Current Situation Of Supportive Care Needs In Patients With Rectal Cancer After Sphincter-preserving Surgery And Preliminary Study Of Health Education Under The Rain Classroom Platform

Objective:1.To investigate the current status and influencing factors of supportive care needs among discharged patients with rectal cancer after sphincter-preserving surgery,and to provid reference for nurses to provide targeted health education for discharged patients with rectal cancer after sphincter-preserving surgery.2.To explore the influence of health education based on rain classroom on the compliance of bowel training,bowel function and quality of life of bowel incontinence discharged patients with rectal cancer after sphincter-preserving surgery.Methods:Part one:By cross-sectional design and convenient sampling method,a questionnaire survey was carried out on the discharged patients with rectal cancer after sphincter-preserving surgery in a third grade hospital in a province in 6-12 months 2018.The questionnaire consisted of the general information,Low Anterior Resection Syndrome Scale(LARSS),and Supportive Care Need Survey short form(SCNS-SF34).Part two:A total of 70 patients with rectal cancer after sphincter-preserving surgery in a third grade hospital in a province in 1-8 months 2019 were selected as the research object,and were randomly divided into an intervention group and a control group,with 35 cases in each group.Control group: regular telephone follow-up and guidance within 6 months after discharge.Intervention group: Health education is carried out through the rain classroom platform on the basis of regular telephone follow-up and guidance.?According to the functions of rain classroom real-time feedback and announcement reminder,according to the characteristics of each module of the rain classroom platform,combined with the demand for health information of discharged patients discharged from rectal cancer anus preserving surgery,determine the content of health education,and add voice,video and answer questions with PPT to Health education and effect evaluation.?One day before discharge: explain to the patient in detail the operation methods related to the rain class,guide and encourage them to complete the PPT study by themselves.?On the day of discharge: Check the patient's learning feedback and perform intensive guidance and answering questions as necessary to ensure that he has mastered the relevant operations,and at the same time inform the intensive review plan within 15 days after discharge and the daily exercise plan within 6 months.?After discharge: Days 1,2,4,7,and 15: Adopt announcement reminders,view learning,and answer feedback to achieve regular reminders,real-time supervision,and effect evaluation,and at the same time supplement phone reminders to communicate with patients in a timely manner Constantly modify and improve the PPT.Within 16 days to 6 months: Change to remind once a week to urge patients to exercise daily.At 1 and 6 months after the intervention,LARSS,defecation training compliance scale,and stool incontinence quality of life questionnaire(FIQL)were used to understand the LARS degree,defecation training compliance,and FIQL scores of the two groups.Results:Part one:1.98 questionnaires out of a total of 100 questionnaires were retrieved effectively with a recovery rate of 98%.2.The scores of SCNS-SF34 of the survey subjects from high to low are health information,psychology,care and support,physiology and daily life,sexual needs.Each item has a score from high to low.6 of the first 10 items belong to the health information dimension and 4 items belong to the psychological dimension.The item with the highest demand is the health information dimension "can be informed that the cancer has been controlled or alleviated".3.Stepwise regression analysis,age,education level,and LARS level are the main influencing factors of supportive care needs of discharged patients with rectal cancer after sphincter-preserving surgery(P <0.05).Part two:1.There was no significant difference in baseline data of the two groups(P >0.05).2.Comparison of compliance in defecation training: After two independent sample t tests,the difference in total scores of compliance in defecation functional training and diseaserelated knowledge and rehabilitation training skills dimensions of the two groups of patients was statistically significant(P <0.05).There was no statistically significant difference between the scores of the self-care ability dimension and the good habits dimension(P >0.05);the total score of compliance with defecation training and the difference in scores of all dimensions were statistically significant(P <0.05)at 6 months after discharge.By paired sample t test,the total scores of defecation function training and the scores of all dimensions in the two groups of patients were statistically significant at 1and 6 months after discharge(P <0.05).3.Comparison of incidence and score of LARS: The total incidence of LARS at 1 and 6months after discharge in the two groups was 87.9% and 48.5%.After two independent sample t tests,there was no statistically significant difference in the LARS score 1 month after discharge between the two groups(P >0.05),and there was a statistically significant difference in LARS score 6 months after discharge(P <0.05).By paired sample t test,the difference in LARS scores between the two groups of patients was statistically significant at 1 and 6 months after discharge(P <0.05).4.Comparison of quality of life for fecal incontinence: After two independent sample t tests,there was no statistically significant difference in the total scores of quality of life and various dimensions of stool incontinence 1 month after discharge from the two groups (P >0.05),and the difference in total scores of quality of life and various dimensions of 6months after discharge all have statistical significance(P <0.05);By paired sample t test,the difference in total quality of life in incontinence and scores in all dimensions between the two groups of patients at 1 and 6 months after discharge was statistically significant(P<0.05).5.Six months after discharge,defecation training compliance score was negatively correlated with LARS score(r =-0.438,P <0.01),defecation training compliance score was positively correlated with stool incontinence quality of life score(r = 0.726,P < 0.01);The stool incontinence quality of life score was negatively correlated with the LARS score at 1 and 6 months after discharge(r =-0.366,r =-0.607,P <0.01).Conclusion:1.The patients with rectal cancer after sphincter-preserving surgery have unsatisfied health information,psychology,care and support,physiology and daily life,and sexual needs.Among them,the unsatisfied health information needs are the most significant.2.Age,Education level,and LARS level are the main factors that affect the need for supportive care for discharged patients rectal cancer after sphincter-preserving surgery.2.3.Rain classroom real-time feedback,PPT added audio and video and other functions have a positive effect on the implementation of health education for patients with rectal cancer after sphincter-preserving surgery.4.Health education based on the rain classroom helps improve the compliance of bowel function training and the quality of life of bowel incontinence discharged patients with rectal cancer after sphincter-preserving surgery,and accelerate the recovery of bowel function.