| Objective: To explore the changes of patients after lung cancer over time,analyze the sentinel symptoms in the chemotherapy period,and provide entry point for symptom intervention,experience and management needs of lung cancer patients,and evaluate quantitative and qualitative results.Research method: Mixed research methodPart 1: Longitudinal survey of the symptom group and sentinel symptoms in patients with postoperative chemotherapy after lung cancerThis section is a prospective longitudinal survey.Using the convenience sampling method,lung cancer patients receiving chemotherapy in the 1st,2nd and 3rd wards of the First Affiliated Hospital of China Medical University and the 2nd and 3rd wards of Chest Department of Liaoning Cancer Hospital from September 2020 to June 2021 were selected as the research subjects.The specific module for lung cancer and the first symptom occurrence schedule were investigated,investigating a total of 2chemotherapy cycles.Exploratory factor analysis was adopted to extract the symptom groups,and to judge the sentinel symptoms in the symptom group based on the association analysis results of the Apriori algorithm and the first occurrence time of the symptoms.Part 2: A qualitative study of the symptom group experience of patients with postoperative chemotherapy after lung cancerThis part is a qualitative study.From October 2020 to March 2021,using the phenomenological research method from the qualitative research,15 postoperative lung cancer patients receiving chemotherapy in the thoracic medicine department of Liaoning Cancer Hospital were selected as the study subjects,and semi-structural interviews were conducted according to the interview outline.Data were analyzed by using the Colaizzi7-step analysis method.Part 3: Construction of the intervention program for patients undergoing chemotherapy after non-small cell lung cancerAccording to the preliminary longitudinal survey and the results of the qualitative interview,the intervention program of each symptom group was constructed based on the stable sentinel symptoms in each symptom group.A research team was set up to formulate the first draft of the intervention program based on the theoretical framework of symptom management theory and knowledge and practice mode,and the intervention program was further optimized and improved through expert consultation and preliminary experiment,and the final draft of the intervention program of symptom group of postoperative chemotherapy patients with non-small cell lung cancer was finally formed.Part 4: Intervention of gastrointestinal symptom group of patients undergoing postoperative chemotherapy for non-small cell lung cancerThis section is an intervention study.The intervention of gastrointestinal symptom group was initially implemented under the guidance of the intervention program constructed in Part 3.From August 2021 to December 2021,330 patients with lung cancer postoperative chemotherapy in the first and second wards of a Grade A hospital in Shenyang were selected as the research subjects.The control group(165patients)received routine care,and the intervention group(165 patients)received the intervention program for gastrointestinal symptom group symptom management based on routine care.Patients were investigated using the Anderson Symptoms Assessment Scale,the Self-Management Effectiveness Questionnaire,and the SF-36 Quality of life questionnaire before the first chemotherapy(T1),before the third chemotherapy(T2),and before the fifth chemotherapy(T3).Results:Part 1: Longitudinal survey of the symptom group and sentinel symptoms in patients with postoperative chemotherapy after lung cancerFour symptom groups exist in patients undergoing chemotherapy after lung cancer,Including gastrointestinal symptoms,respiratory symptoms,psychological symptoms,and somatic symptoms,Outpost symptoms in each symptom group were nausea,cough,sadness,and fatigue;Three symptom clusters were present in cycle 2,Including gastrointestinal symptoms,respiratory symptoms,and psychological-somatic symptoms.Outpost symptoms in each symptom group were nausea,cough,and fatigue;Five symptom groups were present during the third chemotherapy cycle.They are gastrointestinal symptoms,respiratory symptoms,psychological symptoms,somatic symptoms and neurological symptom group.Outpost symptoms in each symptom group are: nausea(gastrointestinal symptom group),cough(respiratory symptom group),fatigue(somatic symptom group),no sentinel symptoms were found in the psychological and neurological symptom groups;A total of four symptom groups were extracted during the fourth chemotherapy cycle,They are gastrointestinal symptoms,respiratory symptoms,psychological symptoms and somatic symptoms.Outpost symptoms in each symptom group are: nausea(gastrointestinal symptom group),cough(respiratory symptom group),fatigue(somatic symptom group),no sentinel symptoms were found in the psychological symptom group.Among them,the psychological and somatic symptom groups were merged into one symptom group in cycle 2,while the neurological symptom group only appeared in cycle 3.Part 2: A qualitative study of the symptom group experience of patients with postoperative chemotherapy after lung cancerFour themes are extracted: patient perception of symptom groups,including psychological prediction and lack of understanding;patient perception includes diversity,timing,and volatility of symptoms;symptom group response strategies include natural course,positive response,and negative depression;and symptom groups affect daily life,work and interpersonal communication.Part 3: Construction of the symptom group intervention program for postoperative chemotherapy patients for non-small cell lung cancerAccording to the symptom management theory,the intervention program framework is divided into three parts: the patient’s symptom experience and illness,patient’s management education and symptom outcomes.The symptom experience in this study is the experience of each patient symptom.Symptoms management education based on communication mode includes three parts: information input,belief strengthening and behavior guidance.Among them,information guidance refers to the guidance on the knowledge and skills needed for patients to conduct the self-management of symptoms.Faith strengthening refers to enhancing patients’ beliefs about the successful management of symptoms.Behavior guidance refers to guiding patients’ symptom self-management behaviors,reducing unhealthy symptom self-management behaviors,and making patients develop healthy symptom management behaviors.Symptomatic outcomes include the incidence,severity of each symptom,self-management efficacy,and quality of life within the patient symptom cluster.Part 4: Intervention of gastrointestinal symptom group of patients undergoing chemotherapy for non-small cell lung cancerComparison of total symptom scores and different time points between the two groups,Total score of symptom groups and each symptom score in T2 and T3,the difference was statistically significant(P<0.05),and the score of the intervention group was lower than the control patients.Comparison between groups of different time points of SUPPH scores in the two groups,the difference was statistically significant(P<0.05),and the SUPP H score of the intervention group patients was higher than that of the control group patients.Comparison between groups scoring different time points in six dimensions of physical function,physical pain,overall health,vitality,emotional function,and mental health,the differences were all statistically significant(P <0.05),and the intervention group scored higher patients than the control group,Inter-group effect of 2 dimensions of physiological and social function,the difference was not statistically significant(P> 0.05).Conclusion:1.Patients with postoperative chemotherapy for lung cancer have relatively stable symptom group and internal sentinel symptoms during chemotherapy.In clinical practice,it is recommended that medical staff take the sentinel symptoms as the entry point for the evaluation and management of the symptom group.2.Before chemotherapy,medical staff should strengthen the health education of patients about chemotherapy.The evaluation of symptoms should be both diversified and individualized,while active and effective symptom group management strategies should be established in order to improve the quality of life of patients with chemotherapy after lung cancer.3.A symptom group management intervention based on symptom management theory and confidence pattern is an acceptable and feasible intervention,and one targeting sentinel symptoms provides a promising approach to treat multiple symptoms within the group simultaneously. |
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