| Objective Laryngeal carcinoma accounts for a large fraction of all head and neck cancer. Nursing for laryngectomy patients undergoing radiotherapy treatment is very complex, Conventional nursing have some limitations for these patients. This study aims to develop an evidence-based cluster based care for laryngectomy patients undergoing radiotherapy treatment. And then evaluate the effect of cluster based care strategy on quality of life, psychological status, toxicity, nutritional status during radiotherapy treatment. So as to provide evidence for the clinical practice.Methods After identifying a theme of care bundle and establishing a multidisciplinary support system. CBM, Cochrane Library, Pub Med, EMBASE, other databases in Chinese and English and related clinical practice guidelines were systematically searched, interventions will have high-quality evidence were included in the care bundle strategy. Then specific clinical cluster based care process was developed after preliminary experiment. Patients hospitalized from February 2015 to August 2015 in our hospital were included as conventional nursing group. Consistent patients hospitalized from August 2015 to February 2016 were included as care bundle group.There was no significant difference in gender, age, educational level, clinical stage, economic status and radiotherapy methods between the two groups. Forty-one patients in the cluster group were treated with cluster based care on the basis of routine nursing. The quality of life, depression and anxiety status, nutritional status, and side effects were evaluated on admission, treatment and after treatment by the quality of life scores sheet, anxiety and depression self-evaluation sheet. The difference between two groups were analyzed. All data were analysis in SPSS 21.0, P<0.05 was considered statistically difference.Results The cluster based care for laryngeal carcinoma includes six major areas:(1) Keeping the skin sanitation,(2) Sustained airway humidification,(3) Multi-Channel communication and education,(4) Maintain or rebuild the function,(5) Pain assessment and management,(6) Anxiety and depression assessment. The results of clinical controlled trials showed that, the quality of life of patients in the cluster based care group was significantly better than that of the routine care group at the end of radiotherapy(MD=11.2,95%CI(6.51-15.89), P<0.0001) and 3 months after radiotherapy(MD= 10.3,95% CI(5.39-15.21), P<0.0001). In cluster based care group, anxiety scores at the beginning of radiotherapy(MD=-3.71,95% CI(-7.24,-0.16), P=0.04) and radiotherapy interim(MD=-3.50,95%CI(-6.83,-0.17),P=0.04) scored significantly lower than the conventional care group; At the beginning of treatment, the score of depression scale of cluster based care group was significantly lower than that of conventional nursing group(MD=-4.30,95%CI(-7.94,-0.66), P=0.02). At the end of radiotherapy, nutritional score in cluster based care group was significantly higher than conventional care group(MD=2.10,95%CI(0.10,4.10), P=0.04). Compared with the conventional nursing group, the patients in the cluster based care group had fewer adverse reactions than those in the stage ?, the hospitalization time was slightly shortened and the radiotherapy compliance was high, but the difference was not statistically significant.Conclusions For laryngeal cancer patients with postoperative radiotherapy, the compliance of cluster based care strategy is good. The use of cluster based care can improve the quality of life of patients during radiotherapy, and can effectively alleviate the depression and anxiety and other negative emotions, and improve the nutritional status of patients during the end of radiotherapy. There is a tendency to reduce the moderate and severe complications, reduce the hospital stay and improve the compliance of radiotherapy. The cluster based care is worthy for further clinical research and application. |
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