姑息照护对淋巴瘤患者及照顾者生命质量的效果研究
发布时间：2018-11-28 11:45
【摘要】：目的1.评价姑息照护对淋巴瘤患者生命质量、症状改善、焦虑抑郁的效果2.评价姑息照护对淋巴瘤患者家庭照顾者的生命质量、照顾负担、焦虑抑郁的效果方法1.本研究以2015年10月~2016年3月河南省两所省级医院的104对淋巴瘤患者及照顾者为研究对象,将两所医院分别作为对照组和干预组。对照组仅接受医院常规标准肿瘤护理,主要包括症状管理、心理支持、健康教育。干预组在接受医院常规标准肿瘤护理的同时接受姑息照护,组建姑息照护团队,依照制定的姑息照护流程,主要从症状管理、信息需求和共同决策、心理社会支持和人文关怀3方面为患者及照顾者提供服务。2.干预前对患者及照顾者进行一般情况调查,采用淋巴瘤患者生命质量测定量表、埃德蒙顿评估量表和医院焦虑抑郁量表测量患者的临床结局,采用简明健康状况量表、Zarit照顾者负担量表、医院焦虑抑郁量表测量照顾角色对照顾者生理及精神健康的影响。资料分别在干预前、干预12周、24周进行收集。采用SPSS 21.0统计软件数据处理。一般资料分析,定量资料采用两独立样本t检验;定性资料采用卡方检验,等级资料采用秩和检验。生命质量、照顾负担、焦虑抑郁量表得分采用重复测量方差分析,症状评估得分采用广义估计方程分析。结果1.两组淋巴瘤患者及照顾者一般资料比较差异无统计学意义(P0.05)。2.在不同时间点两组淋巴瘤患者生命质量、焦虑抑郁各维度得分及总分随时间变化而变化,组间差异有统计学意义(P0.05);两组患者的症状得分,均随时间的变化而变化,两组患者的恶心、气短症状得分差异无统计学意义,而对照组疼痛、疲乏、抑郁、焦虑、食欲、瞌睡、健康状态的得分高于干预组(P0.05)。3.在不同时间点两组照顾者的生理功能、生理职能、躯体疼痛、精神健康随时间变化无明显差异,而干预组的照顾者在总体健康、活力、社会功能、情感功能得分均高于对照组(P0.05);干预组照顾者在干预12周、24周后的照顾负担均小于对照组(P0.05);干预组照顾者的焦虑水平在干预12周、24周后要明显低于对照组(P0.05),而两组抑郁水平得分无明显差异。结论本研究通过建立姑息照护团队,采用多学科合作的模式,将姑息照护应用于有准备、知情、受激励的患者和照顾者,有效提高患者和照顾者的生命质量,降低患者治疗过程中疼痛、疲乏、嗜睡等不良症状及焦虑抑郁,同时也减轻了照顾者的照顾负担,缓解照顾者不良情绪,可以作为慢性病管理实践中的参考。
[Abstract]:Objective 1. To evaluate the effect of palliative care on quality of life, symptom improvement, anxiety and depression in lymphoma patients. To evaluate the effect of palliative care on the quality of life care burden anxiety and depression in patients with lymphoma. From October 2015 to March 2016, 104 cases of lymphoma patients and caregivers in two provincial hospitals in Henan Province were selected as control group and intervention group. The control group only received standard tumor nursing care, including symptom management, psychological support, health education. The intervention group received palliative care at the same time as the standard tumor nursing in hospital, and set up palliative care team. According to the established palliative care process, the intervention group mainly made decisions on symptom management, information demand and common decision. Psychological and social support and humanistic care for patients and caregivers 3 aspects of services. 2. The patients and caregivers were investigated before intervention. The quality of life (QOL) of lymphoma patients, Edmonton evaluation scale and hospital anxiety and depression scale were used to measure the clinical outcome of the patients, and the concise health status scale was used to measure the clinical outcome of the patients. The effects of care role on the caregivers' physical and mental health were measured by the Zarit caregivers burden scale and the Hospital anxiety and Depression scale. Data were collected before, 12 and 24 weeks after intervention. SPSS 21 1.0 statistical software was used to process the data. General data analysis, quantitative data using two independent samples t test, qualitative data using chi-square test, grade data using rank test. Quality of life, care burden, anxiety and depression scale scores were measured repeatedly by ANOVA, and symptom assessment scores were analyzed by generalized estimation equation. Result 1. There was no significant difference between the two groups in general data of lymphoma patients and caregivers (P0.05). At different time points, the quality of life, the scores of anxiety and depression and the total scores of lymphoma patients in two groups changed with time, and the difference was statistically significant (P0.05). There was no significant difference in the scores of nausea and shortness of breath between the two groups, while the control group had pain, fatigue, depression, anxiety, appetite, drowsiness. The score of health status was higher than that of intervention group (P0.05). At different time points, there was no significant difference in physiological function, body pain, mental health between the two groups, while in the intervention group, the overall health, vitality and social function of the caregivers were not significantly different. The scores of affective function were higher than those of the control group (P0.05). The care burden of the carers in the intervention group was lower than that in the control group after 12 weeks and 24 weeks (P0.05). The anxiety level of carers in the intervention group was significantly lower than that in the control group after 12 weeks and 24 weeks (P0.05), but there was no significant difference in depression level between the two groups. Conclusion through establishing palliative care team and adopting multi-disciplinary cooperation model, palliative care can be applied to patients and caregivers who are prepared, informed and motivated, so as to improve the quality of life of patients and caregivers. It can reduce the adverse symptoms such as pain, fatigue, drowsiness and anxiety and depression in the course of treatment, at the same time, it also lightens the care burden of the caregivers and relieves the bad mood of the carers, which can be used as a reference in the practice of chronic disease management.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.73
[Abstract]:Objective 1. To evaluate the effect of palliative care on quality of life, symptom improvement, anxiety and depression in lymphoma patients. To evaluate the effect of palliative care on the quality of life care burden anxiety and depression in patients with lymphoma. From October 2015 to March 2016, 104 cases of lymphoma patients and caregivers in two provincial hospitals in Henan Province were selected as control group and intervention group. The control group only received standard tumor nursing care, including symptom management, psychological support, health education. The intervention group received palliative care at the same time as the standard tumor nursing in hospital, and set up palliative care team. According to the established palliative care process, the intervention group mainly made decisions on symptom management, information demand and common decision. Psychological and social support and humanistic care for patients and caregivers 3 aspects of services. 2. The patients and caregivers were investigated before intervention. The quality of life (QOL) of lymphoma patients, Edmonton evaluation scale and hospital anxiety and depression scale were used to measure the clinical outcome of the patients, and the concise health status scale was used to measure the clinical outcome of the patients. The effects of care role on the caregivers' physical and mental health were measured by the Zarit caregivers burden scale and the Hospital anxiety and Depression scale. Data were collected before, 12 and 24 weeks after intervention. SPSS 21 1.0 statistical software was used to process the data. General data analysis, quantitative data using two independent samples t test, qualitative data using chi-square test, grade data using rank test. Quality of life, care burden, anxiety and depression scale scores were measured repeatedly by ANOVA, and symptom assessment scores were analyzed by generalized estimation equation. Result 1. There was no significant difference between the two groups in general data of lymphoma patients and caregivers (P0.05). At different time points, the quality of life, the scores of anxiety and depression and the total scores of lymphoma patients in two groups changed with time, and the difference was statistically significant (P0.05). There was no significant difference in the scores of nausea and shortness of breath between the two groups, while the control group had pain, fatigue, depression, anxiety, appetite, drowsiness. The score of health status was higher than that of intervention group (P0.05). At different time points, there was no significant difference in physiological function, body pain, mental health between the two groups, while in the intervention group, the overall health, vitality and social function of the caregivers were not significantly different. The scores of affective function were higher than those of the control group (P0.05). The care burden of the carers in the intervention group was lower than that in the control group after 12 weeks and 24 weeks (P0.05). The anxiety level of carers in the intervention group was significantly lower than that in the control group after 12 weeks and 24 weeks (P0.05), but there was no significant difference in depression level between the two groups. Conclusion through establishing palliative care team and adopting multi-disciplinary cooperation model, palliative care can be applied to patients and caregivers who are prepared, informed and motivated, so as to improve the quality of life of patients and caregivers. It can reduce the adverse symptoms such as pain, fatigue, drowsiness and anxiety and depression in the course of treatment, at the same time, it also lightens the care burden of the caregivers and relieves the bad mood of the carers, which can be used as a reference in the practice of chronic disease management.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.73
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