| Objective:This study based on the Kano model construction of postoperative patients with gastric cancer supportive care needs questionnaire,understand the demand of postoperative patients with gastric cancer supportive care status and influencing factors,and the supportive care needs of postoperative patients with gastric cancer attribute classification and prioritization,which will provide a scientific basis for optimization of gastric cancer postoperative nursing care.Method1.Document analysis: Based on the theory of supportive care needs,literature related to gastrointestinal cancer nursing and postoperative care for gastric cancer at home and abroad was analyzed,and a questionnaire on supportive care needs for postoperative patients with gastric cancer was preliminarily constructed.2.Semi-structured interview: The interview outline was constructed under the guidance of experts,and the semi-structured interview method was adopted to conduct face-to-face interviews with patients after gastric cancer surgery.Relevant topics were extracted and the questionnaire contents were supplemented,and the first round of expert consultation questionnaire was formed after group discussion.3.Delphi method: 19 college teachers who have been engaged in surgical nursing,digestive tract tumor and gastric cancer nursing for a long time,director of nursing department,head nurses and chief physicians of third-grade grade A hospitals were invited to consult experts by letter and conduct two rounds of consultation to determine the questionnaire of supportive care needs of postoperative patients with gastric cancer.4.Questionnaire preparation method: Based on the Kano model theory,positive and negative questions were set for each item in the questionnaire on the supportive care needs of postoperative patients with gastric cancer,namely,"provided the service/did not provide the service".The alternatives included five grades from "like" to "dislike" to form the Kano attribute questionnaire,and to test the reliability and validity of the questionnaire.5.Cross-sectional survey: 210 postoperative gastric cancer patients hospitalized in 3 third-grade grade A hospitals in our city were selected by objective sampling method.A cross-sectional survey was conducted using self-made general data questionnaire,Kano attribute questionnaire and existing NSS-SF34 scale.The influential factors of supportive care for postoperative patients with gastric cancer,the score of demand,the attributes of classifying demand as charm and expectation were analyzed,and the importance of demand was sorted through the four-quadrant matrix.6.Statistical methods: Data were processed by Excel19.0 and SPSS21.0.The enthusiasm,authority and consistency of experts are expressed by discrete and aggregate indexes.The selection frequency 、 percentage 、 mean and standard deviation of descriptive data such as general information and supportive care demand level are expressed.Independent sample T test and one-way analysis of variance were used for single factor.Multiple factors were analyzed by linear regression.Kano attribute classification adopts "maximum frequency method" and uses importance matrix for optimization analysis.Result:1.Document analysis: After literature review,5 dimensions with 50 items were initially extracted,including 12 physiological needs,15 information needs,13 psychological needs,7 social needs and 3 daily life needs.2.Semi-structured interview: 15 patients were interviewed,text topics were extracted by Colaizzi7 step method,and 4 physiological needs、4 information needs、2 psychological needs、 2 social needs、 and 3 daily life needs were supplemented.A total of 65 items were collected from 5 dimensions.3.Delphi method: the positive coefficient of two rounds of correspondence consultation with experts is 90.45% and 100%;The coefficient of authority degree was 0.85、 0.88;Kendall ’s W: 0.20、0.21、P < 0.05;Entries were 0.18、 0.21、 P< 0.05.The final questionnaire was adjusted to 5 dimensions and 41 items.4.Questionnaire preparation method: 82 positive and negative questions were set,and item validity(I-CVI)was 0.83;Scale validity(S-CVI)was 0.995;Cronbach’sα validity coefficients for the overall,forward and reverse questions were 0.822,0.741 and 0.783 respectively.5.Cross-sectional survey results:(1)Analysis of influencing factors: Univariate analysis showed that gender 、age、KPS score、 cancer stage、treatment method and postoperative course were different in demand(P<0.05).Multivariate analysis showed that gender and cancer stage had significant differences in demand(P<0.05).(2)Level of supportive care demand: Cronbach’s α coefficient of NSS-SF34 scale was 0.94.After gastric cancer surgery,patients’ physical and daily life needs(18.9±6.89)、psychological needs(36.26±9.94)、 sexual needs(3.9±1.96)、patient care and support needs(16.79±5.31)、 health system and information needs(37.54±11.55).The overall level of unmet supportive care was above moderate,with the highest demand for information.(3)Kano attribute classification: charm demand accounted for 19.51%;Expected demand accounted for 7.32%;24.39% of essential needs;Undifferentiated demand accounted for 48.76%.The 21 requirements have significant effects on postoperative satisfaction of patients with gastric cancer,while the 20 demands had little effect on the change of satisfaction,and no reverse or suspicious results were found.(4)Important-satisfaction analysis: Based on the optimized supportive needs of patients after gastric cancer surgery,9 patients(21.95%)in the first quadrant,11 in the second quadrant(26.83%),11 in the third quadrant(26.83%)and 10 in the fourth quadrant(24.39%).Conclusion:1.Patients with gastric cancer after surgery have unmet needs to a certain extent in terms of different needs,and gender and cancer stage are the main influencing factors.2.Nursing services should steadily provide necessary demand,actively respond to expected demand,actively develop charm demand,flexibly allocate nursing resources,and attach importance to patients’ satisfaction with medical treatment according to Kano attribute and importance-satisfaction result. |
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