| Objectives1.To explore the dilemma of self-nutrition management in elderly patients with gastric cancer comorbid diabetes mellitus with mild malnutrition.2.To Take the elderly patients with gastric cancer comorbid diabetes mellitus with mild malnutrition as the intervention object,and construct the intervention program.3.To explore the effect of intervention on nutritional status,quality of life,BMI and biochemical indexes in elderly patients with gastric cancer comorbid diabetes mellitus with mild malnutrition.MethodsThere is three parts in this study:1.The first part is a qualitative study on the dilemma of self-nutrition management in elderly gastric cancer comorbid diabetic patients with mild malnutrition.Eleven elderly patients with gastric cancer comorbid diabetes mellitus with mild malnutrition chemotherapy were selected according to the inclusion and exclusion criteria,and the theme analysis method was used to understand the plight of self-nutrition management of these patients,so as to provide a basis for the formulation of self-nutrition management intervention program..2.The second part is that self-nutrition management programwas constructed.Under the guidance of literature review,theoretical basis and previous research,based on the survey results to form the first draft of the intervention plan,further carry out the expert group meeting,select 5 patients who meet the inclusion and exclusion criteria for pre-test,and finally form the test draft.3.The third part is to evaluate the effect of self-nutrition management program.A total of 70 patients who met the inclusion and exclusion criteria in the first and third disease areas of the Department of Gastroenterology of Henan Oncology Hospital were selected to carry out similar experimental studies.The intervention group and the control group were carried out at the same time,the control group was given routine nursing in the department of oncology,and the intervention group was given nursing care of self-nutrition management program on the basis of the control group.The European Cancer Research and treatment Organization quality of Life scale((European Organisation for Research and Treatment of Cancer QLQ-C30,EORTC QLQ-C30),subjective holistic assessment(Patient-Generated Subjective Global Assessment,PG-SGA),BMI and biochemical indexes were used to evaluate the changes of quality of life,nutritional status,albumin concentration,total protein concentration and glucose level before and after intervention.Repeated measurement analysis of variance was used to compare the differences between the two groups before intervention,immediately after intervention,1 month after intervention and 3months after intervention.Result1.According to the results of qualitative research,there are three themes: theme1: the obstacles related to medical staff are manifested in the lack of nutrition knowledge and the frequency of nutrition education among junior nurses,and theme 2:obstacles related to patients.it is shown in the lack of nutrition knowledge,difficulties in obtaining nutrition knowledge,incorrect nutrition attitude and incomplete nutrition monitoring methods.Theme 3: the obstacles related to social support are manifested in economic difficulties and external information interference.This part mainly provides the main content of nutrition management knowledge education for the formulation of intervention programs.2.According to the results of qualitative research,there were four themes: theme one was that patients were lacked of awareness of nutritional support and nutrition knowledge,such as food glycemic index,poor knowledge of nutrition knowledge,unreasonable diet structure,etc.Theme two was that gastric cancer had improper dietary transformation behaviors;theme there was that patients hoped to get the guidance of individualized diet;Theme four was that patients hoped to get continuous nutritional guidance from medical staff,which was reflected in the way and content of patients' out-of-hospital dietary guidance.This part mainly provides the main contented of nutrition education for the intervention program and determined the necessity of formulating personalized recipes to guide elderly patients with gastric cancer comorbid diabetes.3.There were 70 subjects participant included,including 9 cases of sample lost,and the loss rate was 12.86%.The effective samples were 61 cases,including 31 cases of intervention group and 30 cases of control group.The main results were as follows:(1)the average score of overall quality of life of patients in the intervention group increased from(48.12±15.77)to(57.80 ±12.53).The scores of 5 functional areas and 3 symptom areas in the intervention group were significantly different in inter-group effect,intra-group effect and interaction effect(P< 0.05),while in 6 single dimensions,there were significant differences in inter-group effect,intra-group effect and interaction effect(P< 0.05).Except for insomnia and constipation,there was no significant difference in the effect between groups(P> 0.05),but there were significant differences in the scores of inter-group effect,intra-group effect and interaction effect(P< 0.05).(2)The average score of PG-SGA decreased from 2.42g/L to 1.35g/L,the average score of albumin concentration increased from 40.22g/L to 46.65g/L,and the average score of total protein concentration increased from 66.75g/L to 68.6g/L,respectively,while the average score of albumin concentration increased from 40.22g/L to46.65g/L,and the average score of total protein concentration increased from66.75g/L to 68.6g/L,respectively.The average score of glucose decreased from(14.22±5.16)mmol/L to(8.18±3.00)mmol/L,BMI and increased from(22.03±3.04)to(24.17±4.15)before intervention.Compared with the control group,the PG-SGA score and biochemical indexes of the intervention group were significantly decreased or improved(P< 0.05).ConclusionSelf-nutrition management combined with personalized diet guidance intervention measures for elderly patients with gastric cancer comorbid diabetes mellitus with mild malnutrition could improve their quality of life,nutritional status and laboratory examination results. |
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