Abstract / Summary
Abstract Purpose Returning to work after breast cancer surgery is a complex psychosocial adaptation process. Return-to-work readiness and self-efficacy are central factors, but the interactions among their multiple components and their patterns across return-to-work statuses remain unclear. This study used network analysis to examine these constructs in patients who had and had not returned to work, identify central and bridge nodes, and compare the self-efficacy networks of the two groups. Methods This cross-sectional study used convenience sampling to recruit postoperative breast cancer patients from a tertiary hospital in Sichuan Province, China, including 323 patients who had not returned to work and 178 who had returned. Participants completed the Return-to-Work Readiness Scale (13-item version for those not working and 9-item version for those working) and the 11-item Return-to-Work Self-Efficacy Scale. Likert items were treated as approximately continuous. Regularized partial correlation networks were estimated with EBICglasso from Pearson correlation matrices. Strength centrality, bridge strength, and node predictability were calculated. Nonparametric and case-dropping bootstraps evaluated edge-weight accuracy and centrality stability, respectively. The Network Comparison Test (NCT) compared the two self-efficacy networks. Results The complete networks of the non-returned and returned groups retained 123 and 93 nonzero edges, respectively. In the non-returned group, RRTW-3 had the highest strength and RTWSE-2 had the highest bridge strength. In the returned group, RTWSE-10 had the highest strength and RRTW-22 had the highest bridge strength. The two 11-item self-efficacy networks did not differ significantly in structure (M = 0.211, p = 0.811) or global strength (S = 0.109, p = 0.512). The correlation-stability coefficients for strength centrality in the self-efficacy networks were 0.498 and 0.478 in the non-returned and returned groups, respectively. Conclusions The overall organization of the self-efficacy network did not differ statistically between patients who had and had not returned to work, although the descriptive rankings of central and bridge nodes varied by return-to-work status. Before return to work, assessment may emphasize readiness to act and beliefs related to coping with work stress. After return to work, assessment may emphasize work motivation, support needs for sustaining employment, and available energy. These network findings provide potential directions for stage-specific vocational rehabilitation, but the node-ranking differences require replication in larger and longitudinal samples. Implications for Cancer Survivors For breast cancer survivors, vocational rehabilitation should continue after work resumption and address both return-to-work readiness and specific aspects of work-related self-efficacy. Assessment of work preparation, anticipated psychological interference, stress coping, energy, motivation, and perceived need for help may identify support needs related to both returning to and sustaining employment. Given the cross-sectional design and the acceptable but not good stability of node rankings, these items should inform comprehensive assessment rather than serve as stand-alone intervention targets.