Intervention Effect Of Narrative Nursing To Health Locus Of Control For Cervical Cancer Patients With Radiotherapy And Chemotherapy

ObjectivesThrough a cross-sectional survey study to describe the status and influencing factors of health psychological control factors(Health Locus of Control,HLC)in cervical cancer patients,analyze the influencing factors of health mental control factors in patients with cervical cancer radiotherapy,and explore the relationship between anxiety,depression and health mental control sources.To evaluate the intervention effect of narrative nursing on healthy psychological control sources,anxiety and depression in patients with chemoradiotherapy for cervical cancer.Methods1.Current investigation and analysis of health psychological control factors of cervical cancer radiotherapy and chemotherapy patientsUsing a cross-sectional survey and research study,Using a self-designed general data questionnaire,multi-dimensional health mental control source scale(Multidimensional Health Locus of Control,MHLC),Extensive Anxiety Scale(Generalized Anxiety Disorder-7,GAD-7)and the Patient Health Questionnaire Depression Symptoms Inventory Scale(Patient Health Questionnaire,PHQ-9),The research subjects were 110 patients with cervical cancer in two Grade A hospitals in Jiangsu Province.Measurement data are described as mean ± standard deviation,Metric data are described as ± standard deviation of mean,which are compared with independent sample t-test and ANOVA or Fisher’s exact test,respectively.Comparison of the ordered classification data was performed using the Kruskal-Wallis test.and count data are expressed as examples and percentage.Linear correlation analysis investigated the association of HLC with anxiety and depression.Multiple linear regression was applied to analyze the influencing factors of health mental control sources.2.Establish the narrative nursing intervention program for patients with radiotherapy and chemotherapy of cervical cancerBased on the current investigation results,the literature review method was used to briefly summarize the domestic and foreign studies to understand the intervention strategies of healthy psychological control sources for patients with radiotherapy and chemotherapy for cervical cancer.On the basis of the preliminary current situation investigation and literature review,the narrative nursing intervention program is preliminarily established,and the expert meeting method is applied to establish the final scheme of narrative nursing intervention.3.Application of narrative nursing intervention program to healthy psychological control sources in patients with chemoradiotherapy for cervical cancerSelect the cervical cancer chemo and chemotherapy patients admitted to Nanjing Gulou Hospital and Zhongda Hospital affiliated to Southeast University from June 2021 to February 2022.In order to avoid the intervention pollution between the trial group and the control group,a simple randomized method is adopted,and the subjects in the same hospital will be divided into the trial group or the control group.The two groups of cervical cancer chemoradiotherapy patients who met the inclusion criteria were 39,respectively.The control group implements the oncology nursing routine;the trial group implements the narrative nursing intervention program based on the control group,and the intervention period is 8 weeks.Data were collected at three time points before intervention,4 weeks after intervention and 8 weeks after intervention.Repeated-measures ANOVA was used to compare the data,anxiety and depression in general data,sources of health psychological control.Results1.Current investigation and analysis of health psychological control factors of cervical cancer radiotherapy and chemotherapy patients(1)In this study,110 patients with cervical cancer were investigated,with the internal control dimension(IHLC)score(23.94±4.57),which was lower than normal mode and at a low level.The other control dimension(PHLC)score(26.68±3.99)and the opportunity dimension(CHLC)(20.66±5.37),which is higher than the normal mode and at a high level.A higher score indicates a stronger bias.The total score of anxiety in patients with cervical cancer chemoradiotherapy was(5.48±5.02),and the total score of depression was(6.3±4.61).(2)The results of univariate and related analysis showed that the total score of HLC cervical cancer patients with different age and education level was different,and the difference was statistically significant(P<0.05).Correlation analysis showed that age was negatively associated with PHLC scores,education and PHLC and CHLC scores,and anxiety and PHLC,which were statistically significant(P<0.05).Multiple linear regression analysis showed that age and education were independent factors influencing HLC in patients undergoing chemoradiotherapy for cervical cancer.2.Establishment of intervention program for healthy psychological control source in cervical cancer(1)On the basis of literature review and status quo investigation,the first draft of the narrative nursing intervention plan for patients with cervical cancer radiotherapy and chemotherapy was established,and then revised and improved through the expert meeting method,and finally the implementation plan of the narrative nursing intervention was established.The theme of the intervention focuses on the main problems of patients during the radiotherapy and chemotherapy treatment of cervical cancer:psychological distress,fear of disease progression,symptom distress,social support and information needs.1)The contents include:① Attention:introduce disease-related knowledge and guide patients to talk about psychological troubles;②Narrative:externalizing problems separate problems from people and change the way of examining problems;③Deconstruction:trace the origin of problems and change the way of thinking;④Growth exploration:share problem solving experience and look to the future.2)Time and frequency of intervention:The intervention period is 8 weeks,once every 4 weeks,and 30-40mins each time,for 3 times.3)Intervention method:one-to-one face-to-face interview.4)Intervention executor:by the researcher himself or by a member of the narrative care team.5)Evaluation tool of intervention effect:multi-dimensional health psychological control source scale,extensive anxiety scale,patient health questionnaire and depression symptoms group scale.6)Time of intervention effect evaluation:before intervention,4 weeks of intervention and 8 weeks of intervention.3.Empirical application of narrative nursing intervention program for healthy mental control sources in cervical cancerIn this study,78 patients with cervical cancer radiotherapy and chemotherapy were collected,including 39 patients in the trial group and 39 patients in the control group.No baseline data for cervical cancer(P>0.05).(1)Source of healthy psychological control:The interaction effect of IHLC score and CHLC score and time between the two groups of cervical cancer patients was statistically significant(P<0.05),indicating that the trend of IHLC score between the control group with time,and the improved score of the test group was significantly higher than that of the control group.No interaction effect between PHLC total score and time between the two groups of cervical cancer chemoradiotherapy(P>0.05).(2)Anxiety:The interaction effect of the total anxiety score and time in the two cervical cancer chemoradiotherapy patients was statistically significant(P<0.05),indicating that the change trend of the total anxiety score of the trial and control groups varied with the change of time,and the improvement score of the test group was significantly higher than that of the control group.(3)Depression:The interaction effect of the total depression score and time in the two cervical cancer chemoradiotherapy patients was statistically significant(P<0.05),indicating that the change trend of the total depression score of the trial and control groups was different with time,and the improvement score of the test group was significantly higher than that of the control group.Conclusions1.The HLC internal control dimension of cervical cancer chemoradiotherapy patients is at the low level,his control type and opportunity type dimension are at the high level;Age and education level are the independent factors affecting HLC in patients with chemoradiotherapy for cervical cancer.2.Age was negatively correlated with PHLC score,education level with PHLC and CHLC score,and HLC his control dimension score was positively associated with anxiety(P<0.05).3.Narrative nursing intervention can significantly improve the internal control dimension score of reduced risk type and reduced opportunity type of HLC of cervical cancer patients,and have no significant effect on the other control dimension score.It has a significant improvement effect on anxiety and depression levels.