| Objective:The purpose of this study is to construct an evidence-based sleep quality improvement program for postoperative chemotherapy patients with breast cancer,and explore the application effect of the program.Methods:1.This study systematically searched the relevant guidelines,evidence summary or systematic evaluation of sleep quality management for breast cancer patients undergoing chemotherapy after surgery at home and abroad.After the search,the literature was screened and evaluated,and the relevant evidence was extracted and integrated,and the first draft of the plan was prepared.Use Delphi method to form the final draft of sleep quality improvement plan for breast cancer patients after chemotherapy.2.This study adopts the quasi experimental research method,and selects breast cancer patients who received chemotherapy after the nail and breast surgery in a tertiary A-level hospital in Suzhou from July 2022 to December 2022.According to the single and double number of wards,30 patients in the single and double number wards are taken as the control group,and conventional sleep intervention methods are used for nursing;30 patients in the double number ward were taken as the intervention group,and the evidence-based sleep quality improvement program for breast cancer patients undergoing postoperative chemotherapy was adopted for nursing.The intervention period was 6 weeks,and the research tools and measurement indicators were the patient general situation questionnaire,the Pittsburgh Sleep Quality Index(PSQI),the Insomnia Severity Index(ISI),the Brief Version of Dysfunctional Beliefs and Attitudes about Sleep(DBAS-16),the Quality of Life Questionnare-Core 30(QLQ-C30)and the serum C-reactive protein level.Results:1.An evidence-based sleep quality improvement program for postoperative chemotherapy patients with breast cancer has been formed.The program consists of three aspects:screening and evaluation of sleep disorders,psychological and behavioral intervention and exercise therapy,including 10 items in total.2.The effect of evidence-based sleep quality improvement program for postoperative chemotherapy patients with breast cancer2.1 PSQI score:(1)Inter-group comparison:There was no statistically significant difference in the total score of PSQI and the scores of each dimension between the two groups before the intervention(P>0.05).After 6 weeks of intervention,the total score of PSQI between the two groups was statistically significant(P<0.05),and the total score of PSQI in the intervention group was significantly lower than that in the control group;In terms of all dimensions,the scores of subjective sleep quality and daytime dysfunction in the control group and the experimental group after the intervention were statistically significant(P<0.05).There was no statistically significant difference in the scores of five dimensions such as sleep time(P>0.05).(2)Intragroup comparison:Before and after intervention,there was a statistically significant difference in the scores of sleep disorders in the control group(P<0.05),while there was no statistically significant difference in the scores of six dimensions such as the total score of PSQI and subjective sleep quality(P>0.05).Before and after intervention,there was a statistically significant difference between the total score of PSQI and the scores of subjective sleep quality,sleep disorders,and daytime dysfunction in the intervention group(P<0.05),while there was no statistically significant difference between the scores of the four dimensions of sleep time,sleep efficiency,sleep time,and hypnotic drugs(P>0.05).2.2 ISI score:(1)Comparison between groups:There was no statistically significant difference in ISI scores between the control group and the intervention group before intervention(P>0.05);After intervention,there was a statistically significant difference between the ISI scores of the control group and the intervention group(P<0.05),and the ISI scores of the intervention group were significantly lower than those of the control group.(2)Intra-group comparison:The ISI scores of the control group and the intervention group before and after the intervention were significantly different(P<0.05).2.3 DBAS-16 score:(1)Inter-group comparison:There was no statistically significant difference in the total score of DBAS-16 and the scores of each dimension between the two groups before the intervention(P>0.05).After the intervention,the total score of DBAS-16 and the scores of each dimension in the two groups were statistically significant(P<0.05),and the total score of DBAS-16 and the scores of each dimension in the intervention group were significantly higher than those in the control group.(2)Intra-group comparison:There was a statistically significant difference between the total score of DBAS-16 and the scores of the three dimensions of insomnia consequences,insomnia concerns,and sleep expectations in the control group before and after the intervention(P<0.05);However,there was no statistically significant difference in the scores of medication status dimension(P>0.05).The total score of DBAS-16 and the consequences of insomnia in the intervention group were compared before and after the intervention,and the differences were statistically significant(P<0.05).2.4 QLQ-C30 score:(1)Inter-group comparison:Before intervention,there was a statistically significant difference in the scores of cognitive function dimensions between the two groups(P<0.05),while there was no statistically significant difference in the scores of 14 dimensions such as physical function(P>0.05).After intervention,there was a statistically significant difference in the scores of emotional function dimension,total health condition dimension,and fatigue dimension between the two groups(P<0.05),and the scores of emotional function dimension and total health condition dimension in the intervention group were significantly higher than those in the control group,while the scores of fatigue symptom dimension in the intervention group were lower than those in the control group;There was no statistically significant difference between the two groups in the scores of 12 dimensions such as body function(P>0.05).(2)Intra-group comparison:There were statistically significant differences in the scores of five dimensions of role function,cognitive function,total health status,nausea and vomiting symptoms and pain symptoms before and after intervention in the control group(P<0.05);However,there was no significant difference in the scores of 10 dimensions such as body function(P>0.05).There was no statistically significant difference in the scores of physical function,diarrhea symptoms,shortness of breath and economic difficulties in the intervention group before and after the intervention(P>0.05);There was significant difference in the scores of 11 dimensions such as role function(P<0.05).2.5 Serum C-reactive protein level:(1)Comparison between groups:There was no significant difference in the level of serum C-reactive protein between the two groups before and after the intervention(P>0.05).(2)Intra-group comparison:The difference between the levels of serum C-reactive protein in the control group before and after the intervention was statistically significant(P<0.05),and the level of serum C-reactive protein in the patients after the intervention was slightly higher than that before the intervention.There was no statistically significant difference in the value of serum C-reactive protein in the intervention group before and after the intervention(P>0.05).Conclusion:1.This study builds a scientific and feasible sleep quality improvement program for breast cancer patients undergoing chemotherapy after surgery based on evidence,which provides a basis for clinical medical staff to carry out related work.2.The quasi experimental research method was used to verify the application effect of this scheme.Compared with the control group,the sleep quality,sleep personal beliefs and attitudes,and quality of life of the patients in the intervention group were significantly improved,while the severity of insomnia was also significantly reduced,which was conducive to the prognosis of breast cancer patients undergoing chemotherapy after surgery. |
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