A Study Of Cognitive Cycle Among Patients With Primary Hepatic Cancer Having Multiple Transcatheter Arterial Chemoembolization(TACE)

ObjectivesThe aim of this study was to explore the cognitive changes of patients with primary hepatic cancer having multiple transcatheter arterial chemoembolization(TACE),and to explore the post-cancer cognitive cycle model from the perspective of patients.On theses grounds,this study was to perform cognitive behavioral intervention,and effect evaluation individually,and provide evidence for the development and perfection of individualized medical treatment and nursing service for patients treated with TACE.MethodsIn the first stage,a qualitative research was performed based on the grounded theory.By purposive sampling in a third class provincial cancer hospital,we conducted an intensive face-to-face interviews in 20 patients with primary hepatic cancer who have multiple transcatheter arterial chemoembolization(equal to or more than 3 times).After the data was saturated,no more patients would be interviewed.Combining with participant observation,writing memos,personal reflection and constant comparison,we collected all the related materials.Afterwards,following the open,axis and core principles of the three-level coding method of grounded theory,we analyzed these materials to achieve the theme,summarized and extracted the categories,studied in depth the dynamic relations among these categories and presented the pattern of post-cancerous cognitive cycles of the liver cancer patients.We conducted a quasi-experimental study in the second stage.By convenience sampling in a third class cancer hospital,we selected 60 patients with primary hepatic cancer who have multiple transcatheter arterial chemoembolization.Thirty-one patients were assigned to the control group and 29 patients were assigned to the observational group by flipping a coin.Patients in the control group were given common care,health education and psychological care of the interventional department.Besides the regular health care,patients in the observational group were given effective cognitive behavioral therapy,based on the "Table of Cognitive and Behavioral Intervention" approved by the expert group.The Connor-Davidson resilience(CD-RISC)scale was used to assess the efficacy before and after the intervention.ResultsThis study summarized three categories from the transcripts of interviews,which included post-cancerous cognition,coping strategies and cognitive outcomes."Post-cancerous cognition" was defined as acknowledgement of cancer and the change of health,life and social character.It can be divided into "benign cognition"and "cancerous cognition"(also known as "malignant cognition")."Benign cognition"refers to the cognition that the process of self-recognition tends to be a virtuous circle after a patient suffers from cancer.Correspondingly,the vicious circle that cannot enter the benign cycle is recognized.The state of knowledge is known as "cancerous(malignant)cognition"."Coping strategies" included self-adjustment and external support system."Cognitive outcomes" referred to patients’ outcomes after adjusting cognition,which included good and poor outcomes.Dynamically related cognition-coping-prognosis formed a cyclical pattern,namely post-cancerous cognitive cycle.Cognitive cycle contained two pathways.One is a cycle of benign cognition-coping positively-good outcomes,and the other one is a cycle of cancerous cognition-coping negatively-poor outcomes;There is a dynamic link between the benign cycle and the vicious cycle.It is a positive"adaptation cycle"from the vicious circle into the benign cycle,and it is a negative "break cycle" from the benign cycle to the vicious cycle.When they are converted,there is a warning prompt,that is,the appearance of certain words suggests that the cognition is about to turn into a benign cycle or a vicious cycle.According to the standard of CD-RISC scale,the patients with primary liver cancer after multiple TACE were evaluated with psychological resilience.Before intervention,no significant differences were tested in the scores between the observational and control group(P>0.05).After intervention,the scores of toughness,self-improvement,optimism and total score were 38.14±6.90,20.69±4.39,10.10±1.74 and 68.93± 12.05 in the observation group,and 31.65±7.14,18.35±4.25,8.94±2.29 and 58.94±12.78 in the control group respectively,The difference between the scores of the control group and the observation group after the intervention was statistically significant(P<0.05).Before and after intervention,the differences were statistically significant(P<0.05)Conclusions:This study primarily revealed the cognitive circulatory model.Cognitive behavior intervention based on this model can improve the psychological tolerance of patients with TACE,and guide the development and improvement of individual quality nursing services for TACE patients.