Construction And Effects Evaluation Of Caregiver Needs Support Intervention For End-of-life Cancer Patients Based On We Chat

ObjectiveO1.Evaluation of the actual caring experience of the end-of-life cancer patients’ caregivers and the user experience of the ’Internet+ medical health’.O2.Construction of a demand support scheme for the terminal cancer patients based on Internet plus,and the evaluation of the intervention effect through comparison with the results of O1.MethodThis study is divided into three parts:Part 1: The investigation of the caring experience and the user experience of the’Internet+ medical care and health’ of the caregivers who are taking care of the end-of-life cancer patients.Phase 1.1: A qualitative study of end-of-life cancer patients’ caregivers’ caring experience.Caregivers who meet the large differences in the inclusion criteria for semi-structured interviews were selected through the purposive sampling method to provide a cornerstone for the construction of intervention methods with an in-depth exploration into the true experience of caregivers of end-stage cancer patients in Part2.Phase 1.2: A qualitative study about the user experience of the ’Internet +medical care and health’ for caregivers who care for end-of-life cancer patients.Caregivers of end-stage cancer patients with the user experience of the ’Internet+ medical care and health’ were selected using the same standards of Phase 1.1 to provide user data as a basis for the construction of intervention methods in Part 2.Part 2: Construction of the needs support intervention plan for end-of-life cancer patients caregiversPhase 2.1: Construction of the We Chat Subscriptions for caregivers who taking care of end-of-life cancer patientsThe first draft of We Chat Subscriptions for caregivers who taking care of end-of-life cancer patients was constructed from the literature review,theoretical frameworks,and quantitative studies.The Delphi expert consultation method was used to revise the official accounts.Phase 2.2: Construction the needs support intervention for caregivers who taking care of end-of-life cancer patientsBased on literature review,theoretical framework,and quantitative studies,the first draft of the needs support intervention of caregivers who took care of the patients with end-of-life cancer was constructed.And the intervention was demonstrated by expert consultation.Then a pilot study was used to verify the intervention to improve the intervention.Part 3: Verification of the effect of caregiver demand support scheme for patients with end-of-life cancerA quasi-experimental study was conducted to evaluate the intervention.65 caregivers of end-of-life cancer patients who met the inclusion criteria and had informed consent in a grade A class 3 hospital in Zhengzhou were selected as intervention subjects,with 32 caregivers in the intervention group and 33 caregivers in the control group.The control group received routine guidance and health education in the hospital.After the control group completed the data collection at baseline and the end of the intervention,then recruited the intervention group.The intervention group implemented the needs support intervention based on routine guidance and health education in the hospital and offered the intervention to them.The intervention was conducted in batches,with caregivers in each batch intervening for 5 weeks,with a total intervention duration of 11 weeks.General information of caregivers,caregiver needs,caregiver capacity,and health-related quality of life were collected before the intervention,and all these questionnaires except the general information were collected again immediately after the intervention.ResultPart 1: The investigation of the caring experience and the user experience of the’Internet+ medical care and health’ of the caregivers who are taking care of the end-of-life cancer patients.Phase 1.1: A qualitative study of end-of-life cancer patients’ caregivers’ caring experience.A total of 15 caregivers of end-of-life cancer patients were selected for a qualitative study.The caregiving experience of caregivers who care for the end-of-life cancer patients was summarized as the following 4 experiences:(1)The process of caring for patients is full of challenging;(2)The caregiver’s life order is disrupted;(3)Caring experience promotes the growth of caregivers;(4)Nursing experience triggers caregivers’ thinking on medical status situation.Phase 1.2: A qualitative study about the user experience of the ’Internet +medical care and health’ for caregivers who care for end-of-life cancer patients.A total of 15 caregivers of end-of-life cancer patients were selected for a qualitative study.The user experience of end-of-life cancer patients caregivers could be summarized into 3 experiences:(1)’Internet+ medical health’ platform is attractive;(2)’Internet+ medical health’ technology platform needs to be improved;(3)Caregivers have obvious needs for the ’Internet+ medical health’ platform;Part 2: Construction of the needs support intervention plan for end-of-life cancer patients caregiversPhase 2.1: Construction of the We Chat Subscriptions for caregivers who taking care of end-of-life cancer patientsAfter the initial construction of the We Chat Subscription,it was revised according to two rounds of Delphi expert consultation,and finally formed an application draft containing three modules of ’patient care’,’self-management’ and’interactive platform’.Phase 2.2: Construction the needs support intervention for caregivers who taking care of end-of-life cancer patientsConstructing a caregiver needs support intervention for patients with end-of-life cancer based on We Chat Subscription:(1)Intervention design: a quasi-experimental study;(2)Intervention mode: combining online and offline;(3)intervention implementers: researchers,department head nurses,medical staff of oncology specialty,spiritual care teachers,etc.(4)Intervention duration: each group of caregivers intervened for 5 weeks,including 3 times face-to-face group interventions and 4 weeks online intervention;(5)Intervention content: Take the actual needs of patients with end-of-life cancer as the core content,and meet their needs through targeted intervention;(6)Evaluation time and indicators: before intervention(general information,caregiver needs,caring ability and quality of life),immediately after intervention(caregiver needs,caring ability and quality of life).Part 3: Verification of the effect of caregiver demand support scheme for patients with end-of-life cancer1.72 caregivers of end-stage cancer patients were hospitalized in the 2departments of a grade A class 3 hospital in Zhengzhou for research and 65 patients received all interventions and received data collection,with a completion rate of90.2%.2.Baseline data were collected before the intervention.No statistical difference was found between the results of the intervention group and the control group.After the intervention,the total needs score of the intervention group was lower than that of the control group(P < 0.05),and the scores of disease knowledge,healthcare-related behavior,hospice-related knowledge,and caregivers’ health dimension were all lower than those of the control group.After completing the intervention,the total scores of caregivers’ caring ability in the intervention group were lower than those in the control group(P < 0.05),and the scores in dimensions of adapting to caring roles,handling personal emotional needs,and evaluating family members and community resources were lower than those in the control group(P < 0.05).3.At the end of the intervention,the differences in the total scores of caregivers’ demands,disease knowledge,and healthcare-related behaviors were statistically significant(P < 0.05),while the differences in the total scores of caregivers’ caring abilities,all dimensions,and the health-related quality of life of caregivers were statistically significant(P < 0.05).4.The caregivers had good application status and compliance with the intervention,were able to skillfully apply the intervention and obtain personalized support in time according to the push,and were able to accept and complete the evaluation.ConclusionThe We Chat-based support program for caregivers of end-stage cancer patients can meet the actual needs of caregivers and improve their care and quality of life.During the investigation,the intervention program showed high feasibility and operability,and the acceptance,compliance,and application effect of the intervention are relatively positive.Caregivers played a leading role in the intervention process by earnestly completing the learning of the push content and intervention content,thereby gaining a strong sense of participation.In general,the intervention program not only effectively meets the needs of caregivers but also improves their care ability and quality of life.