Construction The Protocol For Facilitating Benefit Finding In Breast Cancer Patients Based On Guided Self-Disclosure

BackgroundBreast cancer is the most prevalent malignancy among women worldwide.However,the population of survivors is growing,psychological problems seriously affect the quality of life.Benefit finding,as one of the important research contents of positive psychology,could promote patients’ find the positive significance of diseases and promoting physical and psychological rehabilitation.However,there have been not yet any psychological intervention research specifically targeting the benefit finding with breast cancer in China.Overseas interventions are mostly group-based,with complex contents and need professional staff,which is not suitable for China’s clinical situation.In our previous study,we found self-disclosure is the mechanism of benefit finding,besides,it is an intervention method for promote psychology.Therefore,it is urgent to construct a intervention program for benefit finding in breast cancer patients based on the self-disclosure and the cultural background of our country.ObjectiveTo develop a protocol for promote the benefit finding of breast cancer patient with self-disclosure intervention,and to examine the feasibility and effectiveness of the intervention,provide a guidance to clinical nurses for improve patients’ psychological status.Methods1.Literature Analysis: The literatures on benefit finding and self-disclosure intervention in cancer patients were reviewed systematically and literature analyzed.Extracted the data according to the relevant items of the intervention,and analysis the content of the intervention to form the preliminary draft of the intervention protocol.2.Structured interview: Take the intentional sampling method,the researcher was interview the nurses and patients’ suggestions on the first draft of the protocol according to the interview outline,then modify the plan according to the interview results to revise the draft of the intervention.3.Expert meeting: A panel meeting including breast cancer clinical treatment experts,breast cancer clinical nursing experts,nursing experts,psychological experts,behavioral experts was organized.Send the meeting related materials by email one week in advance,advising experts on issues in intervention protocol.According to experts’ opinions,the study protocol was further revised.4.Pilot study: 30 participants from June to December 2018 were randomly divided into intervention group and control group according to computer generated random numbers.The intervention group used face-to-face self-disclosure intervention,and the control group received routine care.Feasibility evaluation indicators include qualification rate,recruitment rate,compliance and satisfaction.Effectiveness indicators include benefit discovery,self-disclosure,social support,optimism,cognitive evaluation,and coping style to test the feasibility and effectiveness of intervention,and finding the problems in the intervention process,to further adjust and improve the protocol,constructed the protocol finally.Results1.Literature analysis:(1)literature analysis of benefit finding intervention: There are included 9 RCT studies and 2 intervention protocol studies.Among them,there is only one research in China,called Chinese Medicine Five-Element Music,and 10 interventional studies abroad that include 6 studies of group cognitive stress management therapy,2 studies of yoga therapy,and the other are peer support intervention and mindfulness reduction.Group intervention is the main form of intervention.The interveners are psychotherapists or physiotherapists,the start intervening time mostly from 8 weeks after operation or 6 weeks after radiotherapy.The intervening frequency is 8 times,once a week,60-90 minutes once.The evaluation time was at baseline and 3,6,9 months.The main themes of intervention are cognitive reappraisal,stress management,emotional expression,peer support and relaxation techniques.However,the specific content is not detailed and needs to be further enriched.(2)Literature analysis of self-disclosure intervention: There are many studies on self-disclosure of cancer patients,mostly are foreign studies.There are three forms of self-disclosure that include written disclosure,supportive expression group and marital disclosure.Among them,writing disclosure is the main form,and there are specific disclosure paradigms with different themes.But most of them focus on the feelings and ideas of cancer experience.The results show that the psychological status of cancer patients can be partly improved.According to the results of literature analysis,the first draft of intervention protocol was formed.2.Structured interview: A total of 30 patients and 24 nurses were interviewed about the items of the first draft of the intervention protocol to revised the intervention protocol.The revised items include increase the frequency and the forms of protocol,emphasis on protective medicine,respect for patients and other ethical principles in the process of intervention,the content of intervention should based on disease knowledge education,attention to guide patients to disclose the feelings about social support,self-regulation and positive cases.3.Expert meeting: A total of 10 experts were included to improve the revised intervention protocol,improve the intervention according to the expert’s suggestion.The authoritative coefficient of the experts was 0.812.The content to be improved includes: the research design should be changed to randomized controlled trials,the intervention time should be at 6 times which contain before discharge,1,2,4,and 5 times chemotherapy and the last chemotherapy.The evaluation time is baseline,3,6 and 9 months after the baseline,the inclusion criteria for the pre-experiment.The intervention content needs to be refined,and related auxiliary interventions such as cognitive therapy should be added,and should pay attention to feedback of the patient’s disclosure during the intervention.4.Pilot study: A total of 30 breast cancer patients were recruited in the pilot study.There was no statistically significant difference in the general information and the scores of the scales before intervention between the two groups(P>0.05).The eligibility rate of patients was 58.75%,the recruitment rate was 63.83%,the exit rate was 33.33%,the high compliance rate was 66.67%,and the low compliance rate was 33.33%.There was significant difference in satisfaction between the two groups after intervention(P < 0.05).PP analysis and ITT analysis showed that the level of benefit finding in intervention group was significantly higher than that in control group(P < 0.05).ITT analysis showed that there were significant differences in the time main effect of those effective outcomes between patients(P< 0.05);there were significant differences in the benefit finding and the avoidance dimension of cognitive evaluation between groups(P< 0.05);there were differences in the time and intergroup interaction between the invasion dimension and the high arousal dimension of cognitive evaluation(P< 0.05);PP analysis showed that there was significant effect among the dimensions of coping style between groups(P< 0.05),and there was significant interaction between the dimensions of coping style(P < 0.05);there were no significant difference in other indicators(P> 0.05).The protocol is feasible and effective.But there are still some parts that need to be adjusted,including homework needs to be combined with the presentation outline,design specific guidelines,intervention time changed to pre-discharge,first,second,third,fourth and fifth pre-chemotherapy intervention.ConclusionBased on the previous research,this study is based on evidence,have a guidance of theory and methodology,through the steps of intervention analysis,based on literature analysis,combined with stakeholder recommendations and needs,through the expert meeting to further improve the intervention program,and carried out pilot study,construct a breast cancer patient benefit discovery intervention program in line with China’s cultural background finally,which is scientific,feasible and effective,and it provide a guidance for clinical nurses to implement psychological rehabilitation of breast cancer patients.Future research needs to further expand the sample to carry out clinical trials and the intervention program was applied to the clinic.