| Object1.Based on symptom management theory,we constructed a management plan for lung cancer breakthrough cancer pain through semi-structured interviews,case review and literature study,and Delphi method of correspondence with experts,which provides scientific and reasonable care processes and measures.2.To verify the clinical application effect of the management program for lung cancer breakthrough cancer pain.Method1.Semi-structured interviews: This study used a purposive sampling method to include 13 lung cancer patients with breakthough cancer pain from the Department of Respiratory Oncology of a tertiary or higher hospital in Zhengzhou from October 2021 to December 2021 to conduct semi-structured interviews to extract themes of lung cancer patients’ perceptions of breakthrough cancer pain and their care needs,and to provide reference for the development of secondary and tertiary entries in the breakthough cancer pain management framework for lung cancer.2.Chart review: This study conducted a chart review of 59 lung cancer patients with breakthough cancer pain symptoms admitted to the Department of Respiratory Oncology of a tertiary cancer hospital in Zhengzhou from January 2022 to April 2022 to understand the incidence of breakthrough cancer pain,pain intensity,pain location,number of pains,and medical and nursing measures in the clinic to supplement the secondary and tertiary entries in the lung cancer breakthrough cancer pain management framework.3.Literature study: Through systematic search of relevant literature on lung cancer breakthrough cancer pain management,recommendations with higher evidence level in relevant guidelines or consensus were extracted,and combined with the results of semi-structured interviews and case reviews,a preliminary lung cancer breakthough cancer pain management plan was formulated.4.Delphi method: 28 experts from four provinces,namely Henan,Hubei,Anhui and Xinjiang,were selected to revise the relevant entries of the initially formulated lung cancer breakthough cancer pain management scheme and finalize the management scheme of lung cancer breakthrough cancer pain.5.Validation of the lung cancer breakthrough cancer pain management program: 71 lung cancer patients with breakthrough cancer pain who met the inclusion criteria in a comprehensive tertiary general hospital in Zhengzhou City,Henan Province were selected as study subjects.35 patients in the control group were treated with conventional care,and 36 patients in the intervention group were treated with clinical interventions using the lung cancer breakthrough management program constructed based on symptom management theory,and the number of occurrences of breakthough cancer pain,sleep quality and satisfaction scores were compared between the two groups at the time of admission and after the intervention.The number of breakthough cancer pain,sleep quality and nursing satisfaction scores were compared between the two groups.6.Statistical methods: NVivo 12.0 was used to analyze the interview data,and SPSS 25.0 software was used for the istical analysis of the data.The positivity of the correspondence experts was expressed by the return rate of the correspondence questionnaire and the rate of experts who gave opinions.The authority degree of experts was determined by the academic level weights of experts,the coefficient of the basis of experts’ judgment,and the coefficient of experts’ familiarity.The degree of expert opinion coordination was expressed by the coefficient of variation(CV)and Kendall’s harmony coefficient(W).The degree of expert opinion concentration was expressed by the mean,standard deviation,and perfect score of the importance and feasibility of the entries.Descriptive statistical analysis,Chi-square test,variance analysis and nonparametric test were used to verify the scheme.Results1.After semi-structured interviews,six themes were extracted(interference with daily life,physiological changes,emotional cognitive changes,misconceptions about pain medication,need for knowledge guidance related to breakthough cancer pain,and need for social support),and nine subthemes(sleep disturbance,fatigue,anxiety,fear,despair,concern about analgesic drug addiction,concern about opioid adverse effects,need for better understanding of breakthough cancer pain,need for guidance on how to cope with breakthough cancer pain).2.A review of the medical records of 59 primary lung cancer patients with flare-up pain revealed that36 had moderate pain,23 had severe pain,18 had pain duration of 0-14 min,32 had pain duration of 15-29 min,and 9 had pain duration greater than 30 min.The number of pains per day was within the range of 0～3times in 19 people,3～6 times in 29 people,and greater than 6 times in 11 people.The clinical measures for clinical lung cancer breakthough cancer pain were understood from five aspects: prevention,monitoring,assessment,treatment,and nursing measures to provide reference for breakthough cancer pain screening,assessment,judgment criteria for breakthough cancer pain in tertiary entries,and cognitive interventions,behavioral interventions,and continuity of care.3.After systematic literature analysis,two guidelines on cancer pain and two expert consensusesoubreakthroughluded to extract guideline opinions and expert recommendations on assessment,diagnosis,treatment,pharmacological management measures,non-pharmacological management measures,cognitive interventions,behavioral interventions,psychological interventions,and continuity of care for breakthough cancer pbreakthroughsupplement the secondary entries in the lung cancer breakthough cancer pain managembreakthroughxperience,symptom management strategies,effect evaluation)in the tertiary entries(screening,assessment,cognitive interventions,behavioral interventions,psychological interventions,continuity of care,management effects).4.After two rounds of expert correspondence,23 medical and nursing oncology specialists were included in the first round of respondents,and 21 nursing oncology specialists were included in the second round of respondents.The recall rate of all the questionnaires of the two rounds of expert correspondence reached 100%.The authority coefficients of experts in both rounds were 0.85 and 0.81.17 experts gave 10 valuable suggestions in the first round and 5 experts gave 3 valuable suggestions in the second round.The experts’ opinions in both rounds mainly focused on screening,assessment,cognitive intervention,behavioral intervention,psychological intervention,and continuity of care in the tertiary entries.5.Construction of management plan.The lung cancer breakthrough management program includes three parts: symptom experience,symptom management strategy,and management effect.Symptom experience includes screening and assessment.Symptom management strategies include cognitive interventions,behavioral interventions,psychological interventions,and continuity of care.Management effects include functional status and quality of life.6.Validation of the breakthrough management program for lung cancer.The sleep index score in the post-intervention control group(12.89±1.86)was higher than that in the post-intervention intervention group(6.94±2.30).After intervention,the number of pain attacks in the control group(2(1,3))was higher than that in the intervention group(1(1,2)).The percentage of satisfaction in the post-intervention intervention group(97.22%)was higher than the percentage of satisfaction in the post-intervention control group(77.14%).Conclusion1.Based on the symptom management theory,the breakthrougn management program for lung cancer was constructed through qualitative interview,medical record review,literature review,and expert correspondence,and its contents were specific and comprehensive,and the implementation process was scientific and standardized.2.Applying the constructed lung cancer breakthrough cancer pain management program to clinical practice can effectively reduce the number of lung cancer patients with breakthrough cancer pain,improve their sleep quality and increase patient satisfaction. |
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