Research On Continuity Care Model Of Breast Cancer Patients With Fatigue

BackgroundBreast cancer is the most common female malignant tumor, its incidence has been first in female malignant tumors. With increasing levels of medical therapy, improving of cancer diagnosis and treatment, the mortality rate of cancer patients reduced, survival prolonged.The 2012 cancer treatment and survival statistics state that 5-year survival rate of women with breast cancer patients worldwide increased to 90%.Transformation of the medical model and extension of survival of cancer patients put forward a higher demand to the quality of life of cancer survivors.The chronic symptoms of cancer patients in long-term illness and treatment began to be payed attention.Cancer-related fatigue (Cancer-Related Fatigue, CRF) is the most common subjective feelings of cancer patients, cause debilitating lack of passion, likely involved, and can not be relieved by sleep.It’s reported by the American Cancer Comprehensive Network (The National Comprehensive Cancer Network, NCCN) that 70% to 100% of cancer patients experiencing fatigue.The CRF incidence rate of cancer patients on chemotherapy was 99%, and the CRF incidence of breast cancer patients in all cancer patients was highest.CRF occurs with a variety of factors, domestic and foreign researchers found that cancer and its treatment, chronic complications, socio-economic factors, psychological factors can affect the CRF.CRF is multifaceted impact, the impact on physical function in cancer patients is the most obvious,directly influence the patient’s activities of daily living.The side effects of cancer trent ment such as chemotherapy-induced nausea and vomiting, pain, muscle weakness can increase the CRF, resulting in impairing of physical function, may eventually lead to the discontinuity of cancer treatment program, affecting the survival of patients.For cancer survivors, CRF may be accompanied by a few months or a few years, damaged the patient’s family and social function and reduced the quality of life.Breast cancer treatment and rehabilitation is a long and continuous process, the patient’s discharge does not mean the end of the course, while CRF of breast cancer patients as the most affected,greatest harm,largest high probability occurrence symptoms, need attention.At domestic and abroad research for breast cancer patients with fatigue are mostly concentrated in clinical nursing interventions, while patients in the chemotherapy with shorter hospital stay, and effective nursing intervention after discharge can not be continued.Continuity of care model is an extension of the hospital care to home care patients mode, the content is an effective deal with health problems faced by patients after returning home,so that patient safety is transferred from the hospital to home.At present, China’s focus on continuity of care, such as hypertension, diabetes and other chronic diseases,some scholars explored the home care of cancer-related fatigue, but there is no formation of continuity care model for breast cancer patients with fatigue.for Liping et al in 2010 surveyed of China’s 778 hospitalized patients,the results showed that patients after discharged has high demand for home care continuity,especially for professional care technology,prevention of complications,the highest demand for psychological care,including women and the elderly eager to get more care.Nurses and community nurses should provide home care for patients. Chen Xudong et al take intervention on 70 breast cancer hospitalized patients with fatigue,found that the intervention can ease the patient’s CRF, enhance the patient’s self-efficacy.The interventions include questionnaire assessment, evidence-based care, emotional support and information,the establishment of self-care model,to develop individualized programs can be used to draw on continuity of care. Yaling et al take family intervention on 80 cases of breast cancer patients,through psychological intervention,dietary intervention,intervention activities and telephone supervision, CRF of patients in the intervention group to eliminated,quality of life improved.Zhao Jin et al take intervention on 64 cases breast cancer patients discharged from hospital,found that moderate-intensity aerobic exercise at home can delay CRF in breast cancer patients.Continuity of care model can ensure the continuity of nursing and treatment of patients with diseases,lead to positive health outcomes,reduce readmission rates and relapse rates,improve nurse-patient relationship,reasonable allocation of the use of medical resources,cause enormous economic and social benefits.In summary, CRF of breast cancer patients need to get the attention of the medical staff, but there is no systematic CRF continuity of care model.This study is designed to apply CRF incentive questionnaire to survey CRF incentive of breast cancer patients,and based on the founding take the interventions of CRF targeted continuity of care on breast cancer patients discharged, with a view to reduce the CRF of breast cancer patients, improving its quality of life.Purpose1. To investigate the characteristics of CRF and its influencing factors in breast cancer postoperation patients during chemotherapy.2. For breast cancer patients incentives of CRF to develop the system, feasible, continuity of care and individualized intervention programs, explore the effect of continuity of care model on CRF of discharged breast cancer and quality of life of patients,provide basis for quality care and eventually establishmen the CRF continuity of nursing intervention model for breast cancer patients.Method1. SubjectsConvenience sampling method adopted in this study, the target population for the Nanfang Hospital Breast Center, diagnosed as breast cancer patients,Inclusion criteria:①voluntary,conscious, have basic communication and understanding; ②treatment options for breast cancer surgery and adjuvant chemotherapy;③has CRF based on CRF scale on postoperative patients;④informed consent, are willing to accept with the implementation of this study.Exclusion criteria:①diagnosis of mental illness;②patients with disorders of communication and understanding;③combined with other cancer or other major diseases.According to the inclusion and exclusion criteria selected during January to may 2013 in Nanfang Hospital of Southern Medical University by pathological studies confirmed breast cancer patients with 80 cases, according to the admission time sequence number, according to the odd and even number will patients were divided into control group and intervention group,40 cases in each group.Respectively assess general information, CRF, CRF incentives, psychological status, upper-limb function, quality of life of the two groups of patients at the time of enrollment and after the intervention each 21 days patients return hospital assess CRF, psychological status, upper-limb function and after the end of the intervention assess the quality of life of the two groups of patients.2. Research Methods2.1 Research Process①Communicating with Nanfang Hospital Breast Surgery nurse, bachelor degree or above, nurse and titles and more nursing staff selected to participated in this study. On the content of this study were uniform interpretation and training.②According to inclusion and exclusion criteria, selected breast cancer patients confirmed by pathology in January to May 2013 during the Nanfang Hospital. Study group members to explain the process in detail research and to patients, after written informed consent entering the study stage.③According to the odd and even number will patients were divided into control group and intervention group,40 cases in each group, baseline balance were analyzed and compared to ensure the two groups were comparable.④ For the two groups of patients were in group of general information, cancer fatigue, cancer fatigue inducement, psychological status, suffering from upper limb function and quality of life assessment, intervention patients every 21 days return hospital chemotherapy, a cancer fatigue, mental status, suffering from upper limb function evaluation, intervention after the re assessment the quality of life of the patients in the two groups.2.2 Research2.2.1 Routine nursing careTwo groups of patients underwent routine responsibility system nursing and discharge guidance, including wound and drainage tube nursing, diet guidance, rest and exercise guidance, chemotherapy period diet instruction, psychological nursing, health education of CRF symptoms, causes and effective mitigation methods, regularly returned to hospital for treatment, affected side upper limb functional exercise guidance, PICC related matters needing attention. After discharge control group in accordance with the Department of routine follow-up method, by the Department to follow up the nurse a week from the hospital patients randomly selected 20% of the proportion of follow-up, the contents of the follow up for nursing job satisfaction.2.2.2 Continuity of carePatients in the intervention group for the first time since the day of discharge, in the control group received continuous nursing intervention. Specific methods are as follows:Patients were discharged, researchers and patients and their families to talk face to face, the time for 30 minutes, explain the discharge after continue nursing in specific ways and content. To patients free climbing exercise guidance and homemade finger rehabilitation manual. Church with members of the research group made the movement of finger climbing instruction sheet, and individualized guide the patients to exercise time, methods, intensity and the matters needing attention.After the patients were discharged from hospital mainly through network instruction (QQ group, micro channel), telephone follow-up individualized consultation for patients of continuity of care. Patients every 21 days returned to hospital for chemotherapy,1 times weekly telephone follow-up,3 times each chemotherapy treatment at home during the follow-up period, make telephone follow-up content framework:Weekly in the follow-up of patients with movement, rest, psychology, suffering from limb functional exercise, and related knowledge based on different focuses on content, the 1 week to focus on patients with chemotherapy related side effects; rest and movement of the patients with 2 weeks to adjust the focus; the psychological status of patients with the third week adjustment to help patients to establish rehabilitation confidence. Every time the telephone follow-up to content framework as the center, according to patients with specific information needs to provide guidance counseling patients record.Patients were discharged after continuous nursing contents include:(1) The guidance. Urge patients to adhere to aerobic exercise of moderate intensity. Including walking and climbing stairs and walking 30min/D, or climb the stairs 2-3 times daily,30min/D, patients according to adjust their own exercise intensity and duration. Weekly follow up patients exercise compliance, factors related to exercise compliance and give effective guidance. (2) Sleep guide. Weekly follow-up of patients with sleep, guiding the patients with sleep disorder note the bedtime hours to avoid strenuous physical exercise, only when you are sleepy didn’t go to, keep the wake-up time rules and other matters, the church patients every day adhere to practice 2-3 times deep breathing and relaxation training.(3) Limb functional exercise guidance. Patients were instructed to apply the instruction sheet posted in the contralateral arm straight fingertips highest point scale table of 100 cm position, clearing the wound before the wall, by bending the elbow by climbing over the wall to the elbows straight climbing to elevate the shoulders climb a wall,6 times/D,10 minutes each time. After clearing the wound of the positive runup and side climb high alternately. Will the record of each exercise in "my plan" bar, with the last comparison results, make each improved exercise program. Weekly follow-up of patients with limb function exercise compliance, help to find the reasons for poor exercise effect and adjust the training methods. (4) Psychological nursing. The psychological status of patients were followed up every week, psychological intervention regularly give patients psychological counseling, emotional support and distraction.2.3 Evaluation①General information questionnaire (age, marital status, education level, surgical approach, occupation, family income, medical methods, disease stage);② Revised Piper Fatigue Scale;③ Cancer -related fatigue factor questionnaire;④ Brief Profile Mood States;⑤ Upper limb functional exercise four indicators (anterior climb, climb lateral, anterior arm, lateral arm);⑥ Core Quality of Life Questionnaire;2.4 Statistical Methods① All the data entered was collected, using SPSS20.0 statistical software package for statistical analysis of data(test level α=0.05), sided P>0.05 was no significant difference in the bilateral P<0.05 was considered significant difference. Descriptive analysis and t test was used.②Descriptive analysis was used to analysis general information of study patients and cancer-related fatigue factor questionnaire survey results. Measurement data with the mean±standard deviation (x±S), count data is represented by frequency and percentage(%).③ Using t test to compare the fatigue score differences between the control group and intervention group before and after the intervention.④ Using t test to compare BPOMS score differences between the control group and intervention group before and after the intervention.⑤ Using t test to compare functional exercise intervention indicators differences between the control group and intervention group before and after the intervention.⑥ Using t test to compare the quality of life differences between the control group and intervention group before and after the intervention.ResultThe study included 80 cases, each group 40cases, no significant differences between the intervention group and the control group, genaral data of subjects includes age, marital status, education level, surgical approach, occupation, family income, health insurance, disease staging were balanced(P>0.05).1. Analysis of t-test analysis for CRF score, poms scale scores, functional training indicators, the European Quality of Life Questionnaire score between patients of the two groups before intervention were not statistically different (P> 0.05).2. The descriptive analysis concluded that CRF relevant factors include six factors:the treatment of side effects (61.2%), sleep disorders (58.8%), decreased self-care (57.5%), fear of anxiety (55%), fear therapeutic effect (53.8%), fear of economic costs (51.2%).3. The t-test analysis concluded that CRF scores of the two groups patients after a month, two months, three months, four months, five months, six months, seven months intervention were statistically significant (P<0.05).4.The t-test analysis concluded that the two groups of patients after the intervention a month, two months, three months, four months, five months, six months, seven months poms scale scores are statistics learn the difference (P<0.05).5. By t-test analysis concluded that the patients of two groups of the four upper limb functional exercise targets before the intervention,bits climb, climb lateral, anterior arm, lateral arm after one month, the climb anterior, lateral climb after 6 intervention months, climb after 7 interventions months, climbing lateral, anterior arm by statistical t-test analysis was no significant difference (P> 0.05),and after two months,three months, four months, five months intervention, the exercise of the four indicators (anterior climb, climb lateral, anterior arm, lateral arm) of functional exercise of patients of two groups, anterior arm, lateral arm of 6-month intervention, the lateral arm of 7-months after the intervention by statistical t-test analysis were statistically significant (P<0.05).6. The t-test analysis results, the European Cancer Quality of Life Questionnaire scores of two groups after the intervention were significantly different (P<0.05).Conclusion1.CRF relevant factors of breast cancer patients on chemotherapy major include side effects of treatment, sleep disorders, decreased self-care ability, anxiety and fear, fear of treatment effect, worried about the economic costs of the six factors.2. Breast cancer patients on chemotherapy showed moderate CRF and has been increasing over time.3. The implementation of continuing nursing care can effectively reduce chemotherapy in patients with breast cancer CRF, improve psychological status of patients with breast cancer, promote the postoperative breast cancer patients with upper limb function recovery, thus effectively improving the quality of life of patients with breast cancer.4. Through the effective assessment of patients with CRF inducement, individualized interventions, the use of telephone and QQ, followed Wexin new ways of implementing dynamic, established breast cancer patients CRF continuity intervention model.