Construction Of A Supportive Intervention Program For Primary Caregivers Of Patients With Prophylactic Enterostomies

Research background and purpose: This study was based on a systematic evaluation method to evidence the factors influencing the care burden of primary caregivers of patients with enterostomies.The subject team summarized and integrated the influencing factors,systematically sorted out and discussed to form a preliminary draft of a supportive intervention program for primary caregivers of patients with prophylactic enterostomies guided by supportive care theory.The intervention program was further revised and improved by Delphi expert consultation method,and the feasibility and effectiveness of the program were tested through clinical validation.Materials and methods: The system searched domestic and international databases,screened the retrieved literature in strict accordance with the nadir criteria and then evaluated the quality,identified the final included literature and conducted data extraction,the subject members further discussed and analyzed the literature to determine the factors influencing the caregiver’s caregiving burden that could be intervened,and finally formed the first draft of the intervention plan under the guidance of supportive care theory.After the first round of consultation,members of the subject group compiled,analyzed and discussed the experts’ opinions,revised and improved the program,and formed the next round of consultation questionnaire.The final draft of the Primary Caregiver Support Intervention Program was formed.The mean importance value,coefficient of variation,and frequency of full scores were used as the selection criteria of the questionnaire items;the scientificity and operability of the program were judged by the degree of expert authority,the degree of expert motivation,the degree of expert opinion concentration,and the degree of opinion coordination.A non-simultaneous controlled,repeated measures type of experimental study was used to include primary caregivers of patients who underwent prophylactic enterostomy in April-May 2022 and September-October 2022 at a tertiary care general hospital in Mianyang City as study subjects,and patients were grouped in chronological order of admission(15 cases each in the control and intervention groups).The control group received traditional care in the department,and the intervention group received supportive intervention program content care on the basis of the control group.The Caregiver Caregiving Competence Scale,Stoma Care Skills Rating Scale,and Caregiving Burden Scale were used as indicators to evaluate the effectiveness of the program,and the data collection points were the day the patients were admitted to the gastroenterology department,at discharge,1 month after discharge,and 2 months after discharge.Independent samples t′ test was used to compare the changes and differences in caregiver caregiving ability,stoma care skills,and caregiving burden scores between the two groups,repeated measures ANOVA was used to assess the between-group effects of the two groups,one-way ANOVA welch W test was used to compare the differences in the scores of the outcome indicators within the same group,and Origin software was used to depict the trends of the outcome indicators within the same group with changes in the length of intervention.Result: 1.The systematic evaluation section eventually included 14 papers for analysis,yielding 25 factors influencing the caregiving burden of carers of patients with enterostomies.After discussion and analysis by the group,10 main influencing factors that could be intervened were identified,including social support,psychology,acceptance of the stoma,getting along with the patient,quality of life,coping style,family care index,loneliness,stoma complications and carer readiness.The first draft of the supportive intervention programme,which is guided by supportive care theory,includes seven primary,17 secondary and 40 tertiary entries.2.Results of expert consultation: 18 questionnaires were issued in the first round,the response rate of experts was 89%(16/18),the suggestion rate was 63%(10/16),the expert familiarity(Cs)was 0.888,the expert authority coefficient(Cr)was 0.885,the Kendall coordination coefficient(w)was 0.234(P < 0.001),the consistency of expert opinions was low;in the second round,16 questionnaires were issued,the expert response rate was 100%(16/16),the suggestion rate was 25%(4/16),the expert familiarity(Cs)was 0.913,the expert authority coefficient(Cr)was 0.9.In the second round,16 questionnaires were distributed,and the response rate of experts was 100%(16/16),the suggestion rate was 25%(4/16),the expert familiarity(Cs)was 0.913,the expert authority coefficient(Cr)was 0.907,and the Kendall coordination coefficient(w)was 0.470(P < 0.001),and the experts’ opinions were basically consistent.The final draft of the preventive primary caregiver support intervention program for patients with a prophylactic colostomy was determined to have 7 primary entries,19 secondary entries,and 47 tertiary entries,with the mean importance assignment of each entry ranging from 3.94 to 4.94,the coefficient of variation(cv)ranging from 0.05 to 0.24,and the frequency of full scores ranging from 31% to 94%.3.Evaluation of effectiveness(1)Comparison of caregiver caregiving ability: between-group comparisons revealed that caregiver caregiving ability was higher in the intervention group than in the control group at different time points after receiving the intervention,and caregiver caregiving ability scores were significantly lower in the intervention group than in the control group(P<0.05);repeated measures ANOVA showed that there were significant time,between-group and interaction effects for caregiving ability scores in both groups(P<0.05);within-group comparisons The intra-group comparison of caregiver caregiving ability scores in both groups was found to be statistically significant(P<0.05);trend plots found that caregiver caregiving ability scores in both groups showed an increasing trend at the time of patient discharge,a decreasing trend 1 month after patient discharge,and 2 months after discharge.(2)Comparison of caregiver stoma care skills: between-group comparisons revealed that caregiver stoma care skills were higher in the intervention group than in the control group at different time points after receiving the intervention,and caregiver stoma care skill scores were significantly higher in the intervention group than in the control group(P<0.05);repeated measures ANOVA revealed significant time and between-group effects(P < 0.05)and no interaction effects(P > 0.05)for caregiver stoma care skill scores in both groups;intra-group comparisons revealed statistically significant intra-group comparisons for both groups(P<0.05);trend plots revealed that both groups showed an increasing trend in ostomy care skill scores with the extension of the intervention time.(3)Comparison of caregiver care burden: between-group comparisons revealed that caregiver care burden was lower in the intervention group than in the control group at different time points after receiving the intervention,and caregiver care burden scores were significantly lower in the intervention group than in the control group(P<0.05);repeated measures ANOVA revealed significant time,between-group and interaction effects for caregiver care burden scores in both groups(P<0.05);within-group comparisons revealed that caregiver care burden scores were statistically significant in both groups(P<0.05);the trend graph revealed that the caregiver burden scores of the intervention group showed a decreasing trend with the extension of the intervention time,while the caregiver burden scores of the control group showed an increasing and then decreasing trend with the extension of the intervention time.Conclusion: The supportive intervention program for primary caregivers of patients with preventive enterostomies,which is guided by supportive care theory and constructed based on systematic evaluation and Delphi method,is highly scientific and operable,and the results of the effect evaluation show that the program has certain feasibility and effectiveness.The implementation of this program can effectively improve the care ability and stoma care skills of primary caregivers of patients with preventive enterostomies and reduce the care burden of primary caregivers of patients with preventive enterostomies,which can provide reference for clinical nursing practice.