Construction And Application Of Discharge Plan For Patients With Primary Liver Cancer Resection Based On Health Action Process Approach Model

BackgroundPrimary liver cancer is a common clinical malignant tumor,and surgical resection is the primary treatment for long-term survival of patients.However,liver cancer surgery has more catheters and a high incidence of moderate and severe postoperative pain.Patients’ intention to adopt early rehabilitation behavior needs to be strengthened,and their readiness for hospital discharge is below the average.At the same time,patients with liver cancer are often complicated with other chronic liver diseases,such as viral hepatitis and fatty liver,which are closely related to their lack of self-management ability of health behavior.The existing research in China pays little attention to the self-efficacy of health management of patients with liver cancer,and the domestic discharge planning lacks scientific and single-disease specialization.Besides,discharge planning for patients with primary liver cancer undergoing surgery remains to be explored.Objectives1.To construct a systematic discharge planning for patients with liver cancer resection based on Health Action Process Approach model which focuses on the self-efficacy of health behavior management,and provide intervention reference for the promotion of discharge planning in liver cancer wards.2.To Implement this intervention and examine its effects on liver cancer surgical patients’ readiness for hospital discharge,self-efficacy,postoperative recovery indicators,quality of discharge teaching,quality of life,liver cancer patient specific symptom modules,the specific symptom module,and unplanned healthcare resource use 1 month after discharge.Methods1.Exploration of discharge readiness and transition experience for patients with primary liver cancerAn explanatory sequential mixed research method combining quantitative and qualitative methods was used.In the first stage,quantitative data was collected,and in the second stage,qualitative research was constructed according to quantitative results and research objectives.①170 Primary liver cancer patients from one hospital in Guangzhou were selected by convenience sampling method.The preliminary investigation was conducted by using self-made demographic information table and the Readiness for Hospital Discharge scale.②A semi-structured interview method was used to select 11 patients with primary liver cancer surgery who were rated as low readiness for hospital discharge by questionnaire survey.The interview outline was jointly formulated by the research group according to cross-sectional survey results and the research purpose.2.Construction and application of discharge planning for patients with primary liver cancer resectionThe Delphi method was used to determine the discharge planning for patients with primary liver cancer resection through two rounds of expert consultation,and a total of 23 experts from 14 hospitals in 4 provinces in China were included.Then a hierarchical structure model was constructed.3.Clinical implementation of discharge planning for patients with primary liver cancerA randomized controlled open trial design was used,and the patients were randomly divided into control group and intervention group.The control group received routine hospital care,while the intervention group carried out the discharge planning constructed in this study on the basis of the control group.The follow-up was conducted one month after discharging.The effectiveness of the protocol was evaluated using the readiness for discharge,quality of discharge teaching,postoperative recovery indicators,self-management efficacy,liver cancer quality of life,and liver cancer specific symptom module scale.Results1.The score of RHDS was(147.76±88.79),which was at a low level.Among them,the scores of personal status subscale and knowledge subscale were lower than the critical value of 7;3 themes(risk perception of unhealthy behaviors;rehabilitation knowledge and behavior status;continuous rehabilitation needs)and 8 sub-themes were extracted from the semi-structured interviews.2.The authority coefficients of two rounds of expert consultation were 0.805 and 0.810,respectively;the Kendall’s coefficients of concordance W were 0.139,0.100 and 0.087 in round 2(P<0.05).The consistency ratio CR of each judgment matrix of the hierarchical model was less than 0.10.The final protocol included 5 primary indicators,14 secondary indicators and 40 tertiary indicators.3.The first ambulation time and first exhaust time of patients in the intervention group were earlier than those in the control group.The self-management efficacy,readiness for hospital discharge and quality of discharge teaching of patients in the intervention group before discharging were higher than those of the control group.One month after discharging,the quality of life of liver cancer patients in the intervention group was higher than that in the control group;The differences were statistically significant(P<0.05).There were no statistically significant differences in postoperative time to first meal,unplanned healthcare resource use,or liver cancer specific symptom module scores(P>0.05).Conclusion1.The discharge planning for patients with primary liver cancer undergoing hepatectomy based on Health Action Process Approach model is scientific and reliable,which can be used as a reference for clinical practice in liver cancer ward.2.The discharge planning scheme of patients undergoing liver cancer surgery can effectively enhance the self-efficacy of patient,promote postoperative recovery and improve the discharge readiness,quality of discharge teaching and the quality of life for patients with primary liver cancer one month after discharging.