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).