| Objective:(1)To investigate the symptom clusters of middle and advanced cancer patients and the incidence and severity of each symptom cluster,and to identify the most common and serious symptom clusters of middle and advanced cancer patients,so as to lay a foundation for the formulation of intervention program.(2)To construct a computerized cognitive behavior intervention program which is suitable for symptom cluster management of middle and advanced cancer patients.(3)To evaluate the clinical intervention effect of the intervention scheme on patients’ symptom cluster and negative emotion,so as to provide basis and reference for the management of symptom clusters in the future.Methods:(1)Investigation study: Convenient sampling was used to investigate the common symptoms,symptom clusters and the incidence and severity of each symptom cluster of150 middle and advanced cancer patients hospitalized in a third-class hospital in Shanxi Province from January to April 2021.General data questionnaire and Chinese Version of the M.D.Anderson Symptom Inventory(MDASI-C)were used to investigate the common symptoms,symptom clusters and the incidence and severity of each symptom clueter.(2)Program construction: Follow the "6S" evidence model,systematically search the literature at home and abroad,after quality evaluation,extract the best evidence,on this basis,initially formulate a computerized cognitive behavior intervention program for symptom group management of middle and advanced cancer patients;the program was revised by the method of expert meeting,and finally the computerized symptom clusters management scheme of middle and advanced cancer patients was constructed.(3)Intervention study: Using convenient sampling method,77 patients with advanced cancer who were hospitalized in the Oncology Department of a Grade 3A Hospital in Shanxi Province from Septembert to December 2021 were selected and divided into two groups according to the ward.The first ward was the control group(n=39)and the second ward was the experimental group(n=38).The control group received routine nursing for tumor diseases,and the experimental group received five computerized cognitive behavior intervention on the basis of routine nursing.Chinese Version of Brief Pain Inventory(BPI-C),Chinese Version of Brief Fatigue Inventory(BFI-C),Pittsburgh Sleep Quality Index(PSQI),Generalized Anxiety Disorder(GAD-7)and Patient Health Questionnaire(PHQ-9)were used to evaluate the effects of the two groups before and after intervention.Results:(1)The results show that:(1)Among the 13 core symptoms of advanced cancer patients,the highest incidence of symptoms is fatigue,restless sleep,dry mouth and poor appetite,and the incidence rates are 80.7%,65.3%,63.3% and 62.7%,respectively.The highest severity of symptoms is fatigue,with a severity of 3(1,4),followed by sleep restlessness,with a severity of 2(0,4).(2)The symptoms have the greatest influence on the patients’ work or housework,emotion and interest in life.(3)Four symptom groups were obtained by exploratory factor analysis,with a cumulative contribution rate of67.77%.They are disease-related symptoms(pain-fatigue-sleep restlessness),gastrointestinal symptoms(nausea-vomiting-poor appetite),psychological symptoms(distress-sadness)and neurotoxic symptoms(forgetfulness-numbness).(4)The severity of the disease-related symptom group was 5.5(2,9),with an incidence of 68.7%;the severity of the gastrointestinal symptom group was 3(0,5.25),with an incidence of 40%;the severity of the psychological symptom group was 1(0,4),and the incidence rate was20.7%;the severity of the neurotoxic symptom group was 0(0,2),and the incidence rate was 10.7%.(2)Through evidence retrieval and evaluation,a total of 26 articles were included,and 50 pieces of evidence were extracted finally,on the basis of which the research team constructed the first draft of computerized cognitive behavioral intervention plan for symptom cluster management.The expert meeting finally included 10 experts,and the authority coefficient of the experts was 0.897.The research group modified the scheme according to the results of the expert meeting,and established the final scheme.Finally,the computerized symptom clusters management program for middle and advanced cancer patients includes four links: screening,evaluation,intervention and evaluation,among which the intervention is conducted in 5 times.The content including diseases and symptoms of education,pain management,fatigue,sleep and emotional management five modules,each module contains cognitive therapy,cognitive consolidated and behavioral therapy three parts.(3)The results of intervention study showed that:(1)There was no significant difference in general data,symptom score and emotion score between the two groups before intervention(P>0.05).(2)There was no significant difference in the pain score between the two groups after intervention(P>0.05),but the pain score in the experimental group decreased significantly after intervention compared with that before intervention,and the difference was statistically significant(P<0.05).(3)The fatigue score of the two groups decreased significantly after intervention,and there was significant difference compared with that before intervention(P<0.05),and the fatigue score of the test group was significantly lower than that of the control group after intervention(P<0.05).(4)After intervention,the sleep score of the experimental group was lower than that of the control group,and the difference was statistically significant(P<0.05).(5)After intervention,the anxiety and depression scores of the experimental group were lower than those of the control group,and the difference were statistically significant(P<0.05).Conclusion:(1)The burden of symptoms in patients with advanced cancer is heavy,and the incidence and severity of fatigue are the highest.Pain-fatigue-sleep disturbance is the most common and serious symptom cluster in middle and advanced cancer patients.(2)On the basis of investigation and research,this study constructs a computerized cognitive behavioral intervention program based on evidence-based and expert meeting method,which is scientific,reasonable and practical.(3)The computerized symptom cluster management scheme for middle and advanced cancer patients has been proved to have a certain curative effect on pain,fatigue,sleep disorder symptoms and psychological and emotional problems,which is worthy of further research and promotion. |
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