Effect Of Case Management On Improving Quality Of Life And Negative Emotion In Patients With Prostate Cancer Treated With Hormonal Therapy

ObjectiveTo explore the effect of case management on improving the quality of life and negative emotion of anxiety and depression in patients with prostate cancer treated with hormonal therapy.MethodThis was a quasi-experimental study.Using a cluster randomization method,90 patients with prostate cancer treated with hormonal therapy who met the inclusion and exclusion criteria from January to August of2018 in the urology department of a third-grade hospital in Hunan Province were randomly divided into the experimental group and the control group,each group had 45 patients(in the process of study,1 case died and 1 case dropped out in the experimental group,2 cases were lost to follow-up in the control group,finally each group had 43 patients),and the patients in the experimental group and the control group were divided into different wards.Patients in the control group received routine care and follow-up.Patients in the experimental group received 6 months of case management on the basis of routine care and follow-up.With the case manager as the core,the case management team intervened for the patients according to six steps about assessment,planning,implementation,coordination,supervision and evaluation.The main contents had hospital management and out-of-hospital management,involvingsymptoms,diet,bone health,drugs,psychology,follow-up,home and referral management.The EORTC QLQ-PR55(Chinese version)scale was used to evaluate the patient's quality of life,and the anxiety and depression self-rating scale were used to evaluate the patient's negative emotion.All datas were analyzed by SPSS 25.0 statistical software.The statistical description of the count data was expressed by the number of cases and the percentage,and the chi-square test was used for comparison between groups.The statistical description of the measurement data was expressed by the mean ± standard deviation.For the comparison of the two groups' averages,the two independent sample t-tests were used for that obey the normal distribution and homogeneity of the variance,and the approximate t-test was used for the uneven variance.Paired t-test was used before and after intervention in the groups.The data of the two groups that did not obey the normal distribution were compared using the rank sum test.P?0.05 was statistically significant.Results1.There was no significant difference between the two groups in general data(age,occupation,culture,medical insurance,marriage,family economy,family caregivers,contact number,place of residence,complications,duration of treatment upon admission,whether the patients were transferred,etc.),the quality of life,anxiety and depression before intervention(P >0.05),which was comparable.2.The scores of the evaluation indexes of quality of life and anxiety and negative emotions before and after intervention were compared between the experimental group and the control group.In the experimental group,the scores of body,role,mood,cognition,social function and total health quality in the quality of life of the experimental group were higher than those before intervention.The scores of pain,fatigue,insomnia,constipation,diarrhea,urinary symptoms and intestinal symptoms were lower than before the intervention.The scores of anxiety and depression were lower than those before the intervention,and the difference was statistically significant(P<0.05).In the control group,the scores of physical function and total health quality in the quality of life of were higher than those before the intervention.The scores of fatigue,urinary symptoms and intestinal symptoms were lower than before the intervention,and the anxiety score was lower than before the intervention.The difference was statistically significant(P<0.05).3.After 6 months of intervention,the differences in scores between the quality of life and the negative emotion of anxiety and depression were compared between the experimental group and the control group.The greater the score,the more obvious of the improvement effect.3.1 Comparison of quality of life between the two groups:The difference between the scores of the body function of the experimental group and the control group was(10.23±12.96 vs 5.12±8.95),the scoredifference of the role function was(6.98±16.76 vs 1.55±9.49),the score difference of the emotional was(17.44±16.14 vs 0.39±9.44),the score difference of the social function was(15.11±17.75 vs 2.33±11.83),the score difference of the total health quality was(23.45±20.27 vs3.49±9.49),the score difference of pain was(-12.40±18.58 vs-3.88±12.51),the score difference of fatigue was(-11.89±14.43 vs-4.39±12.63),the score difference of insomnia was(-16.28±23.43 vs-4.65±29.62),the score difference of diarrhea was(-6.20±15.01 vs0.78±8.87),the score difference of urinary symptoms was(-10.25±10.50vs-3.88±5.54),and the score difference in the experimental group was higher than that in the control group.The difference was statistically significant(P<0.05).3.2 Comparison of negative emotion of anxiety and depression between the two groups:The statistical results showed that the score difference of anxiety between the experimental group and the control group was(-9.30±7.80 vs-3.63±4.80),the score difference of depression was(-9.63±8.71vs-1.19±3.94).and the score difference in the experimental group was higher than that in the control group.The difference was statistically significant(P<0.05).Conclusion1.Case management can effectively improve the quality of life of patients with prostate cancer treated with hormonal therapy.2.Case management can effectively improve the negative emotion of anxiety and depression in patients with prostate cancer treated with hormonal therapy.