The patients (n = 120) with endometrial cancer who underwent surgical treatment in hospital from October 2017 to October 2019 were divided into the study group and the control group (60 cases in each group) using the random number table method. In the control group, the patients were 40–65 years old with an average age of 55.8 $\pm$ 6.1, and the tumor stage were 46 cases in stage I, 9 cases in stage II, and 5 cases in stage III. In the study group, the patients were 40–68 years old with an average age of 56.2 $\pm$ 6.4, and the tumor stage were 48 cases in stage I, 7 cases in stage II, and 5 cases in stage III. There was no significant difference between the study and control groups in age and tumor stage (t${}_{a\mathit{}g\mathit{}e}$ = 0.380, p = 0.705; x${}^2$${}_{\text{tumor stage}}$ = 0.293, p = 0.945). This study was approved by the Ethics Committee of Affiliated Hospital of North Sichuan Medical College, and obtained informed consent from all patients.

The inclusion criteria: All patients are older than 18 years old, and are diagnosed with endometrial cancer by pathological biopsy, accompanied by persistent or intermittent pain. In addition, the patients have no contraindications to surgery or history of pelvic surgery and are expected to survive for more than one year.

The exclusion criteria: Patients with severe liver and kidney dysfunction and coagulopathy, severe endocrine system diseases like cardiovascular system diseases and diabetes, mental illness and cognitive dysfunction, with a large amount of fluid in the abdomen and pelvis, cancer metastasis or malignant tumors in other parts of body are excluded. In addition, patients had taken anti-anxiety and depression drugs recently or were unwilling to participate in the investigation are excluded.

Patients in the control group are given usual care by the responsible nurses, such as keeping the ward clean and warm, preparing patients for surgery, distributing medicines as directed by doctors, managing the infusions, guiding patients on proper diet, and giving health education for patients and their families.

Patients in the study group receive high-quality nursing based on the hope theory on the basis of the usual care. The main nursing method are as follows:

(1) Assess the patient’s hope index. The nurses conduct a comprehensive evaluation of the patient’s physical and mental condition after admission through communicating the patients and their families, in order to assess patient’s hope index. Then, nurses formulate individualized nursing interventions based on the patient’s awareness of endometrial cancer, education level and economic status.

(2) Correct the patient’s wrong perception of endometrial cancer. Because some patients with endometrial cancer have lost hope in life, nurses should introduce the cancer knowledge and therapies to patients, and communicate with patients in a friendly language. Moreover, nurses not only use lectures, brochures, multimedia to subject health education for patients in order to teach them to face the reality, but also list some good recovery cases to enhance patients’ hope for the future, thereby guiding patients to correctly evaluate the disease, changing their poor cognition, inspiring the patient’s confidence, and improving their treatment compliance.

(3) Clear life goals. Combining the patient’s actual situation and hope index, the nurses assist patients to formulate realistic life goals, such as instructing patients to listen to music, practicing calligraphy and exercising to ease their negative emotion. The nurses supervise patients to complete the daily goals and give high evaluation after the patients completes the goals. For patients who have not completed their goals, the nurses should help them to analyze the failure reasons and encourage them to continue to adhere to their life goals. Through the nurses guiding patients to carry out some daily activities, the patients’ emotions and physical fitness can be well adjusted, thereby reducing the effects of negative emotions.

(4) Establish a good family social support system. The nurses strengthen the health education of the patients’ families to make them aware of the importance of companionship, and then encourage the families to accompany patients throughout the journey to meet the psychological needs of the patients’ love and enhance their confidence in defeating cancer. Furthermore, the nurses should invite the patients’ friends to participate in the treatment. After discharge from the hospital, nurses should also maintain active communication with the patients through video, telephone, visits and other ways to give patients confidence to return to social life, thereby improving their treatment compliance.

The patients in the control and study group were intervened until six months after discharge from hospital. Specifically, all patients were discharged from the hospital with nursing interventions such as living environment, on-time medication administration, and dietary guidance via video, telephone, and visitation twice a month for about 30 min each.

(1) The degree of pain and fatigue before and after intervention were evaluated using visual analogue scale (VAS), chronic pain self-efficacy scale (CPSS) and cancer fatigue scale (RPFS).

VAS score ranges from 0 to 10 points [11]. The 0 point is recorded as painless, and 10 point is unbearable pain. The 0–10 points indicates that the pain level increases in sequence, that is, the higher the patient’s score, the more severe the pain level.

CPSS score consists of 22 items in three dimensions and the score is 22–110 points [12]. For example, the physical self-efficacy score (9–45 points), pain self-management efficiency score (5–25 points), symptom response self-efficacy score (8–40 points). Each item is scored using 5-point Likert scale method, that is, the higher the patient’s score, the stronger the self-efficacy of cancer pain.

RPFS score consists of 22 items and uses the modified Piper fatigue scale, which is mainly used to evaluate the subjective fatigue status of patients [13]. The score of each item is 0–10 points and the total score is 0–220 points. RPFS score needs to divide the total score by 22 to get the average score. The average score is 1–3 points for mild fatigue, 3–6 points for moderate fatigue, and 6 points or more for severe fatigue, that is, the higher the patient’s score, the more severe the fatigue.

(2) The degree of anxiety and depression before and after intervention were evaluated using self-rating anxiety scale (SAS) and self-rating depression scale (SDS).

SAS score consists of 22 items and uses a four-level scoring method [14]. A total score of 50–59 is mild anxiety, 60–69 points count is moderate anxiety, and 69 points or more is severe anxiety, that is, the higher the patient’s score, the more severe the anxiety.

SDS score consists of 22 items and uses forward and reverse four-level scoring method [15]. Its critical value is 50 points, so when the score is greater than 50 points, it means that the patient has depression. The higher the patient score, the more serious the depression state.

(3) The hope-level and coping style before and after intervention were assessed using Herth hope index (HHI) and simplified coping style questionnaire (SCSQ).

HHI score consists of 12 items in three dimensions and uses a four-level scoring method [16]. The total score is 12–48 points, and the higher the score, the higher the patient’s hope-level.

SCSQ score is a self-assessment scale, consisting of 20 items in two dimensions of positive and negative response [17]. Each item is scored using a four-level scoring method with a score of 0–3. Each dimension score ranges from 0–30. The higher the score in which dimension, the more coping style the individual prefers to adopt.

(4) The life quality of patients before and after intervention was assessed using the Medical Outcomes Study item short from health survey (SF-36). SF-36 score includes five dimensions of mental health, emotional function, physical pain, physiological function, and overall health [18]. The score of each dimension is 100 points. The higher the score, the better the patient’s quality of life.

(5) Nursing satisfaction was investigated and compared using homemade questionnaire. It Includes five dimensions of endometrial cancer awareness, patient psychological comfort, hospital environmental facilities satisfaction, nursing staff service satisfaction, and physical comfort. The questionnaire uses a four-level scoring method with a total score of 100 points. The 90–100 points are very satisfied, 60–89 points are satisfied, 40–59 points are average, and less than 40 points are not satisfied. Nursing satisfaction = (very satisfied cases + satisfied cases)/total cases $\times$ 100%.

The data was analyzed using SPSS 22.0 software (IBM Corp., Armonk, NY, USA) and compared with t-test or Chi-square test. The measurement data were expressed as mean $\pm$ standard deviation (SD), and the count data were expressed in p 0.05 was considered statistically significant.

As shown in Table 1, there was no statistically significant difference in VAS score, CPSS score and RPFS score between the control and study group (p $>$ 0.05) before intervention. Conversely, the VAS and RPFS scores in the study group were lower than those in the control group (p 0.05), and CPSS score in the study group was higher than that in the control group after intervention (p 0.05).

As shown in Table 2, there was no statistically significant difference in SAS score and SDS score between the control and study group (p $>$ 0.05) before intervention. But after intervention, the SAS score and SDS score in the study group were lower than those in the control group (p 0.05).

The results in Table 3 showed that there was no statistically significant difference in HHI score and positive response/negative response in SCSQ scores between the control and study group (p $>$ 0.05) before intervention. After intervention, HHI score and positive response in SCSQ scores of the study group were higher than those of the control group (p 0.05), and then negative response in SCSQ scores of the study group was lower than that of the control group (p 0.05).

In Table 4, the results showed that there was no statistically significant difference in each dimension of SF-36 score between the control and study group (p $>$ 0.05) before intervention. Then, SF-36 score in the study group was significantly higher than that in the control group after intervention (p 0.05).

As shown in Table 5, the nursing satisfaction of the study group was significantly higher than that of the control group, and the difference was statistically significant (x${}^2$ = 6.316, p 0.027).

Cancer pain makes the patients suffer from both psychological and physical torture, and also affect their rest, thus reducing the life quality of patients with endometrial cancer. A study has shown that the incidence of cancer-related fatigue in patients with gynecological malignant tumors is about 93% [12]. Endometrial cancer patients often suffer from cancer-related fatigue after undergoing surgery or other treatments [12]. Cancer-related fatigue has the characteristics of rapid development, heavy degree, and long duration, which causes patients to consume too much energy. However, cancer-related fatigue keeps the patient in a chronic state of consumption due to the energy cannot be relieved by rest, which is not conducive to the recovery of the patients’ health [19, 20]. The high-quality nursing based on hope is to find out the relevant factors that affect patients’ emotions from the patients themselves. Meanwhile, nurses and patients’ families co-stimulate patients’ positive mentality to create a good recovery environment for the patients, thereby relieving their pain and fatigue level. The results of this study showed that the VAS score and RPFS score of the study group were lower than the control group, and the CPSS score was higher than the control group, indicating that the high-quality nursing model based on hope theory could significantly reduce the degree of pain and fatigue in endometrial cancer patients.

O’Mara et al. [21] reported that patients with endometrial cancer will face a series of emotional problems after surgery. Due to the patients’ worry about the condition and pain, the fear of life being changed or death, it will cause the patients to have different levels of psychological problems, such as anxiety and depression. These negative emotions affect the regulation of the hypothalamus to the body’s nerves, which in turn leads to tumor growth and the deterioration of endometrial cancer [22]. In addition, negative emotions also reduce the immune function through regulating the central nervous system, thereby weakening patients’ anti-tumor ability, which in turn affects the patients’ postoperative recovery and quality of life [2]. High-quality nursing based on hope theory is achieved by combining the patients’ own situation, with nurses assisting the patients to jointly formulate realistic life goals, which are then patients gain recognition by completing these life goals. Moreover, nurses, patients’ family members and friends strengthen the psychological support to patients, so that they feel loved, thereby slowing their negative emotions. This study found that the SAS score and SDS score of the study group were lower than the control group, demonstrating that high-quality nursing model based on hope theory could boost the negative emotions of patients with endometrial cancer.

Hope theory is an important branch of positive psychology, a good expectation for the future, and a series of positive expectations for achieving one’s own ideal goals. Hope is a power that dominates the spirit and life for every cancer patient, and is also a very important part of cancer treatment process. It is reported that the level of patients’ hope is closely related to their quality of life, and patients’ hope level can be increased through hope nursing [23]. The higher the patients’ level of hope, the easier it is to take positive coping style when facing with illness, thereby prompting patients to overcome difficulties, relieving stress and pain. The results of this study showed that the HHI score, positive response in the SCSQ score and each dimension of SF-36 score of the study group were higher than the control group, while negative response in the SCSQ score was lower than the control group, indicating that high-quality nursing model based on hope theory could enhance endometrial cancer patients’ hope level and quality of life. Furthermore, the nursing satisfaction of the study group was significantly higher than that of the control group, illustrating that high-quality nursing model based on hope theory in endometrial cancer patients has a good effect, and could significantly improve patients’ satisfaction with nursing services.