| Background In recent years,the incidence of thyroid cancer has shown a rapid upward trend.The patients with thyroid cancer must undergo endocrine therapy for life after operation to supplement thyroxine.It also plays an important role in inhibiting the recurrence and metastasis of differentiated thyroid cancer.Domestic and foreign studies have shown that drug non-compliance behaviors such as forgetting to take,missing to take,self-medication reduction and withdrawal are common in patients with thyroid cancer after endocrine therapy.Their compliance is only 45.3%~78.5%.With the prolongation of time,the compliance will gradually decrease.At present,health services for thyroid cancer patients in China mainly focus on hospitalization.There is a lack of effective supervision and timely communication between clinical staff in the process of home treatment,which makes it difficult to guarantee the efficacy and safety of treatment.Mobile health technology breaks the time and space constraints,reduces the economic burden,can also assist medical treatment,improve the health status of patients at home,and shows great potential for development in the management of chronic disease patients at home.Therefore,it is particularly important to explore how to conduct long-term individualized follow-up of patients with endocrine treatment of postoperative thyroid carcinoma under this new service mode to improve their compliance,health indicators and ultimate health outcomes.Objective To construct an intervention program based on mobile health for patients with thyroid cancer after endocrine therapy compliance and evaluate the application effect of this program,in order to provide experience and reference for long-term management of patients with endocrine treatment of postoperative thyroid carcinoma.Methods Through the longitudinal study to explore the changing regularity of the needs of postoperative patients with thyroid cancer treated with endocrine therapy;Delphi method was used to construct a compliance intervention program for patients with thyroid cancer after surgery based on mobile health;randomized controlled trials were used to verify the effectiveness of the program.1.Based on the principle of the greatest difference in age,marital status,educational level and pathological type,16 patients with differentiated thyroid cancer who met the inclusion criteria from July 2017 to September 2017 from two tertiary hospitals in Xinxiang were selected as subjects.A self-made electronic diary was used to investigate the two treatment cycles(60 days).The frequency of each requirement was used as a time function to draw a time series diagram to explore the longitudinal law of the needs of patients with thyroid cancer after endocrine therapy.2.Based on literature review,longitudinal needs survey and the preliminary draft of expert meeting construction scheme,Delphi method was used to conduct two rounds of expert consultation,which was carried out by sending paper questionnaire or e-mail directly.According to the results of the inquiry,the final version of the intervention program based on mobile health was revised.3.From March 2018 to July 2018,96 patients with differentiated thyroid cancer treated by endocrine therapy after operation in two third-level hospitals of Xinxiang City were selected as subjects.The samples were randomly divided into two groups: experimental group(n=48),control group(n=48).The control group received routine discharge education and follow-up.On the basis of this,the experimental group was treated with a mobile healthbased intervention plan for mobile health intervention.The intervention lasted for two treatment cycles(60 days).The difference of knowledge level,belief,compliance and TSH level between the two groups was evaluated after the intervention.Results 1.Longitudinal regularity of demand occurrence in patients with thyroid cancer undergoing endocrine therapy after operation:4 categories of perceived needs were summarized,including 14 themes and 53 sub-themes.In the different time of endocrine therapy cycle,the frequency of each subject is different,and the demand indicators have different changing rules. 2.Intervention schemes based on the compliance of endocrine therapy after operation for thyroid cancer patients with mobile health:(1)Intervention mode: APP service technology in mobile health;(2)Intervention characteristics: continuous individualized comprehensive intervention based on mobile health needs,multi-professional team cooperation;(3)Nursing dose: demand-oriented intervention content given by time node,1-2 pieces of information per day,24 hours online communication with patients,lasted for 2 treatment cycles(60 days).Mobile health management platform includes data acquisition module,intervention module,reminder module,doctor-patient communication module,monitoring and evaluation module to manage patient symptoms and compliance behavior..Evaluation of intervention effect: Before intervention,there was no significant difference in general data,knowledge level of endocrine therapy,belief score between the two groups(P>0.05).After two treatment cycles of intervention,the level of endocrine therapy related knowledge in the experimental group was significantly improved compared with that before intervention,and the difference was statistically significant(P<0.05).The total score of belief in endocrine therapy in the experimental group was significantly higher than that before intervention(P<0.05).The scores of necessity belief dimension in both groups were significantly higher than before,and the difference was statistically significant(P<0.05).There was no significant difference in the scores of the dimension of anxiety belief between the experimental group and before intervention.(P>0.05).In the control group,the scores of anxiety belief dimension were significantly higher than those before intervention(P<0.05).Compared with the control group,the level of knowledge related to endocrine therapy,the total score of medication belief and the dimension score of necessity belief in the experimental group were significantly better than those in the control group,and the difference was statistically significant(P<0.05).The compliance of endocrine therapy and the rate of reaching the standard of TSH level in the experimental group were higher than those in the control group,and the difference was statistically significant(P<0.05).Conclusions 1.During the period of endocrine therapy after thyroid cancer surgery,patients' needs show a longitudinal development law,which should be followed by targeted nursing intervention to meet patients' needs and improve patients' compliance. 2.Based on Delphi method,we constructed an endocrine therapy compliance intervention program for patients with thyroid cancer after operation,which is guided by patients' needs and emphasizes multidisciplinary teamwork,scientific and reliable. 3.The intervention program based on mobile health for patients with thyroid cancer after endocrine therapy compliance can improve patients' knowledge of endocrine therapy,medication belief level,and then improve patients' compliance and TSH compliance rate. |
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