| Objective:Through semi-structured interview and based on planned behavior theory(TPB),the influencing factors of ineffective response to insomnia in patients with gastric cancer undergoing chemotherapy were explored.Based on evidence-based methods and expert meeting methods,a web-based self-help mindfulness intervention program for gastric cancer patients with insomnia undergoing chemotherapy was constructed.The purpose of this study is to improve the sleep quality of patients with insomnia due to chemotherapy for gastric cancer,and provide reference for optimizing tumor care programs.Methods:This study was conducted in three parts.The first part used a semi structured interview method to analyze the influencing factors of ineffective response to insomnia in patients with gastric cancer undergoing chemotherapy;The second part uses evidence-based and expert meeting methods to construct a network self-help mindfulness intervention program for patients with insomnia during chemotherapy for gastric cancer;The third part conduct the quasi experimental study to evaluate the effectiveness of online self-help mindfulness intervention for insomnia patients undergoing chemotherapy for gastric cancer.1.Using the objective sampling method,the study subjects were patients with gastric cancer and insomnia who came to the oncology ward of a third class A hospital in Jiangxi Province for chemotherapy from May 2022 to July 2022.The data were collected using a semi structured interview method,and under the guidance of planned behavior theory,content analysis was used to refine the topic and corresponding subtopics.2.Through literature review and evidence-based methods,combined with the results of the first half structured interview,the first draft of the intervention plan was developed.Using the purposive sampling method,eight experts were selected to implement the expert meeting method.After the meeting,the final draft of the intervention plan was determined based on the opinions and suggestions of experts.3.We selected patients with insomnia due to chemotherapy for gastric cancer who were hospitalized in the oncology department of a third class A hospital in Jiangxi Province from September 2022 to February 2023.The observation group and the control group were set up in different wards and divided into groups by drawing lots.The control group received routine tumor nursing and sleep hygiene education,while the observation group received online self-help mindfulness intervention based on the control group.Intervention content: pre intervention evaluation,mindfulness intervention,related support,and post intervention evaluation.Intervention forms are a combination of offline and online approaches,with pre intervention assessments conducted offline and mindfulness exercises conducted online.The intervention period was 8 weeks,5 days a week,2 times a day,10-20 minutes each time.The Pittsburgh Sleep Quality Index Scale,the Insomnia Severity Scale,and the Mindfulness Attention Awareness Scale were used to evaluate the patients before,at the end of the fourth week of intervention,and at the end of the eighth week of intervention.The patient’s basic information questionnaire was only collected before the intervention.Results:1.A total of 18 patients with insomnia due to chemotherapy for gastric cancer were interviewed.After content analysis,three themes were found: the behavior and attitude of patients with insomnia due to chemotherapy for gastric cancer,the subjective norms of patients with insomnia due to chemotherapy for gastric cancer,and the perceptual behavior control of patients with insomnia due to chemotherapy for gastric cancer.This study found that lack of knowledge related to insomnia can lead to poor behavior and attitudes among patients,namely,attitudes that are not valued or ignored.In addition,subjective norms(including family roles,medical staff roles,and peer roles)can also have an impact on patients’ coping with insomnia.Finally,perceptual behavioral norms refer to the degree of difficulty perceived by patients with insomnia during chemotherapy for gastric cancer in coping with insomnia.High economic pressure,lack of access to insomnia related knowledge,and negative emotional experiences can lead to difficulties in effectively coping with insomnia.2.Using literature review and evidence-based methods,1653 documents were retrieved,and after screening and quality evaluation,8 high-quality documents were ultimately included to construct the first draft of the intervention plan for this study.After the implementation of the expert meeting,health education content was incorporated into mindfulness interventions,and sleep hygiene health education was conducted in the form of brochures,with new compliance indicators added.The final intervention plan includes four parts: pre intervention evaluation,mindfulness intervention,related support,and post intervention evaluation.There are 43 specific implementation plan items.3.(1)Baseline data comparison: A total of 86 patients with insomnia due to chemotherapy for gastric cancer were included in the study,with 43 patients in the control group and 43 patients in the observation group.At the time of the study,2patients were separated from the control group and 4 patients were separated from the observation group.Finally,41 patients were included in the control group and 39 patients were included in the observation group.There was no statistically significant difference in the basic information,Pittsburgh sleep quality score,insomnia severity scale,and mindfulness awareness scale scores of the two groups of patients before intervention(P>0.05),and the two groups of patients could be compared.(2)Comparison of Pittsburgh Sleep Quality Inventory(PSQI)scores between the two groups:(1)Comparison between groups showed that there was no statistically significant difference before intervention(P=0.703);At the end of 4weeks of intervention and 8 weeks of intervention,the scores of the observation group were significantly lower than those of the control group,with significant differences(P<0.05)Repeated measurement comparison showed that there were statistically significant differences in the scores of the Pittsburgh Sleep Quality Scale between the two groups before intervention,at the end of 4 weeks of intervention,and at the end of 8 weeks of intervention(P<0.001);There was an interaction effect between time * groups(P<0.001).(3)Comparison of insomnia severity scale scores(ISI)between the two groups:(1)Comparison between groups showed that there was no statistically significant difference before intervention(P=0.560);At the end of 4 weeks of intervention and 8weeks of intervention,the scores of the observation group were significantly lower than those of the control group,with significant differences(P<0.001)Repeated measurement comparison showed that there were statistically significant differences in the scores of the insomnia severity scale between the two groups before intervention,at the end of 4 weeks of intervention,and at the end of 8 weeks of intervention(P<0.001);There was an interaction effect between time * groups(P<0.001).(4)Comparison of Mindfulness Attention Awareness Scale scores(MAAS)between the two groups:(1)Comparison between groups showed that there was no statistically significant difference before intervention(P=0.672);At the end of 4weeks of intervention and 8 weeks of intervention,the scores of the observation group were significantly lower than those of the control group,with significant differences(P<0.05)Repeated measurement comparison showed that there was a statistically significant difference in the time effect of the Mindfulness Attention Awareness Scale scores between the two groups before the intervention,at the end of the fourth week of the intervention,and at the end of the eighth week of the intervention(P<0.001);However,there was no statistically significant difference in group effects(P=0.51);There was an interaction effect between time * groups(P<0.001).Conclusion:1.Bad behavior and attitude,family role,medical staff role,peer role,high economic pressure,lack of access to insomnia related knowledge,and negative emotional experience are the influencing factors of ineffective response to insomnia behavior in patients with gastric cancer undergoing chemotherapy.2.The online self-help mindfulness intervention program for patients with insomnia due to chemotherapy for gastric cancer is necessary,reliable,and feasible,and can be applied to tumor nursing practice.3.Online self-help mindfulness intervention can significantly improve the sleep quality,insomnia severity,and mindfulness trait level of patients with insomnia due to chemotherapy for gastric cancer. |
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