Investigation Of Advance Care Planning For Cancer Patients And The Effect Of Intervention Based On Motivational Interviewing With Transtheoretical Model

Objectives1.To understand the behavior status and stage of behavior change related to the advance care planning for tumor patients;2.To use the motivational interviewing based on the transtheoretical model to evaluate the intervention effect.Methods1.The first part of the study is a cross-sectional survey,using convenience sampling method,selected 220 tumor patients admitted to the oncology department of a tertiary first-class general hospital in Jinan,Shandong Province from April 2022 to December 2022.General data questionnaire and advance care planning engagement survey(ACPES)were used to conduct the survey.2.The second part of the study is an quasi-experimental study,100 tumor patients who met the requirements of the above cross-sectional survey and had a ACPES score of less than 3 were selected,and the study subjects were artificially assigned to the control group and the intervention group,with 50 patients in each group.The control group was given routine care measures to the oncology department,and the intervention group was given the advance care planning(ACP)intervention based on the transtheoretical model.The two groups completed baseline data collection within 1-2 days of admission,and agreed on the intervention for each chemotherapy course or review,with an intervention interval of 2-3 weeks,completed 4 interventions,and collected outcome data within 1 week after the last intervention.Data analysis was performed using SPSS25.0,and statistical analysis methods included descriptive statistics,independent sample t-test,chi-square test,Fisher’s exact probability method,paired sample t-test,with P<0.05 considered as a statistically significant difference.Results1.The cross-sectional study findingsSome tumor patients took ACP-related behaviors,among which the number of "signed official documents" was the least(3.18%),the number of "asked doctor questions" was the most(74.55%),and no one participated in all four ACP behaviors.157(71.36%)tumor patients were in the pre-awareness phase of ACP,50(22.73%)tumor patients were in the behavioral thinking stage,and 13(5.91%)tumor patients were in the preparation stage.The scores of each dimension of the questionnaire were knowledge dimension(3.58±1.45),thinking dimension(10.44±2.55),and self-efficacy score(26.09±9.21),and preparation dimension(37.31±11.61).2.Results of quasi-experimental studiesA total of 75 tumor patients completed the entire data collection,including 38 patients in the intervention group and 37 patients in the control group.The results show that:(1)Before the intervention,there was no significant difference in the ACPES scores(P>0.05).(2)Before the intervention,there was no significant difference in anxiety and depression scores among the patients in both groups(P>0.05).(3)After intervention,the ACPES knowledge dimension score of patients in the intervention group increased,and the difference between the two groups was statistical significance(P<0.05);the intervention group,and the difference between the two groups was statistical significance(P<0.05);the self-efficacy dimension increased in the intervention group,and the difference between the two groups was statistically significant(P<0.05);in the intervention group,and the difference between the two groups was statistically significant(P<0.05).(4)After the intervention,the self-anxiety score of patients in the intervention group was lower than that of the control group,and the difference between the two groups was statistically significant(P<0.05);the difference in the self-depression scores between the two groups was not significant(P>0.05).Conclusion1.Some tumor patients have ACP-related behaviors,most tumor patients are in the ACP awareness stage,some are in the thinking stage,and a few are in the preparation stage;ACP knowledge、self-efficacy and preparation level are generally low.2.Motivational interviewing based on the transtheoretical model was successfully implemented in the ACP for tumor patients,which alleviated the anxiety of cancer patients to some extent,and did not cause negative effects on patients’ depression,and did not bring psychological burden to patients.3.Motivational interviewing based on transtheoretical model in ACP application can improve the level of ACP knowledge,promote the ACP related behavior thinking,discuss ACP self-efficacy,to a certain extent,help tumor patients in the face of disease,clarify the values and medical preferences,promote the ACP related behavior stage change.