Construction And Application Of Peri-radiotherapy Self-management Program For Nasopharyngeal Carcinoma Patients With Simultaneous Radiotherapy And Chemotherapy Based On HAPA Theory

ObjectiveBased on the theory of health action process approach(HAPA),this study constructed a self-management plan for patients with nasopharyngeal carcinoma(NPC)during peri-radiotherapy and chemotherapy,and explored the effects of this scheme on disease knowledge and belief,quality of life and self-management ability of patients with NPC,so as to provide theoretical basis for self-management and continuous nursing of NPC patients during peri-radiotherapy and chemotherapy.Methods1Construction of intervention program.(1)Literature review:Search for and understand the current situation of simultaneous radiotherapy and chemotherapy for nasopharyngeal carcinoma at home and abroad and the progress in the application of HAPA theory.(2)Semi-structured interview:A semi-structured interview was conducted on nasopharyngeal carcinoma patients with simultaneous radiotherapy and chemotherapy in the Department of Oncology and radiotherapy of a Grade 3A Hospital in Qingdao in April2022.The topic of the interview was extracted,and the self-management scheme of patients with nasopharyngeal carcinoma during peri-radiotherapy and chemotherapy based on HAPA theory was constructed.(3)Delphi expert letter inquiry:On the basis of literature review and semi-structured interview,combined with relevant national norms and guidelines,17experts in the field of oncology were consulted by Delphi method for 2 rounds to determine the self-management plan of nasopharyngeal carcinoma patients during peri-radiotherapy and chemotherapy.2Application of intervention programs:(1)Sample selection:A total of 112 patients with nasopharyngeal carcinoma were selected from the Department of Oncology and radiotherapy of a Grade 3A Hospital in Qingdao since July 2022.The patients collected from July to September in 2022 were used as the control group,and the patients collected from November 2022 to January2023 as the experimental group.(2)Informed consent:All participants signed informed consent form and self-management commitment form,and were instructed by professionals to fill in the questionnaire,including cancer self-management assessment scale,head and neck tumor quality of life scale,RTOG radiation injury scale.(3)Collect relevant data:General data:Such as gender,marital status,smoking history,education level and chronic medical history.Nutritional indicators:Such as hemoglobin(Hb),albumin(ALB),body mass index(BMI),triceps skinfold thickness(TSF).(4)Intervention measures:The control group adopted routine nursing measures,including admission education,collective education,issuing instruction manual and record book on the day of discharge,discharge guidance,online or outpatient follow-up on time after discharge,and examination of patient management,while the intervention group adopted nursing intervention measures based on HAPA theory.(5)Statistical analysis:EXCEL2010 was used to establish the database of all data,and SPSS 23.0 was used to analyze the data.χ~2 test was used to compare the counting data.The measurement data are compared by independent t-test,and if the data are non-normal distribution,rank sum test is carried out.Repeated measurement analysis of variance was used for comparison before and after intervention.There was significant difference inα=0.05(P<0.05).Result:1Construction of intervention program.The main results are as follows(1)Literature review:Through literature retrieval,10 articles were obtained(4 in English and 6 in Chinese).(2)Semi-structured interview:A total of 12 patients were included in a semi-structured interview,and the topic was extracted and the scheme was constructed according to the interview content.The intervention program was initially identified as 3first-level items,10 second-level items and 14 third-level items.(3)Expert letter inquiry:A total of 17 questionnaires were sent out by the first round of expert letters,17 valid questionnaires were recovered,and 17 valid questionnaires were collected in the second round.After calculation,the authority coefficients of the two rounds of experts are 0.79,0.78 respectively,and the results of letter inquiries are reliable,while the Kendall’s W coefficients of the two rounds of expert letters are 0.432 and 0.453 respectively,which proves that the opinions of experts are consistent.The final draft of the intervention plan consists of 3 first-level items,10second-level items and 17 third-level items.2Application of the intervention program112 patients were included in the plan,4 fell off,and the total drop-out rate was3.57%.A total of 108 patients were actually included,including 54 in the control group and 54 in the experimental group.there was no significant difference in baseline data between the two groups(P>0.05).It’s comparable.The incidence of complications of radiotherapy and chemotherapy in the intervention group was significantly lower than that in the control group from the third week of radiotherapy,the 6th week of radiotherapy,third weeks after radiotherapy and third months after radiotherapy.The difference was statistically significant(P<0.05).The results of cancer self-management scale showed that the intervention group was higher than the control group,while the results of head and neck tumor quality of life scale and RTOG radiation injury scale in the intervention group were lower than the control group(P<0.05).ConclusionBased on HAPA theory,the self-management program of nasopharyngeal carcinoma patients undergoing simultaneous radiotherapy and chemotherapy has good reliability and validity,and can reduce the side effects of radiotherapy and chemotherapy,improve disease knowledge,develop self-care ability,and provide reference for further improving the self-management ability of nasopharyngeal carcinoma patients undergoing radiotherapy and chemotherapy.