxiety→Resignation→FOP 0.123 0.049-0.228 0.001 Total effects Anxiety→FOP 0.360 0.146-0.531 0.003 Diff -0.091 -0.201-0.001 0.051 Abbreviations: LLCI, low‐limit confidence interval; ULCI, upper‐limit confidence interval. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Sep, 2025 Read the published version in BMC Psychology → Version 1 posted Editorial decision: Revision requested 28 May, 2024 Editor assigned by journal 25 May, 2024 Submission checks completed at journal 25 May, 2024 First submitted to journal 15 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-4423438","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":307843508,"identity":"8c1a46c6-2f58-4300-90f2-6349cd3d024f","order_by":0,"name":"Xiao-Hong Jin","email":"","orcid":"","institution":"Affiliated Hospital of Nantong University","correspondingAuthor":false,"prefix":"","firstName":"Xiao-Hong","middleName":"","lastName":"Jin","suffix":""},{"id":307843512,"identity":"d0d0df5c-a6bc-4616-9156-59b391993be7","order_by":1,"name":"Xiao-Man Liu","email":"","orcid":"","institution":"Affiliated Hospital of Nantong University","correspondingAuthor":false,"prefix":"","firstName":"Xiao-Man","middleName":"","lastName":"Liu","suffix":""},{"id":307843513,"identity":"14d23ec2-e9cc-4b19-9161-37cfdf76d349","order_by":2,"name":"Hai-Yan Huang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYBACxvbmww8+VLDV27c3EKmFuedYmuGMM3wJBjwHiNTCPsPHQJqzTS7BQCKBSC28MxgMjBnYzPLMJR9vvMFQYxNNUIvk7IaExwU8acWWs9OKLRiOpeU2ENJiOOfAAeMZEscYG27nmEkwNhwmrMX+RmKDNI/Bf8aGm2eI1MI4I5lBmieBLXHDDR5itfQcYzOccYDNWLIH6JcEYvzC2N7/+cHHf2xy/OyHN974UGNDWAsyID5qkLSQqmMUjIJRMApGBgAAb9BDLXCI7S8AAAAASUVORK5CYII=","orcid":"","institution":"Affiliated Hospital of Nantong University","correspondingAuthor":true,"prefix":"","firstName":"Hai-Yan","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2024-05-15 07:45:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4423438/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4423438/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40359-025-03323-6","type":"published","date":"2025-09-25T15:58:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58144935,"identity":"dd87351e-e292-4ed0-8f55-ac46c8a0eaba","added_by":"auto","created_at":"2024-06-11 18:27:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":14991,"visible":true,"origin":"","legend":"\u003cp\u003eAverage item score for FOP.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4423438/v1/63eec0f1964696dd0a6ae615.jpg"},{"id":58144934,"identity":"e4aaa2b0-9c74-458b-ac69-ec3d023aeb1b","added_by":"auto","created_at":"2024-06-11 18:27:00","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":79150,"visible":true,"origin":"","legend":"\u003cp\u003eStandard coefficients of the mediator model.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4423438/v1/788afc87761f04aa1a699afd.jpg"},{"id":92430565,"identity":"c2a2b74d-741b-4750-ac6b-be0be50dae17","added_by":"auto","created_at":"2025-09-29 16:05:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3122828,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4423438/v1/6e26209d-aba7-45da-8007-d11dab113244.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Fear of progression in patients with cervical precancerous lesions: a cross-sectional survey","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer is the fourth most common cancer in women, with about 570,000 new cases and 311,000 deaths worldwide in 2018. There are about 106,000 new cases of cervical cancer and 48,000 deaths, and cervical cancer remains an important public health problem affecting women's health[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Patients go through the process of HPV infection, to cervical precancerous lesions and then to cervical cancer. Most low-grade precancerous cervical lesions resolve spontaneously, but high-grade precancerous cervical lesions have the potential to become cancerous and can progress to cervical cancer[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Patients at different stages of the disease face different pressures, resulting in a lot of negative emotions that negatively affect their physical and mental health to varying degrees[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In recent years, with the improvement of people's awareness of the disease, more and more cervical cancer cases have been diagnosed and treated early. In the early stage of cervical intraepithelial lesions, patients can take interferon therapy, cervical conization and other methods to alleviate or relieve the deterioration of the disease. However, patients in the precancerous stage face a great risk of cancer, with a roughly 50% probability of becoming cancerous[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], which leads to negative emotions such as fear, anxiety, and stigma[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].. As a result, many patients with cervical precancerous lesions will be chronically ill and very fearful of the progression of the disease, because, cervical cancer implies a threat to the patient's life.\u003c/p\u003e \u003cp\u003eFear of progression (FOP) is a psychological state in which an individual feels extreme fear and concern about the possibility of further deterioration or worsening of his or her health status or that of others. From a psychological point of view, fear of progression is a common and normal psychological reaction in patients[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Previous studies have shown that FOP is one of the common distressing symptoms in cancer patients, with a prevalence of roughly 31%-82.5% in adolescents and adults with cancer[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Excessive concern or fear can lead to a range of inappropriate behavioral, cognitive, and emotional responses, such as avoidance of follow-up or screening, frequent visits to the doctor, and increased psychological distress, which can seriously affect the quality of survival of cancer patients[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It is also worth noting that fear of disease progression is a persistent negative emotion, and it has demonstrated that most patients reported FOP, and still suffer from it even years after their initial diagnosis[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].Studies have shown that FOP is closely related to death anxiety, and cancer patients with severe fear of progression suffer from severe death anxiety, which is a negative psychological state that will threaten the life safety of patients[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Previous studies have also confirmed that severe FOP can lead to sleep problems, causing patients to have difficulty falling asleep at night or to wake up frequently, which may have a negative impact on recovery and immune function[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. FOP may be a psychological trigger for disease progression in patients with cervical precancerous lesions. Thus, the assessment of FOP in patients with precancerous lesions is necessary for improving their management and alleviate FOP in patients.\u003c/p\u003e \u003cp\u003eCurrently, more and more researchers are focusing on the negative effects of FOP on cervical cancer patients. The study noted that cervical cancer patients have severe fears about the pain caused by the disease, the impact of the disease on the family, and the deterioration of the disease, which results in poor quality of life for patients[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Thus, it is particularly important to analyze the causes of fear of disease progression in cervical cancer patients. In terms of demographic factors, previous investigations have suggested that a variety of factors associated with FOP in adult cancer survivors included younger age, marital status, residence, employment, duration since initial diagnosis, and stage of the disease [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Nagele followed the patients for one year, and FOP levels at one year were lower than at six months, meaning that the longer the disease lasted, the patients' FOP decreased slightly. Meanwhile, the results of this study showed that whether or not to take surgical treatment had no effect on patients' FOP[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].Previous studies have reported anxiety disorder and depression were identified as independent predictors for FOP[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].Many scholars have paid attention to the impact of coping styles on FOP, and found that patients who adopt avoidance coping mode have more severe FOP, and there is a mediating effect between anxiety, coping mode and FOP[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Mediating effects between anxiety, depression, sleep belief and FOP have also been confirmed[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].Likewise, several other associated factors such as social support, pathological worry, and quality of life have been suggested to act as predictors of FOP[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Based on these findings, we may be able to hypothesize that there may be a mediating effect between anxiety, coping style, and FOP. However, the associations among these variables in patients with cervical precancerous lesions remain to be elucidated.\u003c/p\u003e \u003cp\u003eIn summary, patients with precancerous cervical lesions face the unpredictable possibility of deterioration, treatment modalities, as well as unemployment and financial distress due to the deterioration of the disease. We need to investigate the FOP of patients in the period of precancerous cervical lesions and analyze the factors affecting it so that effective measures can be taken to alleviate the FOP, which is conducive to the mental health of patients. Previously, few studies have looked at FOP in patients with cervical precancerous lesions. Therefore, the present study was aimed to investigate the following:(i) the severity of FOP in patients with cervical precancerous lesions; (ii) predictors or risk factors of FOP in patients with cervical precancerous lesions and their mediating effects on FOP.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThis was a single-center cross-sectional investigation with patients with cervical precancerous lesions. This study was approved by the local Hospital\u0026rsquo;s Ethics Committee(2021-K051). Patients were from the gynecological clinic or department of a large university hospital were sampled (i.e, from September, 2022 to July 2023). All patients were involved in the treatment and nursing process by the researchers themselves, and all understood the purpose and significance of this investigation. Self-reporting was utilized for patient socio-demographic information collection. Electronic medical records were accessed to obtain clinical data relating to hospitalization.\u003c/p\u003e \u003cp\u003ePatients in this study meet the following inclusion criteria: (i) adult\u0026thinsp;\u0026gt;\u0026thinsp;18 years of age; (ii) diagnosed with cervical precancerous lesions (CIN III)[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]; (iii) verbal communication and information technology skills to complete the questionnaire; (iv)who agreed with the participation scope and provided informed consent. Patients were excluded from the study if they met any of the following exclusion criteria: (i) abnormal or impaired communication;(ii) have a malignant tumor elsewhere;(iii) had undergone major surgery, or suffered severe cerebrovascular sequelae, acute heart failure, and/or acute infection;(iv) history of psychiatric disorders.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eFear of Progression, FOP\u003c/h2\u003e \u003cp\u003eThe 12-item short version of the Fear of Progression Questionnaire-Short Form (FOP-Q-SF) was used to measure patient FOP in this study. It consists of 12 items, including two dimensions of physical and social/family well-being, which have been successfully applied to patients with chronic diseases such as cancer. The items are scored on a 5-point Likert Scale ranging from 1 to 5 (never to very often), with a total score ranging from 12 to 60. A higher score indicates a higher FOP for the patient. The Cronbach\u0026rsquo;s α value reported previously for the Chinese version of this scale is 0.883[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eSelfRating Anxiety Scale, SAS\u003c/h2\u003e \u003cp\u003eThe scale contains 20 items, and the higher the score SAS, the greater is the severity of anxiety. This scale contained 20 items, with each item scored from 1 (never) to 4 (always). The final evaluation score is obtained by multiplying the scores of each item by 1.25. In China, the standard score is 50, between 50 and 59 is mild anxiety, between 60 and 69 is moderate anxiety, and above 70 is severe anxiety. The Cronbach\u0026rsquo;s α value reported previously for the Chinese version of this scale is 0.850[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eMedical Coping Modes Questionnaire, MCMQ\u003c/h2\u003e \u003cp\u003eThe scale contains 20 items, and three dimensions, namely confrontation, avoidance, and resignation. The MCMQ was designed to assess disease-related cognitive and behavioral coping modes. The most frequently applied coping modes are measured through ratings of \u0026ldquo;never,\u0026rdquo; \u0026ldquo;sometimes,\u0026rdquo; \u0026ldquo;often,\u0026rdquo; and \u0026ldquo;always.\u0026rdquo; The dimension with the highest cumulative score indicated the particular coping strategy the patients likely to use. The Cronbach\u0026rsquo;s α value reported previously for the Chinese version of this scale ranged from 0.68 to 0.74[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eSociodemographic and Clinical Characteristics\u003c/h2\u003e \u003cp\u003eThe demographic variables included: age, whether fertility, marriage status, occupation, educational level, residence, monthly per capita income. Medical records were assessed to extract the data on clinical characteristics. Clinical variables including course of disease, treatment method, family history of cervical cancer, and whether suffering from chronic diseases (e.g. gout, hypertension, diabetes, stroke, coronary heart disease, chronic lung disease).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were statistically analyzed and presented by GraphPad Prism9.5.1, IBM SPSS26.0 and IBM AMOS 26.0. Kolmogorov-Smirnov was used to test whether the data was normal. Normal data distribution was represented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). Descriptive statistics were provided for skewed distributions, which were represented as medians (25th and 75th percentiles). Independent sample \u003cem\u003et\u003c/em\u003e test and one-way analysis of variance were used. Spearman correlation test was used to analyze continuous variables. The variable (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.1) in univariate analysis was considered the independent variable. Using the threshold of \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.1 as the screening criterion for entry into the multiple linear regression analysis, ensured that the variables were less likely to be omitted compared to the commonly used significance level of 0.05[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Multiple linear regression to identify the potential predictors of FOP. The results were regarded as significant when \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-sided). Furthermore, parallel mediation analysis was used to evaluate the mediating role of different coping styles in the relationship between anxiety and FOP. 2000 bootstrap resamples were used to determine the role of coping styles as a moderator variable for anxiety and FOP. The confidence interval of the mediating effect was calculated by the Bootstrap method with bias correction.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eStudy Sample\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe excluded 13 patients who filled out the questionnaire for a very short period of time and who filled it out incompletely. The mean age of the patients was \u003cem\u003eM\u0026nbsp;\u003c/em\u003e= 44.13 years (minimum\u0026ndash;maximum: 23\u0026ndash;75). All 167 patients in the study were diagnosed with CINIII and treated with conization of cervix. The mean course of disease was \u003cem\u003eM\u0026nbsp;\u003c/em\u003e= 41days (minimum\u0026ndash;maximum: 7\u0026ndash;180).\u0026nbsp;Further sociodemographic and clinical characteristics are presented in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnivariate analysis of the\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edemographic, clinical\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;characteristics of FOP in patients with cervical precancerous lesions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the univariate analysis of demographic and clinical variables are presented in \u003cstrong\u003eTable 1\u003c/strong\u003e. Course of disease (\u003cem\u003et\u003c/em\u003e=1.747, \u003cem\u003eP\u003c/em\u003e=0.083) and family history of cervical cancer\u003csup\u003e\u0026nbsp;\u003c/sup\u003e(\u003cem\u003et\u003c/em\u003e=-2.398, \u003cem\u003eP\u003c/em\u003e=0.018) were associated with FOP in patients with cervical precancerous lesions. Patients with long disease duration and a family history of cervical cancer have a more severe fear of disease progression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePsychological scale scores and correlation with FOP in patients with precancerous cervical lesions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe scores of FOP in patients with precancerous cervical lesions was 27.84\u0026plusmn;10.51,which is in the medium severity range(\u003cstrong\u003eFigure 1\u003c/strong\u003e). The scores of SAS was 42.50(36.25,47.50). The scores of\u0026nbsp;confront coping style\u0026nbsp;was 18.00(16.00,20.00), and the average item score was 2.23. The scores of\u0026nbsp;avoid coping style\u0026nbsp;was 14.00(16.00,17.00), and the average item score was 2.21. The scores of\u0026nbsp;resigned coping style\u0026nbsp;was7.00(5.00,9.00), and the average item score was 1.53. MCMQ scores mean that the majority of patients adopt a confrontational or avoidant coping style, and a small percentage take\u0026nbsp;resigned coping style.\u0026nbsp;The results of the Spearman correlation test show a correlation between Anxiety and FOP (\u003cem\u003er\u003c/em\u003e=0.235,\u003cem\u003e\u0026nbsp;P\u0026lt;0.01\u003c/em\u003e), Confrontation and FOP (\u003cem\u003er\u003c/em\u003e=-0.184,\u003cem\u003e\u0026nbsp;P\u0026lt;0.05\u003c/em\u003e), Avoidance and FOP (\u003cem\u003er\u003c/em\u003e=0.193,\u003cem\u003e\u0026nbsp;P\u0026lt;0.05\u003c/em\u003e), Resignation and FOP (\u003cem\u003er\u003c/em\u003e=0.350,\u003cem\u003e\u0026nbsp;P\u0026lt;0.01\u003c/em\u003e) (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate linear regression model of the factors associated with FOP\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ein patients with precancerous cervical lesions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo further investigate the potential predictors of the factors associated with FOP in patients with precancerous cervical lesions, a multiple linear regression analysis was conducted and the analysis results are presented in \u003cstrong\u003eTable 3\u003c/strong\u003e. The potential predictors of FOP among patients with precancerous cervical lesions were Anxiety (\u003cem\u003e\u0026beta;\u003c/em\u003e=0.175, \u003cem\u003eP\u003c/em\u003e =0.015), Confrontation (\u003cem\u003e\u0026beta;\u003c/em\u003e=-0.188, \u003cem\u003eP\u003c/em\u003e =0.009), Avoidance (\u003cem\u003e\u0026beta;\u003c/em\u003e=0.229, \u003cem\u003eP\u003c/em\u003e =0.002), Resignation (\u003cem\u003e\u0026beta;\u003c/em\u003e=0.181, \u003cem\u003eP\u003c/em\u003e \u0026lt;0.001), Family history of cervical cancer (\u003cem\u003e\u0026beta;\u003c/em\u003e=0.221, \u003cem\u003eP\u003c/em\u003e =0.001). These 5 factors explained 27.1% of FOP in patients with precancerous cervical lesions. In multiple linear regression analysis, the independent variables were tested for collinearity, normality, independence and homogeneity of variance. The variance inflation factor (VIF) ranged from 1.024 to 1.190, indicating that there was no multicollinearity among variables. Durbin-Watson value is 2.114, indicating that residuals are independent of each other. In this study, a false discovery rate (FDR) correction based on R Studio was performed to minimize false positive results. After FDR adjustment, the 5 influences of FOP remained significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePathway analysis for\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e,\u0026nbsp;\u003cstrong\u003eMedical Coping Modes\u003c/strong\u003e\u003cstrong\u003e, and FOP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnxiety was analyzed as the X variable, Confrontation and Resignation as mediating variables, and FOP as the Y variable. The results of the pathway analysis showed a significant direct correlation between the four variables. Medical Coping Mode played a mediating role in the relationship between anxiety and FOP. The direct effect of anxiety on FOP is 0.169, \u003cem\u003et\u003c/em\u003e=2.271,95%CI:0.026 to 0.383, \u003cem\u003eP\u003c/em\u003e=0.023. Confrontation as a mediating variable mediates anxiety and FOP, with an indirect mediating effect of 0.032, 95%CI:0.001 to 0.093, \u003cem\u003eP\u003c/em\u003e=0.041.\u0026nbsp;Resignation as a mediating variable mediates anxiety and FOP, with an indirect mediating effect of 0.123, 95%CI:0.049 to 0.228, \u003cem\u003eP\u003c/em\u003e=0.001. The total effect of anxiety on FOP is 0.360, 95%CI:0.146 to 0.531, \u003cem\u003eP\u003c/em\u003e=0.003. Comparing the indirect effects of the two pathways, the results showed that Resignation was more likely to mediate the effect of anxiety on FOP than Confrontation (\u003cem\u003eP\u003c/em\u003e=0.051) (Table 4, Figure 2).\u0026nbsp;Model summary of the Structural equation: \u003cem\u003e\u0026chi; \u003csup\u003e2\u0026nbsp;\u003c/sup\u003e/df\u003c/em\u003e=2.556, RMSEA=0.097, GFI=0.992, AGFI=0.924, CFI =0.974, TLI=0.842.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, using Fear of Progression Questionnaire-Short Form to measure fear of disease progression in patients with precancerous cervical lesions. Regression analysis found that anxiety, a family history of cervical cancer, avoidant and resigned coping style were risk factors for FOP, and confrontational coping style to disease was a protective factor for FOP. Additionally, confrontational and resigned coping styles mediate the effects of anxiety on FOP (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). Clinicians and nurses involved in patients\u0026rsquo; treatment should focus on these factors and connection, so as to take effective psychological intervention measures timely.\u003c/p\u003e \u003cp\u003eInterestingly, the FOP scores show that the higher scoring entries were \u0026ldquo;I become anxious at the thought that the disease may progress\u0026rdquo; (2.73 points), \u0026ldquo;I feel nervous before doctor's appointments and regular checkups\u0026rdquo; (2.70 points), \u0026ldquo;I am afraid of the pain caused by the disease\u0026rdquo; (2.60 points). It can be seen that the source of the patient's fearfulness is mainly the symptoms of the disease and stems from the social family dimension to a lesser extent. Similar to Nakata's findings[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], patients were concerned about the severity of their symptoms and the results of their tests. Moreover, patients with precancerous cervical lesions undergo frequent tests, and each time they face a change in the results, it is a psychological ordeal for them[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Several psychological interventions have been shown to be effective in reducing patients' FOP[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and the results of the present study add to previous findings that healthcare professionals should pay more attention to patients' disease symptoms and reduce their excessive fear of medical visits and examinations.\u003c/p\u003e \u003cp\u003eFirstly, patients in the study with a family history of cervical lesions were more fearful of progression compared to those without a family history of the disease. This is similar to the results of previous studies[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Most patients with a family history of the disease have witnessed the illness and treatment of their family members, they have clearly perceived the symptoms and pain of the disease, and they have empathized with the worry and anxiety brought about by the disease, so they are very afraid. The results of this study suggest that we should pay more attention to patients with a family history of cervical lesions. Healthcare professionals are aware of the family history of the patients during the health assessment of the patients, so we can start psychological counseling for these patients before they undergo the examination and treatment to alleviate their nervousness and fear. Furthermore, timely education of patients with specialized medical knowledge is also effective in alleviating FOP. Dissemination of knowledge about the disease aims to minimize excessive fear in patients so that they understand that having a family history of the disease does not mean a greater risk of death[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. We may have better results if we give patients medical knowledge education and psychological counseling at the evaluation stage, just like a preventive shot, which can give patients time to do psychological construction.\u003c/p\u003e \u003cp\u003eAs a main result, our analysis revealed that anxiety was a mainly relevant determinant of FOP. Anxiety is an irritable emotion caused by excessive worry about one's life safety, future destiny[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The more anxious the patient with precancerous cervical lesions, the more severe the fear of disease progression. Anxiety in cervical cancer survivors was a risk factor for FOP in Hanprasertpong's study[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In this study, patients with precancerous cervical lesions faced great uncertainty, as it was difficult to determine whether there would be further deterioration and what future treatment would be required. The resulting anxiety further exacerbates the fear of progression. Therefore, alleviating patients' anxiety may be critical to improving their psychological state and reducing their fear in the face of the disease. Themes from some qualitative studies suggest that sources of patient anxiety may include: consequences of cancer: thoughts about death or impact on loved ones, higher perceived risk of cancer, stigma, and fertility worries (younger women)[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Healthcare professionals can address these aspects by providing patients with specialized knowledge about the disease thereby reducing their worries and rumination. Patients with precancerous cervical lesions certainly experience anxiety, which is normal, especially for women[\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The results of previous studies have confirmed that measures such as knowledge education and mindfulness-based cognitive therapy are effective in relieving patients' anxiety[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. We should learn from these effective psychological intervention measures to reduce the anxiety of patients and thereby alleviate their FOP.\u003c/p\u003e \u003cp\u003eThis study also investigated patients' coping styles with illness. Lazarus' theory points out that coping styles refer to the methods, means, or strategies that an individual employs to cope with the demands of the internal and external environments and their associated emotional distress, which are influenced by the stressful environment and personality traits[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Confrontation is the ability to confront the problem in a stressful situation and is considered a positive way of coping that is beneficial to the patient's physical and mental health. Avoidance and resignation coping styles are often perceived as negative and can weaken the patient's ability to self-regulate in the face of illness. The outcome of coping affects many aspects of an individual's outlook on life, attitude toward life, social adjustment, and mental and physical health[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The results of the study show that most of the patients will use confrontational coping style and only a small percentage of patients will use avoidance and resignation to cope with the disease. However, this is not encouraging because the way a patient copes with the disease can easily change, and it is difficult to determine if the patient will always be able to be positive about the disease[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The results of multiple linear regression in this study showed that avoidant and resigned coping style were risk factors for FOP, and confrontational coping style to disease was a protective factor for FOP. This result suggests that we should encourage patients with precancerous cervical lesions to face the disease positively, and that although avoidance coping may bring short-lived psychological comfort, it may cause serious FOP, which may jeopardize the patient's mental health status even more.\u003c/p\u003e \u003cp\u003eAs the results of this study show, anxiety and fear about health or disease are unavoidable. Previous studies have suggested a mediated effect relationship between FOP and psychological factors such as anxiety[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]; therefore, we conducted a preliminary mediated effect analysis of FOP, anxiety, and coping styles in patients with cervical precancerous lesions, which may help us to analyze in depth the role of the influence between psychological factors. We first analyzed the effects of confrontation, avoidance coping styles between anxiety and FOP, however the fit of the parallel mediator was poor, so we did not adopt a mediating role between this. We put confrontation and resignation into a parallel mediation effects model, and the results showed that confrontation and resignation mediated anxiety and FOP in each of the two pathways. Confrontation was a negative predictor between anxiety and FOP, implying that patients should be positive about the disease and thus reduce their internal fears. Additionally, the results showed that resignation was more likely to mediate the effect of anxiety on FOP than Confrontation, which means resignation may bring the patient severe anxiety and fears. As the results of previous studies have shown, confrontation can improve patients' mental health, which can lead to optimism about the disease[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Different coping styles will affect patients' FOP to different degrees, therefore, healthcare professionals should pay more attention to the psychological status of patients with precancerous cervical lesions in the course of treatment. It is necessary for healthcare professionals to give patients professional medical knowledge and psychological comfort, guide them to adopt the most appropriate coping styles, and help them build up confidence in treating the disease[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClearly, this study has some limitations. Firstly, the data were collected through an online questionnaire, which may have some filling in errors, but these patients were seen in our hospital, we were familiar with the patients before collecting the questionnaire, and we continued to follow up with the patients by phone after collecting the questionnaire to minimize the data errors. Secondly, the Adjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e of the multiple linear regression equation is not ideal, but we used the FDR correction for statistical results. Thirdly, we need to conduct a qualitative study to further explore the causes and solutions of patients' fear of disease progression. Moreover, we only used parallel mediation modeling to analyze the relationship between psychological factors, and more complex structural equation modeling could be used in the next phase of the study to explore the influences of FOP.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study is an important step toward exploring potential predictors of FOP in patients with cervical precancerous lesions and the role these predictors play in FOP, and provides preventive measures for delay in cervical precancerous lesions. The findings suggest that yielding is more likely to have an effect on FOP than confronting. It provides theoretical guidance for us to take effective methods to prevent the fear of progression in patients with cervical precancerous lesions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCervical intraepithelial neoplasia, CIN\u003c/p\u003e\n\u003cp\u003ehuman papilloma virus, HPV\u003c/p\u003e\n\u003cp\u003eFear of progression, FOP\u003c/p\u003e\n\u003cp\u003eSelf‑Rating Anxiety Scale, SAS\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMedical Coping Modes Questionnaire, MCMQ\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiao-Hong Jin: conception and design, administrative support, provision of study materials or patients, collection and assembly of data. Xiao-Man Liu: data analysis and interpretation. Hai-Yan Huang: review of manuscripts. Manuscript writing: All authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was approved by the local Hospital\u0026rsquo;s Ethics Committee(2021-K051) and obtained signed informed consent from all patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: All authors have completed the ICMJE uniform disclosure form. The authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to extend our sincere gratitude to our patients who were willing to participate in our study, share their experience with us, and help and support people around.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets presented in this article are not readily available because participants did not provide consent for public availability of the data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eArbyn M, Weiderpass E, Bruni L, de Sanjose S, Saraiya M, Ferlay J, Bray F: \u003cstrong\u003eEstimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis\u003c/strong\u003e. \u003cem\u003eLancet Glob Health \u003c/em\u003e2020, \u003cstrong\u003e8\u003c/strong\u003e(2):e191-e203.\u003c/li\u003e\n\u003cli\u003eBuskwofie A, David-West G, Clare CA: \u003cstrong\u003eA Review of Cervical Cancer: Incidence and Disparities\u003c/strong\u003e. \u003cem\u003eJ Natl Med Assoc \u003c/em\u003e2020, \u003cstrong\u003e112\u003c/strong\u003e(2):229-232.\u003c/li\u003e\n\u003cli\u003eWang SM, Shi JF, Kang DJ, Song P, Qiao YL, Chinese HPVSG: \u003cstrong\u003eImpact of human papillomavirus-related lesions on quality of life: a multicenter hospital-based study of women in Mainland China\u003c/strong\u003e. \u003cem\u003eInt J Gynecol Cancer \u003c/em\u003e2011, \u003cstrong\u003e21\u003c/strong\u003e(1):182-188.\u003c/li\u003e\n\u003cli\u003eMcBride E, Marlow LAV, Bennett KF, Stearns S, Waller J: \u003cstrong\u003eExploring reasons for variations in anxiety after testing positive for human papillomavirus with normal cytology: a comparative qualitative study\u003c/strong\u003e. \u003cem\u003ePsychooncology \u003c/em\u003e2021, \u003cstrong\u003e30\u003c/strong\u003e(1):84-92.\u003c/li\u003e\n\u003cli\u003eSkare TL, Neppel A, Machoski MCC, Maestri CA, Messias-Reason I, Nisihara R: \u003cstrong\u003eAntinuclear antibodies in patients with cervical lesions and invasive cervical cancer\u003c/strong\u003e. \u003cem\u003eImmunol Lett \u003c/em\u003e2019, \u003cstrong\u003e208\u003c/strong\u003e:8-10.\u003c/li\u003e\n\u003cli\u003eNagele E, Reich O, Greimel E, Dorfer M, Haas J, Trutnovsky G: \u003cstrong\u003eSexual Activity, Psychosexual Distress, and Fear of Progression in Women With Human Papillomavirus-Related Premalignant Genital Lesions\u003c/strong\u003e. \u003cem\u003eJ Sex Med \u003c/em\u003e2016, \u003cstrong\u003e13\u003c/strong\u003e(2):253-259.\u003c/li\u003e\n\u003cli\u003ePeterson CE, Silva A, Goben AH, Ongtengco NP, Hu EZ, Khanna D, Nussbaum ER, Jasenof IG, Kim SJ, Dykens JA: \u003cstrong\u003eStigma and cervical cancer prevention: A scoping review of the U.S. literature\u003c/strong\u003e. \u003cem\u003ePrev Med \u003c/em\u003e2021, \u003cstrong\u003e153\u003c/strong\u003e:106849.\u003c/li\u003e\n\u003cli\u003eCoutts-Bain D, Sharpe L, Pradhan P, Russell H, Heathcote LC, Costa D: \u003cstrong\u003eAre fear of cancer recurrence and fear of progression equivalent constructs?\u003c/strong\u003e \u003cem\u003ePsychooncology \u003c/em\u003e2022, \u003cstrong\u003e31\u003c/strong\u003e(8):1381-1389.\u003c/li\u003e\n\u003cli\u003eSharpe L, Michalowski M, Richmond B, Menzies RE, Shaw J: \u003cstrong\u003eFear of progression in chronic illnesses other than cancer: a systematic review and meta-analysis of a transdiagnostic construct\u003c/strong\u003e. \u003cem\u003eHealth Psychol Rev \u003c/em\u003e2023, \u003cstrong\u003e17\u003c/strong\u003e(2):301-320.\u003c/li\u003e\n\u003cli\u003eDinkel A, Marten-Mittag B, Kremsreiter K: \u003cstrong\u003eAssociation Between Daily Worry, Pathological Worry, and Fear of Progression in Patients With Cancer\u003c/strong\u003e. \u003cem\u003eFront Psychol \u003c/em\u003e2021, \u003cstrong\u003e12\u003c/strong\u003e:648623.\u003c/li\u003e\n\u003cli\u003eSun H, Yang Y, Zhang J, Liu T, Wang H, Garg S, Zhang B: \u003cstrong\u003eFear of cancer recurrence, anxiety and depressive symptoms in adolescent and young adult cancer patients\u003c/strong\u003e. \u003cem\u003eNeuropsychiatr Dis Treat \u003c/em\u003e2019, \u003cstrong\u003e15\u003c/strong\u003e:857-865.\u003c/li\u003e\n\u003cli\u003eCoutts-Bain D, Sharpe L, Russell H: \u003cstrong\u003eDeath anxiety predicts fear of Cancer recurrence and progression in ovarian Cancer patients over and above other cognitive factors\u003c/strong\u003e. \u003cem\u003eJ Behav Med \u003c/em\u003e2023.\u003c/li\u003e\n\u003cli\u003eHanprasertpong J, Geater A, Jiamset I, Padungkul L, Hirunkajonpan P, Songhong N: \u003cstrong\u003eFear of cancer recurrence and its predictors among cervical cancer survivors\u003c/strong\u003e. \u003cem\u003eJ Gynecol Oncol \u003c/em\u003e2017, \u003cstrong\u003e28\u003c/strong\u003e(6):e72.\u003c/li\u003e\n\u003cli\u003eNagele E, Trutnovsky G, Greimel E, Dorfer M, Haas J, Reich O: \u003cstrong\u003eDo different treatment strategies influence women\u0026apos;s level of psychosexual distress? Observational cohort study of women with premalignant HPV-associated genital lesions\u003c/strong\u003e. \u003cem\u003eEur J Obstet Gynecol Reprod Biol \u003c/em\u003e2019, \u003cstrong\u003e236\u003c/strong\u003e:205-209.\u003c/li\u003e\n\u003cli\u003eWu F, Howell D, Fang Q, Chen J, Yuan C: \u003cstrong\u003eTrajectory Patterns and Factors Influencing Self-management Behaviors in Chinese Patients With Breast Cancer\u003c/strong\u003e. \u003cem\u003eCancer Nurs \u003c/em\u003e2020, \u003cstrong\u003e43\u003c/strong\u003e(2):E105-E112.\u003c/li\u003e\n\u003cli\u003eKim H, Cho IK, Lee D, Kim K, Lee J, Cho E, Park CHK, Chung S: \u003cstrong\u003eEffect of Cancer-Related Dysfunctional Beliefs About Sleep on Fear of Cancer Progression in the Coronavirus Pandemic\u003c/strong\u003e. \u003cem\u003eJ Korean Med Sci \u003c/em\u003e2022, \u003cstrong\u003e37\u003c/strong\u003e(36):e272.\u003c/li\u003e\n\u003cli\u003eKrok-Schoen JL, Naughton MJ, Bernardo BM, Young GS, Paskett ED: \u003cstrong\u003eFear of recurrence among older breast, ovarian, endometrial, and colorectal cancer survivors: Findings from the WHI LILAC study\u003c/strong\u003e. \u003cem\u003ePsychooncology \u003c/em\u003e2018, \u003cstrong\u003e27\u003c/strong\u003e(7):1810-1815.\u003c/li\u003e\n\u003cli\u003eLiu J, Peh CX, Simard S, Griva K, Mahendran R: \u003cstrong\u003eBeyond the fear that lingers: The interaction between fear of cancer recurrence and rumination in relation to depression and anxiety symptoms\u003c/strong\u003e. \u003cem\u003eJ Psychosom Res \u003c/em\u003e2018, \u003cstrong\u003e111\u003c/strong\u003e:120-126.\u003c/li\u003e\n\u003cli\u003ePeng G, Dong H, Liang T, Li L, Liu J: \u003cstrong\u003eDiagnosis of cervical precancerous lesions based on multimodal feature changes\u003c/strong\u003e. \u003cem\u003eComput Biol Med \u003c/em\u003e2021, \u003cstrong\u003e130\u003c/strong\u003e:104209.\u003c/li\u003e\n\u003cli\u003eMehnert A, Herschbach P, Berg P, Henrich G, Koch U: \u003cstrong\u003e[Fear of progression in breast cancer patients--validation of the short form of the Fear of Progression Questionnaire (FoP-Q-SF)]\u003c/strong\u003e. \u003cem\u003eZ Psychosom Med Psychother \u003c/em\u003e2006, \u003cstrong\u003e52\u003c/strong\u003e(3):274-288.\u003c/li\u003e\n\u003cli\u003eLi Q, Liu L, Gu Z, Li M, Liu C, Wu H: \u003cstrong\u003eSense of coherence mediates perceived social support and depressive and anxiety symptoms in cervical cancer patients: a cross-sectional study\u003c/strong\u003e. \u003cem\u003eBMC Psychiatry \u003c/em\u003e2023, \u003cstrong\u003e23\u003c/strong\u003e(1):312.\u003c/li\u003e\n\u003cli\u003eJin R, Xie T, Zhang L, Gong N, Zhang J: \u003cstrong\u003eStigma and its influencing factors among breast cancer survivors in China: A cross-sectional study\u003c/strong\u003e. \u003cem\u003eEur J Oncol Nurs \u003c/em\u003e2021, \u003cstrong\u003e52\u003c/strong\u003e:101972.\u003c/li\u003e\n\u003cli\u003eLi Y, Zhang X, Zhang J, Zhang D, Wang Y, Zhu Y, Xu X: \u003cstrong\u003eStigma and unhealthy psychological characteristics in patients with acromegaly: A cross-sectional study and identification of the associated factors\u003c/strong\u003e. \u003cem\u003eActa Neurochir (Wien) \u003c/em\u003e2022, \u003cstrong\u003e164\u003c/strong\u003e(8):2069-2081.\u003c/li\u003e\n\u003cli\u003eNakata H, Halbach S, Geiser F, Stock S, Kowalski C, Enders A, Pfaff H, Ernstmann N: \u003cstrong\u003eHealth literacy, mental disorders and fear of progression and their association with a need for psycho-oncological care over the course of a breast cancer treatment\u003c/strong\u003e. \u003cem\u003ePsychol Health Med \u003c/em\u003e2021, \u003cstrong\u003e26\u003c/strong\u003e(7):818-831.\u003c/li\u003e\n\u003cli\u003eTauber NM, O\u0026apos;Toole MS, Dinkel A, Galica J, Humphris G, Lebel S, Maheu C, Ozakinci G, Prins J, Sharpe L\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eEffect of Psychological Intervention on Fear of Cancer Recurrence: A Systematic Review and Meta-Analysis\u003c/strong\u003e. \u003cem\u003eJ Clin Oncol \u003c/em\u003e2019, \u003cstrong\u003e37\u003c/strong\u003e(31):2899-2915.\u003c/li\u003e\n\u003cli\u003eLyu MM, Siah RC, Lam ASL, Cheng KKF: \u003cstrong\u003eThe effect of psychological interventions on fear of cancer recurrence in breast cancer survivors: A systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eJ Adv Nurs \u003c/em\u003e2022, \u003cstrong\u003e78\u003c/strong\u003e(10):3069-3082.\u003c/li\u003e\n\u003cli\u003eYang Y, Qi H, Li W, Liu T, Xu W, Zhao S, Yang F, Humphris G, Chen Y, Sun H: \u003cstrong\u003ePredictors and trajectories of fear of cancer recurrence in Chinese breast cancer patients\u003c/strong\u003e. \u003cem\u003eJ Psychosom Res \u003c/em\u003e2023, \u003cstrong\u003e166\u003c/strong\u003e:111177.\u003c/li\u003e\n\u003cli\u003eOmidi Z, Kheirkhah M, Abolghasemi J, Haghighat S: \u003cstrong\u003eEffect of lymphedema self-management group-based education compared with social network-based education on quality of life and fear of cancer recurrence in women with breast cancer: a randomized controlled clinical trial\u003c/strong\u003e. \u003cem\u003eQual Life Res \u003c/em\u003e2020, \u003cstrong\u003e29\u003c/strong\u003e(7):1789-1800.\u003c/li\u003e\n\u003cli\u003eDinkel A, Kremsreiter K, Marten-Mittag B, Lahmann C: \u003cstrong\u003eComorbidity of fear of progression and anxiety disorders in cancer patients\u003c/strong\u003e. \u003cem\u003eGen Hosp Psychiatry \u003c/em\u003e2014, \u003cstrong\u003e36\u003c/strong\u003e(6):613-619.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Connor M, Costello L, Murphy J, Prendiville W, Martin CM, O\u0026apos;Leary JJ, Sharp L, Irish Screening Research C: \u003cstrong\u003e\u0026apos;I don\u0026apos;t care whether it\u0026apos;s HPV or ABC, I just want to know if I have cancer.\u0026apos; Factors influencing women\u0026apos;s emotional responses to undergoing human papillomavirus testing in routine management in cervical screening: a qualitative study\u003c/strong\u003e. \u003cem\u003eBJOG \u003c/em\u003e2014, \u003cstrong\u003e121\u003c/strong\u003e(11):1421-1429.\u003c/li\u003e\n\u003cli\u003eMcBride E, Marlow LAV, Forster AS, Ridout D, Kitchener H, Patnick J, Waller J: \u003cstrong\u003eAnxiety and distress following receipt of results from routine HPV primary testing in cervical screening: The psychological impact of primary screening (PIPS) study\u003c/strong\u003e. \u003cem\u003eInt J Cancer \u003c/em\u003e2020, \u003cstrong\u003e146\u003c/strong\u003e(8):2113-2121.\u003c/li\u003e\n\u003cli\u003eYang CM, Sung FC, Mou CH, Liao CH, Wang PH, Shieh SH: \u003cstrong\u003eAnxiety and depression risk in Taiwan women with breast cancer and cervical cancer\u003c/strong\u003e. \u003cem\u003eFront Oncol \u003c/em\u003e2022, \u003cstrong\u003e12\u003c/strong\u003e:946029.\u003c/li\u003e\n\u003cli\u003eYang YL, Liu L, Wang XX, Wang Y, Wang L: \u003cstrong\u003ePrevalence and associated positive psychological variables of depression and anxiety among Chinese cervical cancer patients: a cross-sectional study\u003c/strong\u003e. \u003cem\u003ePLoS One \u003c/em\u003e2014, \u003cstrong\u003e9\u003c/strong\u003e(4):e94804.\u003c/li\u003e\n\u003cli\u003eYang X, Huang L, Li C, Ji N, Zhu H: \u003cstrong\u003eThe effectiveness of mindfulness-based stress reduction intervention on alleviating anxiety and depression in postoperative patients with cervical cancer: A protocol for systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eMedicine (Baltimore) \u003c/em\u003e2022, \u003cstrong\u003e101\u003c/strong\u003e(5):e28706.\u003c/li\u003e\n\u003cli\u003eNissen ER, O\u0026apos;Connor M, Kaldo V, Hojris I, Borre M, Zachariae R, Mehlsen M: \u003cstrong\u003eInternet-delivered mindfulness-based cognitive therapy for anxiety and depression in cancer survivors: A randomized controlled trial\u003c/strong\u003e. \u003cem\u003ePsychooncology \u003c/em\u003e2020, \u003cstrong\u003e29\u003c/strong\u003e(1):68-75.\u003c/li\u003e\n\u003cli\u003eLazarus RS: \u003cstrong\u003eCoping theory and research: past, present, and future\u003c/strong\u003e. \u003cem\u003ePsychosom Med \u003c/em\u003e1993, \u003cstrong\u003e55\u003c/strong\u003e(3):234-247.\u003c/li\u003e\n\u003cli\u003ePfaendler KS, Wenzel L, Mechanic MB, Penner KR: \u003cstrong\u003eCervical cancer survivorship: long-term quality of life and social support\u003c/strong\u003e. \u003cem\u003eClin Ther \u003c/em\u003e2015, \u003cstrong\u003e37\u003c/strong\u003e(1):39-48.\u003c/li\u003e\n\u003cli\u003eShang M, Cai T, Meng Y, Wang Q, Cui Y, Zhang F: \u003cstrong\u003eDyadic coping in young and middle-aged women with gynecological cancer: a latent class analysis\u003c/strong\u003e. \u003cem\u003eSupport Care Cancer \u003c/em\u003e2022, \u003cstrong\u003e31\u003c/strong\u003e(1):47.\u003c/li\u003e\n\u003cli\u003eCurran L, Sharpe L, MacCann C, Butow P: \u003cstrong\u003eTesting a model of fear of cancer recurrence or progression: the central role of intrusions, death anxiety and threat appraisal\u003c/strong\u003e. \u003cem\u003eJ Behav Med \u003c/em\u003e2020, \u003cstrong\u003e43\u003c/strong\u003e(2):225-236.\u003c/li\u003e\n\u003cli\u003eLi LR, Lin MG, Liang J, Hu QY, Chen D, Lan MY, Liang WQ, Zeng YT, Wang T, Fu GF: \u003cstrong\u003eEffects of Intrinsic and Extrinsic Factors on the Level of Hope and Psychological Health Status of Patients with Cervical Cancer During Radiotherapy\u003c/strong\u003e. \u003cem\u003eMed Sci Monit \u003c/em\u003e2017, \u003cstrong\u003e23\u003c/strong\u003e:3508-3517.\u003c/li\u003e\n\u003cli\u003ePradhan P, Sharpe L, Menzies RE: \u003cstrong\u003eTowards a Stepped Care Model for Managing Fear of Cancer Recurrence or Progression in Cancer Survivors\u003c/strong\u003e. \u003cem\u003eCancer Manag Res \u003c/em\u003e2021, \u003cstrong\u003e13\u003c/strong\u003e:8953-8965.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eResults of univariate analysis on the factors\u0026nbsp;of FOP in patients with cervical precancerous lesions (\u003cem\u003en\u003c/em\u003e=167).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"591\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003eFOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et/F\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eAge \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e0.416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e0.660\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e28.23\u0026plusmn;10.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e45-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e28.11\u0026plusmn;9.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e26.11\u0026plusmn;10.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eWhether fertility \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e1.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e27.72\u0026plusmn;10.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e38.00\u0026plusmn;5.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eMarriage status\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003edivorced or widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e28.50\u0026plusmn;11.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003emarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e27.81\u0026plusmn;10.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eOccupation\u0026nbsp;\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e-1.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eunemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e26.69\u0026plusmn;10.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e28.73\u0026plusmn;10.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eEducational level \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003esecondary school or below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e28.23\u0026plusmn;10.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003ejunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e26.60\u0026plusmn;10.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003ecollege or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e27.70\u0026plusmn;9.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eResidence\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e-0.874\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e0.383\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003evillage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e27.25\u0026plusmn;11.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003etown or city\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e28.65\u0026plusmn;9.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eMonthly per capita income, RMB\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e30.06\u0026plusmn;12.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e2000-3999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e26.84\u0026plusmn;10.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e4000-5999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e28.03\u0026plusmn;7.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e27.76\u0026plusmn;10.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eCourse of disease(day)\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e1.747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.083\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026le;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e28.75\u0026plusmn;10.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e25.65\u0026plusmn;10.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eChronic diseases\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e-0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e0.542\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e28.93\u0026plusmn;12.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e27.61\u0026plusmn;10.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eFamily history of cervical cancer\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e-2.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e34.46\u0026plusmn;9.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.324324324324323%\" valign=\"top\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\" valign=\"top\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.54054054054054%\" valign=\"top\"\u003e\n \u003cp\u003e27.28\u0026plusmn;10.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.486486486486486%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations:\u0026nbsp;FOP,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eFear of progression.\u003c/p\u003e\n\u003cp\u003eVariables in bold are those considered statistically significant(\u003cem\u003eP\u0026lt;0.1\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eValues are presented as number and mean \u0026plusmn; standard deviation.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eValues are analyzed by\u0026nbsp;One Way ANOVA(\u003cem\u003eF\u003c/em\u003e). \u003csup\u003eb\u003c/sup\u003e Values are analyzed by Independent Sample Test(\u003cem\u003et\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eResults of correlation BETWEEN Psychological scale scores and FOP in patients with precancerous cervical lesions.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.122040072859743%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.397085610200364%\" valign=\"top\"\u003e\n \u003cp\u003eFOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.397085610200364%\" valign=\"top\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.21129326047359%\" valign=\"top\"\u003e\n \u003cp\u003eConfrontation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.029143897996356%\" valign=\"top\"\u003e\n \u003cp\u003eAvoidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843351548269581%\" valign=\"top\"\u003e\n \u003cp\u003eResignation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.122040072859743%\" valign=\"top\"\u003e\n \u003cp\u003eFOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.397085610200364%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.397085610200364%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.21129326047359%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.029143897996356%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843351548269581%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.122040072859743%\" valign=\"top\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.397085610200364%\" valign=\"top\"\u003e\n \u003cp\u003e0.235**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.397085610200364%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.21129326047359%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.029143897996356%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843351548269581%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.122040072859743%\" valign=\"top\"\u003e\n \u003cp\u003eConfrontation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.397085610200364%\" valign=\"top\"\u003e\n \u003cp\u003e-0.184*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.397085610200364%\" valign=\"top\"\u003e\n \u003cp\u003e-0.169*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.21129326047359%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.029143897996356%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843351548269581%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.122040072859743%\" valign=\"top\"\u003e\n \u003cp\u003eAvoidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.397085610200364%\" valign=\"top\"\u003e\n \u003cp\u003e0.193*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.397085610200364%\" valign=\"top\"\u003e\n \u003cp\u003e-0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.21129326047359%\" valign=\"top\"\u003e\n \u003cp\u003e0.214**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.029143897996356%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843351548269581%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.122040072859743%\" valign=\"top\"\u003e\n \u003cp\u003eResignation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.397085610200364%\" valign=\"top\"\u003e\n \u003cp\u003e0.350**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.397085610200364%\" valign=\"top\"\u003e\n \u003cp\u003e0.286**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.21129326047359%\" valign=\"top\"\u003e\n \u003cp\u003e-0.185*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.029143897996356%\" valign=\"top\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843351548269581%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e**\u003cem\u003eP\u0026lt;0.01\u003c/em\u003e, *\u003cem\u003e\u0026nbsp;P\u0026lt;0.05.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003eMultivariate linear regression model of the factors associated with\u0026nbsp;FOP in patients with precancerous cervical lesions.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"563\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.106761565836297%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.14946619217082%\" valign=\"top\"\u003e\n \u003cp\u003eB (SE)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676156583629894%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142348754448399%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676156583629894%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142348754448399%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-FDR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.106761565836297%\" valign=\"top\"\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.106761565836297%\" valign=\"top\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.14946619217082%\" valign=\"top\"\u003e\n \u003cp\u003e0.212(0.086)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676156583629894%\" valign=\"top\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142348754448399%\" valign=\"top\"\u003e\n \u003cp\u003e2.459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676156583629894%\" valign=\"top\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142348754448399%\" valign=\"top\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.106761565836297%\" valign=\"top\"\u003e\n \u003cp\u003e(0.042,0.383)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.106761565836297%\" valign=\"top\"\u003e\n \u003cp\u003eConfrontation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.14946619217082%\" valign=\"top\"\u003e\n \u003cp\u003e-0.519(0.197)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676156583629894%\" valign=\"top\"\u003e\n \u003cp\u003e-0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142348754448399%\" valign=\"top\"\u003e\n \u003cp\u003e-2.640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676156583629894%\" valign=\"top\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142348754448399%\" valign=\"top\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.106761565836297%\" valign=\"top\"\u003e\n \u003cp\u003e(-0.907, -0.131)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.106761565836297%\" valign=\"top\"\u003e\n \u003cp\u003eAvoidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.14946619217082%\" valign=\"top\"\u003e\n \u003cp\u003e0.887(0.275)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676156583629894%\" valign=\"top\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142348754448399%\" valign=\"top\"\u003e\n \u003cp\u003e3.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676156583629894%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142348754448399%\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.106761565836297%\" valign=\"top\"\u003e\n \u003cp\u003e(0.344,1.430)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.106761565836297%\" valign=\"top\"\u003e\n \u003cp\u003eResignation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.14946619217082%\" valign=\"top\"\u003e\n \u003cp\u003e1.157(0.297)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676156583629894%\" valign=\"top\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142348754448399%\" valign=\"top\"\u003e\n \u003cp\u003e3.890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676156583629894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142348754448399%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.106761565836297%\" valign=\"top\"\u003e\n \u003cp\u003e(0.570,1.745)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.106761565836297%\" valign=\"top\"\u003e\n \u003cp\u003eFamily history of cervical cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.14946619217082%\" valign=\"top\"\u003e\n \u003cp\u003e8.630(2.624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676156583629894%\" valign=\"top\"\u003e\n \u003cp\u003e0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142348754448399%\" valign=\"top\"\u003e\n \u003cp\u003e3.289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676156583629894%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142348754448399%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.106761565836297%\" valign=\"top\"\u003e\n \u003cp\u003e(3.448,13.812)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eModel summary:\u0026nbsp;\u003cem\u003eF\u003c/em\u003e=11.259,\u003cem\u003e\u0026nbsp;P\u003c/em\u003e\u0026lt;0.001, Adjusted \u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=27.1%.\u003c/p\u003e\n\u003cp\u003eAbbreviations: SE, standard error; FDR,\u0026nbsp;false discovery rate.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e Path analysis on the direct and indirect effects of anxiety on FOP in patients with precancerous cervical lesions.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"503\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.57455268389662%\" valign=\"top\"\u003e\n \u003cp\u003eEffects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.22465208747515%\" valign=\"top\"\u003e\n \u003cp\u003eStandardized estimator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.09145129224652%\" valign=\"top\"\u003e\n \u003cp\u003eLLCI-ULCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.109343936381709%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.57455268389662%\" valign=\"top\"\u003e\n \u003cp\u003eIndirect effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.22465208747515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.09145129224652%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.109343936381709%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.57455268389662%\" valign=\"top\"\u003e\n \u003cp\u003eAnxiety\u0026rarr;Confrontation\u0026rarr;FOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.22465208747515%\" valign=\"top\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.09145129224652%\" valign=\"top\"\u003e\n \u003cp\u003e0.001-0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.109343936381709%\" valign=\"top\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.57455268389662%\" valign=\"top\"\u003e\n \u003cp\u003eAnxiety\u0026rarr;Resignation\u0026rarr;FOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.22465208747515%\" valign=\"top\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.09145129224652%\" valign=\"top\"\u003e\n \u003cp\u003e0.049-0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.109343936381709%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.57455268389662%\" valign=\"top\"\u003e\n \u003cp\u003eTotal effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.22465208747515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.09145129224652%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.109343936381709%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.57455268389662%\" valign=\"top\"\u003e\n \u003cp\u003eAnxiety\u0026rarr;FOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.22465208747515%\" valign=\"top\"\u003e\n \u003cp\u003e0.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.09145129224652%\" valign=\"top\"\u003e\n \u003cp\u003e0.146-0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.109343936381709%\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.57455268389662%\" valign=\"top\"\u003e\n \u003cp\u003eDiff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.22465208747515%\" valign=\"top\"\u003e\n \u003cp\u003e-0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.09145129224652%\" valign=\"top\"\u003e\n \u003cp\u003e-0.201-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.109343936381709%\" valign=\"top\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: LLCI, low‐limit confidence interval; ULCI, upper‐limit confidence interval.\u003c/p\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":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Fear of progression, Anxiety, Coping Modes, Cervical precancerous lesions","lastPublishedDoi":"10.21203/rs.3.rs-4423438/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4423438/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eFOP is a psychological experience of excessive fear that threatens the mental and physical health of patients, resulting in poor treatment outcomes and decreased quality of life. This study aimed at investigating the associations among anxiety, coping modes, and FOP in patients with cervical precancerous lesions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eThis is a cross-sectional study that includes 167 patients with cervical precancerous lesions. Patients filled out the FOP Questionnaire, the Self‑Rating Anxiety Scale, and the Medical Coping Modes Questionnaire. The parallel mediation analysis was used to evaluate the mediating role of different coping styles in the relationship between anxiety and FOP.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eThe scores of FOP in patients with precancerous cervical lesions was 27.84±10.51.. The potential predictors of FOP among patients were anxiety (\u003cem\u003eβ\u003c/em\u003e=0.175, \u003cem\u003eP\u003c/em\u003e=0.015), confrontation (\u003cem\u003eβ\u003c/em\u003e=-0.188, \u003cem\u003eP\u003c/em\u003e =0.009), avoidance (\u003cem\u003eβ\u003c/em\u003e=0.229, \u003cem\u003eP\u003c/em\u003e =0.002), resignation (\u003cem\u003eβ\u003c/em\u003e=0.181, \u003cem\u003eP\u003c/em\u003e \u0026lt;0.001), family history of cervical cancer (\u003cem\u003eβ\u003c/em\u003e=0.221, \u003cem\u003eP\u003c/em\u003e =0.001). Parallel mediation results show that confrontationand resignation played the mediating role in the relationship between anxiety and FOP.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eAs expected, Anxiety, confrontation, avoidance, resignation, and family history of cervical cancer are potential predictors of FOP in patients. The results of parallel mediation showed that confrontation and resignation played a mediating role in the relationship between anxiety and FOP.. The results suggest that medical staff need to give them professional medical knowledge and guide them to adopt appropriate and positive coping styles.\u003c/p\u003e","manuscriptTitle":"Fear of progression in patients with cervical precancerous lesions: a cross-sectional survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 18:26:56","doi":"10.21203/rs.3.rs-4423438/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-28T16:42:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-25T17:54:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-25T17:54:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2024-05-15T07:44:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dd17b251-6b2c-4591-96c9-63e13dfc23c8","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-29T16:01:55+00:00","versionOfRecord":{"articleIdentity":"rs-4423438","link":"https://doi.org/10.1186/s40359-025-03323-6","journal":{"identity":"bmc-psychology","isVorOnly":false,"title":"BMC Psychology"},"publishedOn":"2025-09-25 15:58:07","publishedOnDateReadable":"September 25th, 2025"},"versionCreatedAt":"2024-06-11 18:26:56","video":"","vorDoi":"10.1186/s40359-025-03323-6","vorDoiUrl":"https://doi.org/10.1186/s40359-025-03323-6","workflowStages":[]},"version":"v1","identity":"rs-4423438","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4423438","identity":"rs-4423438","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}