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中华乳腺病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 366 -372. doi: 10.3877/cma.j.issn.1674-0807.2021.06.006

论著

叙事护理联合信息化分层管理模式在晚期乳腺癌患者心理干预中的应用研究
陶红竹1, 张欢1, 郑晓东2, 唐榕英3, 胡蕖4, 张照莉2,()   
  1. 1. 400030,重庆大学附属肿瘤医院乳腺肿瘤中心
    3. 400030,重庆大学附属肿瘤医院护理部
    4. 400030,重庆大学附属肿瘤医院肿瘤放射治疗中心
  • 收稿日期:2021-03-30 出版日期:2021-12-01
  • 通信作者: 张照莉
  • 基金资助:
    国家癌症中心攀登基金(NCC201822B73)

Narrative nursing combined with information-based hierarchical management model for psychological intervention of advanced breast cancer patients

Hongzhu Tao1, Huan Zhang1, Xiaodong Zheng2, Rongying Tang3, Qu Hu4, Zhaoli Zhang2,()   

  1. 1. Breast Cancer Center, Cancer Hospital of Chongqing University, Chongqing 400030, China
    2. Department of Nursing, Cancer Hospital of Chongqing University, Chongqing 400030, China
    4. Tumor Radiotherapy Center, Cancer Hospital of Chongqing University, Chongqing 400030, China
  • Received:2021-03-30 Published:2021-12-01
  • Corresponding author: Zhaoli Zhang
引用本文:

陶红竹, 张欢, 郑晓东, 唐榕英, 胡蕖, 张照莉. 叙事护理联合信息化分层管理模式在晚期乳腺癌患者心理干预中的应用研究[J/OL]. 中华乳腺病杂志(电子版), 2021, 15(06): 366-372.

Hongzhu Tao, Huan Zhang, Xiaodong Zheng, Rongying Tang, Qu Hu, Zhaoli Zhang. Narrative nursing combined with information-based hierarchical management model for psychological intervention of advanced breast cancer patients[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2021, 15(06): 366-372.

目的

探讨叙事护理联合信息化分层管理模式在晚期乳腺癌患者中的应用效果。

方法

根据纳入及排除标准,入组2018年3月至2021年5月在重庆大学附属肿瘤医院乳腺肿瘤中心的120例晚期乳腺癌患者进行前瞻性研究。通过随机数字表法分为研究组和对照组,每组各60例。对照组采用本院构建的信息化分层管理模式进行心理筛查和干预,研究组采用分层管理模式联合叙事护理进行干预。在干预前(入院24 h内)、干预后(出院时)采用心理痛苦管理筛查工具(DMSM)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、乳腺癌患者生命质量测定量表(FACT-B)、匹兹堡睡眠质量指数(PSQI)、症状自评量表(SCL-90)对2组患者进行评估。在DMSM、SAS、SDS、FACT-B与SCL-90量表评分方面,组内干预前后比较采用配对t检验,组间对比采用独立样本t检验。PSQI评分比较采用非参数检验。

结果

干预后DMSM评分结果显示,研究组在交往、情绪、心理痛苦3个方面评分优于对照组(t=2.420、2.168、4.664,P均<0.050)。对照组干预前SAS评分为(55.2±8.4)分,干预后为(53.7±7.4)分;研究组干预前SAS评分为(57.1±8.0)分,干预后为(49.6±6.7)分;2组评分均较干预前降低(t=2.090、8.203,P均<0.050),且研究组干预后评分低于对照组(t=3.244,P=0.002)。对照组干预前SDS评分为(62.8±9.8)分,干预后为(61.5±10.0)分;研究组干预前SDS评分为(64.3±8.9)分,干预后为(57.1±7.8)分;2组评分均较干预前降低(t=2.085、9.583,P均<0.050),且研究组干预后评分低于对照组(t=2.684,P=0.008)。干预后,研究组FACT-B各维度评分(生理状况、社会家庭状况、情感状况、功能状况及乳腺附加关注)和总分均优于干预前[t=-14.171、-6.201、-10.692、-8.060、-9.707,P均<0.001;总分:(94.9±8.4)分比(79.6±6.2)分,t=-22.428,P<0.001],且情感状况、功能状况、乳腺附加关注评分及总分均优于对照组[t=-3.056、-2.692、-5.174,P均<0.050;总分:(94.9±8.4)分比(88.1±6.3)分,t=-5.064,P<0.001]。PSQI结果显示:干预后,对照组除"睡眠效率"外其他各维度评分均有下降,研究组所有维度评分均有下降,研究组总分低于对照组[4.0(3.0,5.0)分比7.0(6.0,8.0)分,Z=-8.223, P=0.001]。2组SCL-90评分结果均显著优于干预前[对照组:(200.2±22.7)分比(235.7±24.0)分,t=26.884,P<0.001;研究组:(173.9±19.3)分比(237.2±21.1)分,t=18.705,P<0.001],研究组干预后评分优于对照组[(173.9±19.3)分比(200.2±22.7)分,t=6.840,P<0.001]。

结论

信息化的分层管理模式下进行叙事护理可改善晚期乳腺癌患者的心理困扰,值得临床推广应用。

Objective

To explore the application of narrative nursing combined with information-based hierarchical management mode in patients with advanced breast cancer.

Methods

According to the inclusion and exclusion criteria, a total of 120 patients with advanced breast cancer in the Breast Cancer Center, Cancer Hospital of Chongqing University from March 2018 to May 2021 were enrolled in this perspective study. They were randomly divided into study group and control group by the random number table method, 60 patients in each group. The control group adopted the hierarchical management model constructed by our hospital for psychological screening and intervention, and the study group received the combination of narrative nursing and hierarchical management. The patients in two groups were evaluated using the Distress Management Screening Measure (DMSM), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Functional Assessment of Cancer Therapy-Breast (FACT-B), Pittsburgh Sleep Quality Index (PSQI) and Symptom Checklist 90(SCL-90) at admission (before intervention) and discharge (after intervention). The scores of DMSM, SAS, SDS, FACT-B and SCL-90 scales before and after intervention were compared in the same group by paired t test, and the comparison between groups was performed by independent-sample t test. The PSQI scores were compared using the non-parametric test.

Results

After intervention, the DMSM results showed that the scores in study group was significantly lower than those in control group in dimensions of communication, emotion and psychological distress (t=2.420, 2.168, 4.664, all P<0.050). The SAS score in control group was 55.2±8.4 before intervention and 53.7±7.4 after intervention; the SAS score in study group was 57.1±8.0 before intervention and 49.6±6.7 after intervention. Both groups presented a significant improvement compared with scores before intervention (t=2.090, 8.203, both P<0.050), and the score in study group was significantly lower than that in control group after intervention (t=3.244, P=0.002). The SDS score in control group was 62.8±9.8 before intervention and 61.5±10.0 after intervention; the SDS score in study group was 64.3±8.9 before intervention and 57.1±7.8 after intervention. The scores in two groups were significantly lower than those before intervention (t=2.085, 9.583, both P<0.050), and the score in study group was significantly lower than that in control group (t=2.684, P=0.008). The scores in all dimensions (physiological status, social and family status, emotional status, functional status and additional attention of the breast) and total score of FACT-B in study group after intervention were significantly better than those before intervention (t=-14.171, -6.201, -10.692, - 8.060, -9.707, all P<0.001; total score: 94.9±8.4 vs 79.6±6.2, t=-22.428, P<0.001); The scores in dimensions of emotional status, functional status, breast additional attention score and total score in study group were significantly higher than those in control group after intervention (t=-3.056, -2.692, -5.174, all P<0.050; total score: 94.9±8.4 vs 88.1±6.3, t=-5.064, P<0.001). The PSQI results showed that after intervention, the scores in control group were significantly decreased in all dimensions except "sleep efficiency" ; the scores in study group were significantly decreased in all dimensions; and the total score in study group was significantly lower than that in control group [4.0(3.0, 5.0) vs 7.0(6.0, 8.0), Z=-8.223, P=0.001]. The SCL-90 total scores in two groups after intervention were significantly lower than those before intervention (control group: 200.2±22.7 vs 235.7±24.0, t=26.884, P<0.001; study group: 173.9±19.3 vs 237.2±21.1, t=18.705, P<0.001); the score in study group was significantly lower than that in control group after intervention (173.9±19.3 vs 200.2±22.7, t=6.840, P<0.001).

Conclusion

Narrative nursing under a information-based hierarchical management model can improve the psychological distress of advanced breast cancer patients, worthy of clinical application.

表1 2组晚期乳腺癌患者的基线资料比较
表2 2组晚期乳腺癌患者干预前后心理痛苦管理筛查工具评估结果比较(分,±s)
表3 2组晚期乳腺癌患者干预前后SAS及SDS评分结果比较(分,±s)
表4 2组晚期乳腺癌患者干预前后乳腺癌生活质量测定量表评分结果比较(分,±s)
表5 2组晚期乳腺癌患者干预前后匹兹堡睡眠质量指数量表评分结果比较[分,M(P25, P75) ]
表6 2组晚期乳腺癌患者症状自评量表(SCL-90)评分结果比较(分,±s)
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