{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T14:26:37Z","timestamp":1779200797351,"version":"3.51.4"},"reference-count":36,"publisher":"Wiley","issue":"13-14","license":[{"start":{"date-parts":[[2022,11,29]],"date-time":"2022-11-29T00:00:00Z","timestamp":1669680000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Nursing"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims and Objectives<\/jats:title><jats:p>To determine whether self\u2010efficacy mediates the relationship between Symptom Clusters (SC) and quality of life (QOL) in patients with myasthenia gravis (MG).<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>The QOL in patients with MG can be affected not only by the SC but the self\u2010efficacy in previous studies, while the latter may also be contributed by the former. However, it is still unclear whether self\u2010efficacy mediates the relationship between SC and QOL in patients with MG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A cross\u2010sectional survey was conducted in patients with MG who were recruited from our institution from October 2021 to March 2022, which was reported in line with the STROBE guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The hypothetical model was tested and all the effects of SC and self\u2010efficacy on QOL were estimated based on structural equation modelling (SEM) analysis after conducting a confirmatory factor analysis of the scales in a separate cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three scales for symptoms (four summated items), self\u2010efficacy (four plus one parcelled item) and MG\u2010QOL (three summated items) were validated according to the confirmatory factor analysis in 72 patients. An SEM analysis of another 310 participants revealed that SC exerted significant direct effects on QOL and self\u2010efficacy, with values of .585 and \u2212.293, respectively, and self\u2010efficacy also had a significant effect on QOL (\u2212.141). The indirect effect of SC on QOL via self\u2010efficacy was .041, accounting for 6.6% of the overall effect. Male and female patients did not differ in the direct and indirect effects of symptoms on QOL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study suggests that, although self\u2010efficacy partially mediates the relationship between SC and QOL in patients with MG, worsening of symptoms remains the leading contributor to the decreased QOL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Relevance to Clinical Practice<\/jats:title><jats:p>These results may provide a potential clue for doctors, nurses, and other caregivers to optimise treatment strategies for targeted patients with MG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patient or Public Contribution<\/jats:title><jats:p>Involved in developing and answering research questions, management and conduct.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocn.16569","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T06:59:17Z","timestamp":1669791557000},"page":"3921-3928","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of symptom clusters on quality of life mediated by self\u2010efficacy among individuals with myasthenia gravis: A structural equation modelling analysis"],"prefix":"10.1111","volume":"32","author":[{"given":"Fan","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan China"},{"name":"School of Nursing, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hai\u2010Shan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1113-0236","authenticated-orcid":false,"given":"Ling","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,11,29]]},"reference":[{"key":"e_1_2_12_2_1","article-title":"Symptom clusters predictive of quality of life among Jordanian women with breast cancer","volume":"2","author":"Al Q. 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