自我管理对化疗期胃癌患者癌因性疲乏的干预效果研究
发布时间：2018-08-30 18:53
【摘要】：目的了解化疗期胃癌患者癌因性疲乏症状的特性,评价自我管理应用于化疗期胃癌患者癌因性疲乏症状管理的可行性及干预效果的研究。方法第一阶段,横断面调查:采用便利抽样法连续收集2014年1月至6月在安徽医科大学第一附属医院肿瘤内科住院的恶性肿瘤患者,反复入院者排除,于化疗第一天向患者发放自行编制的一般人口统计学变量问卷、疲乏数字等级量表、癌症疲乏量表(CFS)和癌症治疗功能评价量表(FACT-G)。通过此次横断面调查,明确化疗期癌症患者癌因性疲乏状况与生命质量以及两者之间的关系。第二阶段,试验性研究:选择2014年7月至2014年12月在安徽医科大学第一附属医院肿瘤内科住院的胃癌患者,排除重复入院,研究对象①纳入标准:临床诊断或病理学检查确诊为恶性肿瘤;确定化疗方案;小学及以上文化水平;年龄≥18周岁;知情同意并明确自身病情。②排除标准:有精神疾病及认知障碍者;语言沟通障碍者;疾病严重威胁生命者。最终将符合纳入标准的67名患者作为研究对象,并将2014年7月-9月入院的32名患者列入干预组,2014年10月-12月入院的35名患者列入对照组。两组患者均在化疗第一天收集基线资料,干预组在常规护理的基础上进行自我管理症状干预模式:个性化问题进行个别解决,共性问题利用小组会议2-4人/组(护士长1名,在校研究生2名,医生1名)的形式,借助PPT为媒介,结束后每人发放自我管理手册。居家期间(出院第7天)电话干预,并评价手册使用情况,同时约定患者再次入院化疗时间。化疗周期再次入院第一天再次用评估工具进行测量。对照组给予常规护理,收集资料及评估工具测量的时间同干预组,在试验研究结束后给他们发放自我管理手册,但资料不用于试验性效果研究。两组患者均用一般资料调查表、癌症疲乏量表(CFS)及癌症治疗功能评价量表(FACT-G)进行测量。采用SPSS10.0软件进行统计数据分析。采用一般统计描述量性研究的数据,正态分布的计量资料使用均数和标准差进行描述,非正态分布的用中位数和四分位数间距描述;使用单样本K-S拟合优度检验癌因性疲乏和生命质量量表各维度均服从正态分布,因此,干预组和对照组干预前后的癌因性疲乏和生命质量差异性检验使用两独立样本的t检验法;干预组自身干预前后、对照组自身干预前后的癌因性疲乏和生命质量差异性检验使用配对样本的t检验。结果本研究通过横断面调查显示:化疗期癌症患者的癌因性疲乏的发生率为76.7%。各维度得分标准化后,大小依次是情感疲乏、认知疲乏、躯体疲乏,说明本次样本群的患者在情感方面最为疲乏,在躯体方面较轻,化疗期癌症患者的癌因性疲乏管理措施应重视情感疲乏。使用多元回归分析癌因性疲乏对生命质量的影响,结果显示躯体疲乏、情感疲乏和认知疲乏是导致患者生命质量下降的预测因子,其中躯体疲乏的贡献最大。试验性研究中显示:干预前两组患者人口学资料和疾病相关资料得分构成差异无统计学意义(P0.05)。干预前两组患者的癌因性疲乏各维度和总分以及生命质量各维度和总分差异均无统计学意义(P0.05)。干预后两组患者的癌因性疲乏各维度和总分差异有统计学意义(P0.01),干预组癌因性疲乏的各维度和总分均小于对照组。干预后两组患者的生命质量各维度和总分差异有统计学意义(P0.01),干预组生命质量的各维度和总分均大于对照组。干预组干预前后癌因性疲乏和生命质量量表各维度和总分差异有统计学意义(P0.01),干预后干预组癌因性疲乏得分比干预前均降低,生命质量得分均提高。与干预前相比,对照组干预后癌因性疲乏除情感疲乏差异无统计学意义外(P0.05),躯体疲乏、认知疲乏和CFS总分下降有统计学意义(P0.01)。与干预前相比,对照组干预后社会维度得分升高有统计学意义(P0.05),其它维度和总分差异无统计学意义(P0.05)。结论本研究显示,癌因性疲乏各个方面都会导致患者生活质量的下降。以自我管理为主的干预模式,对于化疗期胃癌患者癌因性疲乏症状可以有效地缓解,从而改善和提高了患者的生命质量。常规护理措施对对照组化疗期胃癌患者的癌因性疲乏和生命质量起了一定的作用,但没有干预组的效应大。提示临床医务人员应加强对化疗期胃癌患者癌因性疲乏的全面评估,采用有效的针对性的干预措施,如认知行为干预、延伸服务。健康教育等有效预防和控制癌因性疲乏,改善癌症患者的生活质量。
[Abstract]:Objective To investigate the characteristics of cancer-related fatigue symptoms in patients with gastric cancer during chemotherapy, and to evaluate the feasibility and intervention effect of self-management in cancer-related fatigue symptoms management in patients with gastric cancer during chemotherapy. Patients with malignant tumors in the oncology department of our hospital were excluded from repeated admission. On the first day of chemotherapy, self-made general demographic variables questionnaire, fatigue rating scale, cancer fatigue scale (CFS) and cancer treatment function evaluation scale (FACT-G) were distributed to the patients. Through this cross-sectional survey, the causes of cancer in the chemotherapy period were identified. In the second stage, experimental study: Gastric cancer patients hospitalized in the Department of Oncology, the First Affiliated Hospital of Anhui Medical University from July 2014 to December 2014 were selected and excluded from repeated admission. (2) Exclusion criteria: those with mental illness and cognitive impairment; those with language communication impairment; those with serious life-threatening illness. Finally, 67 patients who met the inclusion criteria were selected as subjects and 32 patients admitted to hospital from July to September 2014 were included. Patients in the intervention group were enrolled in the control group from October to December 2014. The baseline data were collected on the first day of chemotherapy in both groups. The intervention group was given self-management symptom intervention mode on the basis of routine nursing. Individual problems were solved individually, and the common problems were solved by group meetings of 2-4 persons/group (head nurse, 2 postgraduates in school). In the form of PPT, each person issued a self-management manual at the end of the session. Telephone intervention was conducted during home (7 days after discharge) and the use of the manual was evaluated. Chemotherapy was scheduled to be re-hospitalized. Chemotherapy cycles were re-hospitalized on the first day of re-hospitalization. Routine care was given to the control group and funding was collected. Both groups were measured with the General Data Questionnaire, the Cancer Fatigue Scale (CFS) and the Cancer Therapeutic Function Assessment Scale (FACT-G). SPSS10.0 software was used for statistical analysis. Analysis. Data from general statistical descriptive studies were used. The measurements of normal distribution were described by means of mean and standard deviation, while non-normal distribution was described by median and quartile spacing. Cancer-related fatigue and quality-of-life differences before and after intervention in the control group were examined by two independent samples t-test; before and after intervention in the intervention group, cancer-related fatigue and quality-of-life differences before and after intervention in the control group were tested by paired samples t-test. The incidence of cancer-related fatigue was 76.7%. After standardization, the dimensions were emotional fatigue, cognitive fatigue and physical fatigue in turn, indicating that the patients in this sample group were the most emotional fatigue and the patients in the body were the lighter. The results showed that physical fatigue, emotional fatigue and cognitive fatigue were the predictors of the quality of life, and physical fatigue contributed the most to the quality of life. There was no significant difference in the dimensions and total scores of cancer-related fatigue and quality of life between the two groups before and after intervention (P 0.05). There was significant difference in the dimensions and total scores of cancer-related fatigue between the two groups after intervention (P 0.01). The dimensions and total scores of cancer-related fatigue in the intervention group were less than those in the control group. There was significant difference in each dimension and total score of QOL between the intervention group and the control group (P 0.01). The scores of QOL in the intervention group were higher than those in the control group. Compared with the control group, there was no significant difference in the scores of cancer-related fatigue except emotional fatigue (P 0.05), physical fatigue, cognitive fatigue and CFS (P 0.01). There was no significant difference in the degree and total score (P 0.05). Conclusion The study showed that all aspects of cancer-related fatigue would lead to the decline of patients'quality of life. It is suggested that clinical medical staff should strengthen the comprehensive evaluation of cancer-related fatigue in patients with gastric cancer during chemotherapy and adopt effective and targeted interventions, such as cognitive behavioral intervention and extended service. Education can effectively prevent and control cancer-related fatigue and improve the quality of life of cancer patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R473.73
本文编号：2213988
[Abstract]:Objective To investigate the characteristics of cancer-related fatigue symptoms in patients with gastric cancer during chemotherapy, and to evaluate the feasibility and intervention effect of self-management in cancer-related fatigue symptoms management in patients with gastric cancer during chemotherapy. Patients with malignant tumors in the oncology department of our hospital were excluded from repeated admission. On the first day of chemotherapy, self-made general demographic variables questionnaire, fatigue rating scale, cancer fatigue scale (CFS) and cancer treatment function evaluation scale (FACT-G) were distributed to the patients. Through this cross-sectional survey, the causes of cancer in the chemotherapy period were identified. In the second stage, experimental study: Gastric cancer patients hospitalized in the Department of Oncology, the First Affiliated Hospital of Anhui Medical University from July 2014 to December 2014 were selected and excluded from repeated admission. (2) Exclusion criteria: those with mental illness and cognitive impairment; those with language communication impairment; those with serious life-threatening illness. Finally, 67 patients who met the inclusion criteria were selected as subjects and 32 patients admitted to hospital from July to September 2014 were included. Patients in the intervention group were enrolled in the control group from October to December 2014. The baseline data were collected on the first day of chemotherapy in both groups. The intervention group was given self-management symptom intervention mode on the basis of routine nursing. Individual problems were solved individually, and the common problems were solved by group meetings of 2-4 persons/group (head nurse, 2 postgraduates in school). In the form of PPT, each person issued a self-management manual at the end of the session. Telephone intervention was conducted during home (7 days after discharge) and the use of the manual was evaluated. Chemotherapy was scheduled to be re-hospitalized. Chemotherapy cycles were re-hospitalized on the first day of re-hospitalization. Routine care was given to the control group and funding was collected. Both groups were measured with the General Data Questionnaire, the Cancer Fatigue Scale (CFS) and the Cancer Therapeutic Function Assessment Scale (FACT-G). SPSS10.0 software was used for statistical analysis. Analysis. Data from general statistical descriptive studies were used. The measurements of normal distribution were described by means of mean and standard deviation, while non-normal distribution was described by median and quartile spacing. Cancer-related fatigue and quality-of-life differences before and after intervention in the control group were examined by two independent samples t-test; before and after intervention in the intervention group, cancer-related fatigue and quality-of-life differences before and after intervention in the control group were tested by paired samples t-test. The incidence of cancer-related fatigue was 76.7%. After standardization, the dimensions were emotional fatigue, cognitive fatigue and physical fatigue in turn, indicating that the patients in this sample group were the most emotional fatigue and the patients in the body were the lighter. The results showed that physical fatigue, emotional fatigue and cognitive fatigue were the predictors of the quality of life, and physical fatigue contributed the most to the quality of life. There was no significant difference in the dimensions and total scores of cancer-related fatigue and quality of life between the two groups before and after intervention (P 0.05). There was significant difference in the dimensions and total scores of cancer-related fatigue between the two groups after intervention (P 0.01). The dimensions and total scores of cancer-related fatigue in the intervention group were less than those in the control group. There was significant difference in each dimension and total score of QOL between the intervention group and the control group (P 0.01). The scores of QOL in the intervention group were higher than those in the control group. Compared with the control group, there was no significant difference in the scores of cancer-related fatigue except emotional fatigue (P 0.05), physical fatigue, cognitive fatigue and CFS (P 0.01). There was no significant difference in the degree and total score (P 0.05). Conclusion The study showed that all aspects of cancer-related fatigue would lead to the decline of patients'quality of life. It is suggested that clinical medical staff should strengthen the comprehensive evaluation of cancer-related fatigue in patients with gastric cancer during chemotherapy and adopt effective and targeted interventions, such as cognitive behavioral intervention and extended service. Education can effectively prevent and control cancer-related fatigue and improve the quality of life of cancer patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R473.73
【参考文献】
相关期刊论文 前6条
1 吴婉英;癌因性疲乏的研究进展[J];护理与康复;2004年05期
2 谈学灵;刘素珍;;癌因性疲乏评估研究进展[J];护理研究;2008年05期
3 万崇华;孟琼;汤学良;张灿珍;罗家洪;张晓磐;;癌症患者生命质量测定量表FACT-G中文版评介[J];实用肿瘤杂志;2006年01期
4 张凤玲;韩丽沙;;癌因性疲乏的护理研究进展[J];中华护理杂志;2008年03期
5 许虹波;姜丽萍;尹志勤;金玉爱;李萍;涂海霞;;肺癌化疗患者癌因性疲乏状况的调查[J];中华护理杂志;2010年04期
6 申存珍;孙小琴;;自我效能干预对结直肠癌术后化疗患者癌因性疲乏的影响[J];实用临床医药杂志;2013年18期
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