| [Objective]Draw lessons from the domestic and foreign related research results,combined with the actual situation of clinical and social development in our country the status quo,to construct narrative therapy technology as the carrier of the breast cancer chemotherapy patients life significance feeling intervention plan,provide a bridge for clinical medical staff and patient communication,for clinical nursing staff to improve the patient’s psychological condition,improve the quality of life to provide helps for the intervention of the guidance.[Methods]1.Literature analysis:Based on the evidence-based system,we searched Chinese and English databases for articles on the intervention of cancer patients’ sense of life meaning and articles on the intervention of cancer patients by narrative therapy,and combined with the previous research results of the research team,we formed a draft of the intervention plan of breast cancer chemotherapy patients’ sense of life meaning.2.Structured interview:Using structured interview,clinical nurses and breast cancer chemotherapy patients were selected as research objects through intentional sampling,and the draft intervention plan was revised according to their opinions on the previous plan.3.Delphi consultation:Clinical nursing specialists,clinical therapists,and narrative nursing/psychological research specialists were selected to conduct specialist consultation,and the intervention plan was further revised based on the results of two rounds of Delphi specialist consultation.[Results]1.Literature analysis:(1)Literature analysis of life-meaning interventions in cancer patients:17 randomized controlled trials(3 in Chinese and 14 in English)on life-meaning interventions in cancer patients were included,including 3 study protocols.10 studies used meaningful intervention therapy,6 of which used individualized psychological intervention,and the remaining 4 studies used group psychological intervention.There were two literatures using life review therapy,one of which was WeChat-based life review intervention.The remaining five studies used advanced cancer patient assessment combined with graded needs care,acceptance and commitment therapy,death education programs,mindfulness-based cancer recovery,and Managing Cancer and Living Meaningfully(CALM),respectively.Most of the interventionists were psychotherapists,psychiatrists or social workers,and the frequency of the intervention was different.The duration of the intervention was usually 2-3 months after the inclusion of the study,and the duration of each intervention ranged from 15min to 2h.The follow-up time was mostly 3 and 6 months.Fourteen studies(excluding three protocols)showed improved or enhanced life meaning in cancer patients.(2)cancer patients with narrative therapy technique for intervention of literature analysis,finally into 17 of narrative essay about cancer patients nursing research,main is to use narrative nursing techniques to intervene in the psychological status and quality of life of cancer patients,the results show that using the narrative therapy can alleviate the negative mood of cancer patients,and relieve pain.Formulate a draft intervention plan based on the results of the evidence-based study and the research context.2.Structured interview:A total of 20 clinical nurses and 35 patients with breast cancer chemotherapy to participate in the structured interview,in view of the intervention form(increased health will push model and sharing of knowledge),the intervention in place(if in ward patients request and not constrained by the previously set workshop),frequency of intervention(pair intercropping adjustment,instead the first 40 to 60 min,the late 20-40 min,adjust according to the actual status of patients),evaluation time(mid increased intervention during the third round of chemo intervention effect evaluation)do the corresponding adjustment,In the part of intervention content,some auxiliary measures were added,such as pushing health knowledge on relevant information platform,teaching patients some ways to relax themselves,and adding disease-related propaganda and education work in the process of intervention.3.Delphi consultation:A total of 15 experts in related fields were consulted by expert consultation,with an expert authority coefficient of 0.895.According to the enquiry for the expert’s opinion,the following content was revised,will be limited as the research object,modified to breast cancer chemotherapy patients aged 18 to 60 and staging Ⅰ-Ⅲ period;Increased the frequency of intervention,from 6 to 7,and increased the intervention during the fourth chemotherapy;The evaluation index increased the compliance and satisfaction to evaluate its applicability and feasibility;In the part of evaluation time,the follow-up at 3 months after intervention was added to evaluate the long-term effect of the intervention.Intervention content was also adjusted.For example,therapeutic documents and external witnesses were added as adjuvant measures during the first,third and final chemotherapy,and some special cases were noted.[Conclusion]On the basis of evidence-based research,structured interview and expert consultation,this study preliminarily constructed the "Narrative Therapy Technology Based Intervention Program for the Sense of Life Meaning of Patients with Breast Cancer Chemotherapy".In the process of construction,the theoretical basis and framework are clarified to make the intervention plan scientific and rigorous.It provides reference and research basis for further clinical psychological intervention and reconstruction of breast cancer patients’ sense of life meaning. |
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