同期家庭护理干预对乳腺癌术后化疗患者自我感受负担的影响

发布时间：2019-04-10 07:28

【摘要】：[目的]了解乳腺癌术后化疗患者的家庭功能状况及自我感受负担水平,探讨同期家庭护理对乳腺癌患者自我感受负担的影响,为乳腺癌术后化疗患者的家庭护理提供参考依据。[方法]本研究将2016年2月至2016年10月到昆明医科大学第三附属医院(云南省肿瘤医院)乳腺中心就诊并接受乳腺癌改良根治术加术后辅助化疗的100例患者随机分为实验组和对照组,每组各50例。对照组采用常规护理干预方法;实验组除常规护理干预外,行以医务工作者、淋巴水肿治疗师、心理咨询师、营养师、志愿者及研究者为干预团队的家庭护理(包括:疾病指导、认知干预、应对技巧训练、知识讲座、患教活动、APP平台信息推送及名医热线、放松训练、家属同步健康教育、家属同步肢体功能锻炼指导、成立家属联盟等)。分别在干预前和干预18周结束时应用家庭功能评定量表及乳腺癌患者自我感受负担问卷,比较两组患者干预前后家庭功能状况及自我感受负担水平,评估家庭护理在乳腺癌术后化疗护理中的作用。[结果]干预前两组患者基本情况、家庭功能状况及自我感受负担水平的统计分析结果如下:(1)实验组和对照组基本情况:年龄、民族构成、居住地分布、文化程度、婚姻状况、家庭关系、宗教信仰、职业、工作状况、家庭人均月收入、医疗费用支付形式方面差异无统计学意义(P0.05)。实验组和对照组疾病认知情况:患者对疾病的认识、疾病主要认知途径、肿瘤分期及有无转移进行比较后差异无统计学意义(P0.05)。实验组和对照组家庭护理者情况:主要照顾者、照顾者性别、年龄、身体健康状况及照顾时间进行比较后差异无统计学意义(P0.05)。(2)干预前现况分析:①乳腺癌患者SPB评分总分为118.88±11.94,处于中度负担水平,其中低度负担患者达(26/100,26%),中度负担患者达(51/100,51%),高度负担患者达(23/100,23%);对SPBS-BC的5个维度进行评分,其中情感和经济负担维度评分最高(为35.61±4.36)。实验组SPB评分为118.46±10.83,对照组SPB评分为119.30±13.05,两组干预前SPB评分结果差异无统计学意义(P0.05)。②家庭功能评分总分为133.29±8.98,其中仅有6% (6/100)患者家庭功能处于良好状态。实验组FAD评分为133.00±9.00,对照组SPB评分为133.58±9.01,两组干预前FAD评分结果差异无统计学意义(P0.05)。干预18周后两组患者家庭功能状况及自我感受负担水平统计分析结果如下:(1)患者自我感受负担的干预效果评价:干预18周后,实验组SPB评分总分为86.83±6.23,对照组为117.27±13.46,对两组患者的SPB评分进行比较,结果显示:生活负担、情感和经济负担、社会负担、家庭结构、疾病和治疗所致的负担均有缓解,且缓解有统计学差异(P0.001)。对两组患者干预前后的自我感受负担评分进行组内比较,结果显示:实验组在生活负担、情感和经济负担、社会负担、家庭结构、疾病和治疗所致的负担均有缓解,且缓解有统计学差异(P0.001);对照组除家庭结构负担这一维度外,其他生活负担、情感和经济负担、社会负担、疾病和治疗所致的负担均有缓解,但缓解无统计学差异(P0.05)。(2)家庭功能的干预效果评价:干预18周后进行家庭功能的比较,实验组家庭功能评分总分为123.43±7.41,对照组为129.92±8.30,两组患者的家庭功能除角色这一维度的评分结果无统计学意义(P0.05)外,其他维度:问题解决、沟通、情感反应、情感介入、行为控制和总的功能评分结果均有统计学意义(P0.05)。对两组患者干预前后的家庭功能进行组内比较,结果显示:实验组除沟通这一维度的评分无统计学意义(P0.05)外,其他维度:问题解决、角色、情感反应、情感介入、行为控制和总的功能评分结果均有统计学意义(P0.05);对照组在问题解决、情感介入、行为控制和总的功能评分结果上有统计学意义(P0.05),其余角色、沟通及情感反应评分结果均无统计学意义(P0.05)。[结论]同期家庭护理干预能有效提高乳腺癌患者的家庭功能,明显降低乳腺癌患者自我感受负担体验,在乳腺癌术后化疗患者的临床护理工作中有推广应用价值。
[Abstract]:[Objective] To study the family function and self-perceived burden of patients with breast cancer after operation, and to explore the effect of home care on the self-feeling burden of breast cancer patients. [Methods] The present study randomly divided into experimental group and control group, and 50 cases of each group were randomly divided into experimental group and control group, from Feb.2016 to October,2016 to the breast center of the Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital) and received the modified radical operation of breast cancer. The control group adopts the conventional nursing intervention method; in addition to the routine nursing intervention, the experimental group is a medical worker, a lymphedema therapist, a psychological consultant, a nutritionist, a volunteer and a home care for the intervention team (including disease guidance, cognitive intervention, coping skill training, Knowledge lecture, affected teaching activity, APP platform information push and name medical hotline, relaxation training, family synchronous health education, family synchronization limb function exercise guidance, establishment of family union, etc.). The status of home function and self-perceived burden were compared between the two groups before and after the intervention, and the role of home care in the postoperative chemotherapy of breast cancer was evaluated. [Results] The results of the statistical analysis of the basic conditions, family function and self-perceived burden of the two groups before intervention were as follows: (1) Basic conditions of the experimental group and the control group: age, ethnic composition, distribution of place of residence, degree of culture, marital status, family relationship, religious belief, There was no significant difference in the form of occupational, work and family-per-month income and medical expenses (P0.05). The cognitive status of the disease in the experimental group and the control group: the patient's knowledge of the disease, the main cognitive way of the disease, the stage of the tumor and the presence or absence of metastasis were not statistically significant (P0.05). In the experimental group and the control group, there was no significant difference in the situation of home care in the experimental group and the control group (P0.05). (2) The pre-intervention status analysis: The total score of SPB in breast cancer patients was 118.88 and 11.94, which was in moderate burden, among which low-burden patients (26/100,26%), moderate-burden patients (51/100,51%), high-burden patients (23/100,23%), and 5 dimensions of SPBS-BC, Among them, the score of emotional and economic burden is the highest (35.61-4.36). The SPB scores of the experimental group were 118.46 and 10.83, and the SPB scores of the control group were 119.30 and 13.05, and the difference of SPB scores between the two groups was not statistically significant (P0.05). The total score of the family function was 133.29-8.98, of which only 6% (6/100) of the patients had a good family function. The score of FAD in the experimental group was 133.00-9.00, the SPB score of the control group was 133.58-9.01, and the difference of the FAD scores between the two groups was not statistically significant (P0.05). After 18 weeks of intervention, the results of the statistical analysis of the family function and self-perceived burden of the two groups were as follows: (1) Evaluation of the intervention effect of the self-feeling burden of the patient: after 18 weeks of intervention, the SPB score of the experimental group was divided into 86.83 and 6.23, and the control group was 117.27-13.46. The results showed that the burden of life, the emotional and economic burden, the social burden, the family structure, the disease and the burden of treatment were relieved and the statistical difference was relieved (P 0.001). The results showed that the burden of life, emotional and economic burden, social burden, family structure, disease and treatment of the experimental group were relieved and the statistical difference was relieved (P 0.001). The burden of other living, emotional and economic burden, social burden, disease and treatment were relieved in the control group, except for the family structure burden, but there was no statistical difference (P0.05). (2) The evaluation of the intervention effect of the family function: compared with the family function after 18 weeks of intervention, the score of the family function in the experimental group was 123.43-7.41, the control group was 129.92-8.30, and the scores of the family function of the two groups were not statistically significant (P0.05). Other dimensions: problem solving, communication, emotional reaction, emotional intervention, behavior control and overall functional scoring results are of statistical significance (P0.05). The family function before and after the intervention of the two groups of patients was compared, and the results showed that, in the experimental group, the score of the dimension was not statistically significant (P0.05), and the other dimensions were: problem resolution, role, emotional response, emotional intervention, The results of behavior control and total functional score were of statistical significance (P0.05); the control group had statistical significance in the results of problem resolution, emotional intervention, behavior control and overall functional score (P0.05), and the other characters, communication and emotional response scores were not statistically significant (P0.05). [Conclusion] The home-care intervention in the same period can effectively improve the family function of the breast cancer patients, and obviously reduce the self-feeling burden experience of the breast cancer patients, and has the popularization and application value in the clinical nursing work of the chemotherapy patients after the breast cancer operation.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.73

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