探讨个案管理模式在首次行日间化疗乳腺癌患者中的应用效果。

根据纳入及排除标准，纳入2021年1～12月在陆军军医大学第一附属医院乳腺甲状腺外科首次行日间化疗的638例患者进行回顾性分析。其中，2021年1月1日至6月31日化疗患者315例，采用传统护理模式，作为对照组；2021年7月1日至12月31日化疗患者323例，采用个案管理模式，作为试验组。于首次化疗后对患者医疗决策参与的满意度进行评估，分别在化疗第1、3、6周期对患者进行心理痛苦、疾病不确定感及化疗依从性评价。满意度评分以±s描述，组间比较采用独立样本t检验，组内干预前后比较采用配对t检验。心理痛苦评分、疾病不确定感评分采用重复测量方差分析。

(1)试验组与对照组干预前医疗决策参与满意度各指标(信息、交流协商、决策、总满意度及信心、总分)比较差异均无统计学意义(P均>0.050)，干预后试验组各项评分均高于对照组(P均<0.001)，同一组干预前后评分差异均有统计学意义(P均<0.001)。(2)干预后试验组患者化疗心理痛苦评分均低于对照组(时间点比较：F＝294.337，P<0.001；组间比较：F＝354.744，P<0.001；交互作用：F＝9.657，P<0.001)。(3)试验组患者疾病不确定感评分低于对照组(时间点比较：F＝3 592.265，P<0.001；组间比较：F＝641.060，P<0.001；交互作用：F＝128.967，P<0.001)。(4)化疗第1、3、6周期试验组患者的化疗依从性优于对照组(Z＝－4.689、－5.463、－10.956，P均<0.001)。

个案管理模式可以降低患者疾病不确定感及心理痛苦，促进患者参与医疗决策，提升化疗依从性。

To investigate the application outcome of case management mode in breast cancer patients undergoing daytime chemotherapy for the first time.

According to the inclusion and exclusion criteria, a retrospective analysis was performed on 638 patients who underwent daytime chemotherapy for the first time in the Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Army Medical University from January to December 2021. Among them, 315 patients who underwent daytime chemotherapy from January 1 to June 31 were treated in traditional nursing mode, regarded as the control group, and 323 patients who underwent daytime chemotherapy in case management mode from July 1 to December 31, 2021 served as the experimental group. After the first chemotherapy, the patients’ satisfaction with their participation in medical decision-making was evaluated. The psychological distress, disease uncertainty and chemotherapy compliance of patients were evaluated at the 1st, 3rd and 6th cycles of chemotherapy, respectively. Satisfaction scores were expressed as ±s, and independent-sample t test was used for comparisons between groups, and paired t test was used for comparison before and after intervention in the same group. The scores of psychological distress and disease uncertainty were analyzed by repeated-measurement analysis of variance.

(1) There was no significant difference in the satisfaction with medical decision-making participation between the experimental group and the control group before intervention (information, communication and negotiation, decision-making dimensions, total satisfaction and confidence, total score) (all P>0.050); the scores in the experimental group after intervention were significantly higher than those in the control group (all P<0.001); there were statistically significant differences in satisfaction scores in the same group before and after intervention (all P<0.001). (2) The score of psychological distress in the experimental group was significantly lower than that in the control group after intervention (comparison between different time points, P=294.337, P<0.001; comparison between groups, P=354.744, P<0.001; interaction, P=9.657, P<0.001). (3) The score of disease uncertainty in the experimental group was significantly lower than that in the control group (comparison between different time points, P=3 592.265, P<0.001; comparison between groups, F=641.060, P<0.001; interaction, F=128.967, P<0.001). (4) At the 1st, 3rd and 6th cycle of chemotherapy, the patients in the experimental group showed a significantly higher chemotherapy compliance compared with the control group (Z=-4.689, -5.463, -10.956, all P<0.050).

The case management mode can reduce patients’ uncertainty about disease and psychological suffering, promote their participation in medical decision-making and improve chemotherapy compliance.