Abstract:

Objective

To explore the application of hierarchical psychological nursing model in breast cancer patients with postoperative upper extremity lymphedema, and provide references for psychological nursing.

Methods

According to the inclusion and exclusion criteria, the patients with upper extremity lymphedema after breast cancer surgery in the clinic of lymphedema nursing, Department of Breast Disease,First Affiliated Hospital, Nanjing Medical University from March to November 2016 were collected for a prospective study. A baseline survey of the patient's mental state was performed at the first visit with the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7). Totally 66 patients with PHQ-9 score≥5 and (or) GAD-7 score≥5 were divided into control group (n=33) and experimental group(n=33) using a random number table. The quality of life in patients of two groups was evaluated by the upper limb lymphedema 27 questionnaire at their first visit. According to the results of experimental group, the psychological nursing grades of the patients were defined and hierarchical psychological nursing was given accordingly. The control group was given routine psychological care. The scores in PHQ-9, GAD-7 and the upper limb lymphedema 27 questionnaire were recorded in the middle and final stages of lymphedema treatment in both groups. The depression and anxiety symptoms and the result of upper limb lymphedema 27 questionnaire were compared between two groups by repeated measurement analysis of variance.

Results

Totally 62 patients completed the evaluation (4 cases missing), including 32 in experimental group and 30 in control group. After the intervention of hierarchical psychological nursing, the score of PHQ-9 dropped from 11.81±3.86 to 4.56±1.50 in experimental group, from 11.97±4.08 to 8.57±3.27 in control group, which presented a significant difference (comparison between groups: F=6.331, P=0.015; comparison at different time points: F=282.350, P<0.001; interaction between grouping and different time points: F=36.899, P<0.001). The score of GAD-7 declined from 10.41±2.47 to 3.66±1.26 in experimental group, from 10.23±4.18 to 7.40±3.59 in control group, which presented a significant difference (comparison between groups:F=4.365, P=0.041; comparison at different time points: F=388.358, P<0.001; interaction between grouping and different time points: F=56.517, P<0.001). In upper limb lymphedema 27 questionnaire, the total score decreased from 68.03±14.13 to 31.84±3.57 in experimental group, from 70.80±10.47 to 46.60±4.70 in control group, which presented a significant difference (comparison between groups: F=23.645, P<0.001; comparison at different time points:F=421.183,P<0.001;interaction between grouping and different time points: F=16.597, P<0.001).

Conclusion

The hierarchical psychological nursing can effectively relieve the negative emotions of patients with postoperative upper limb lymphedema, improve the physiological,social and psychological function and quality of life, which is superior to routine psychological care.

Key words: Breast neoplasms, Nursing process, Lymphedema