Intervention Of Narrative Nursing Onhair Loss,Distress,Stigma And Quality Of Life In Breast Cancer Chemotherapy Patients

Objective:1.Through the interview with patients with hair loss induced by breast cancer chemotherapy,we deeply understand the real psychological experience of hair loss,discuss the psychological impact of chemotherapy-induced hair loss on psychology and the needs of psychological intervention,so as to prepare for the subsequent intervention research.2.Apply narrative nursing practice mode to intervene in breast cancer chemotherapy patients,and explore the intervention effect of narrative nursing practice mode on hair loss,psychological pain,stigma and quality of life of breast cancer chemotherapy patients.Methods:1.Using purpose sampling method,from March 2020 to June in a level 3 first-class hospital in Shandong province conform to the inclusion and exclusion criteria of 15 breast cancer chemotherapy patients(sample size to achieve saturation)face to face half structured interview,interview the record and recording data,after repeated listening,transcription,for written words.Data analysis used Colaizzi’s 7-step analysis and Nvivo12 qualitative analysis software to code,summarize and refine the theme.2.Using convenient sampling method,selected from July 2020 to December 2021 in Shandong province,a tertiary hospital oncology department of 88 female breast cancer chemotherapy patients,to reduce the group interference,from July 2020 to February 2021 patients included in the control group,patients included in March 2021 to December 2021,a total of 3 cases fall off.The control group(n=42)received routine care for chemotherapy for breast cancer,The experimental group(n=43)conducted narrative nursing practice on the basis of routine nursing,Narrative nursing practice includes researchers’ training of narrative ability,narrative environment layout and application of narrative nursing,On the day of the second chemotherapy(before the intervention),the day of the fourth chemotherapy(after the intervention),and three months after the intervention,a psychological distress thermometer(Distress Thermometer,DT),Chemotherapy induced Alopecia Distress Scale(Chemotherapy induced Alopecia Distress Scale CADS),Social Impact Scale(Social Impact Scale,SIS),Cancer Functional Treatment Evaluation System-Breast Cancer Quality of Life Assessment Scale(Functional Assessment of Cancer Therapy-Breast Quality of Life Instrument,FACT-B)in the two groups.Data were statistically analyzed using SPSS25.0 software,using descriptive statistics,independent sample t-test,chi-square test,two-sided test level α=0.05,P<0.05 was considered statistically significant.Results:1.The inductive analysis of the collected data revealed three themes:hair loss aggravates psychological distress;hair loss enhances stigma;the desire for psychological intervention,especially during the second chemotherapy to the fourth chemotherapy.2.Intervention effect of narrative nursing practice mode on hair loss,psychological pain,stigma and quality of life in breast cancer chemotherapy patients:(1)Intervention effect of narrative nursing practice mode on hair loss in patients with breast cancer chemotherapy:The total CADS scores and dimensions in the two groups(P>0.05).After the intervention,the CADS total score and emotional dimension and relationship dimensions between the two groups were statistically significant(P<0.05),with no significant difference in physiological and daily activity dimensions(P>0.05).Three months after the intervention,the CADS total scores and emotional dimensions,daily activity dimensions,and relationship dimensions between the two groups were statistically significant(P<0.05),but not in physiological dimensions(P>0.05).(2)Intervention effect of narrative nursing practice model on psychological distress in patients with breast cancer:There was no significant difference in DT scores between the two groups before the intervention(P>0.05).After the intervention and three months after the intervention(P<0.05).(3)Intervention effect of narrative nursing practice model on stigma in patients with chemotherapy-induced hair loss in breast cancer:There were no significant difference in the total SIS scores and the dimensions(P>0.05).After the intervention,the differences in total SIS scores and scores in the social isolation,social exclusion,and intrinsic factor dimensions were significant(P<0.05),and not in the economic discrimination dimension(P>0.05).Three months after the intervention,the total SIS scores and the dimensions were statistically significant(P<0.05).(4)Intervention effect of narrative nursing practice model on quality of life of patients with breast cancer:No difference in total FACT-B scores or dimensions was significant(P>0.05).After the intervention,the total FACT-B scores in affective,functional and breast dimensions were significant(P<0.05),and no difference in physiological and social/family dimensions(P>0.05).Three months after the intervention,the total FACT-B scores between the two groups(P<0.05),and no differences in physiological,social/family,and functional dimensions(P>0.05).Conclusions:1.Clinical personnel need to strengthen their psychological attention to CIA patients,help patients get more social support,and actively explore individualized psychological intervention programs to reduce psychological pain,reduce the burden of stigma,and improve the quality of life.2.Narrative nursing practice mode can reduce the hair loss,psychological pain and stigma level of breast cancer chemotherapy patients,improve the quality of life of patients,and have a good long-term impact,which is worth further promotion and application in clinical practice.