Application Of A Family-centered Preemptive Medical Care Plan In Advanced Cancer Patients And Family Primary Caregivers

Part I Study the status quo and influencing factors of ACP readiness in advanced cancer patients and family primary caregiversObjective To investigate the status quo and related influencing factors of ACP readiness in advanced cancer patients and family primary caregivers through a questionnaire survey.To explore the correlation between ACP readiness and quality of life in patients with advanced cancer,and between ACP participation of family primary caregivers and presentiment sadness,laying the foundation for further development of targeted interventions at a later stage.Methods 340 pairs of advanced cancer patients and their main family caregivers who met the inclusion criteria were selected from November 2021 to May 2022 in the Department of Oncology of a Grade-A hospital in Yunnan Province by convenience sampling method.Patients were investigated by general data questionnaire,ACP readiness scale and Quality of Life Scale(EORTCQLQ-C30).Family primary caregivers were surveyed using the general Information Questionnaire,the Surrogate Decision Maker’s Advance Medical Care Plan Participation Questionnaire(ACPES-SDM),and the Primary Caregiver of Cancer Patient Presentiment Grief Scale(AGS).Using SPSS26.0 statistical software to statistical analysis of data,measurement data of normal distribution with mean+ /-standard deviation( X± S)said,use independent sample t test and variance analysis;Count data were described in frequency/percentage terms and were tested by X2.Result s2.Univariate analysis showed that there were statistically significant differences in ACP readiness among patients with different levels of education,occupation,family location,whether they had received or been exposed to rescue experience,and whether they had heard of ACP(P < 0.05).There were statistically significant differences in ACP readiness among patients with different disease course,disease stage,disease state and hospitalization frequency(P < 0.05)1.The total score of ACP readiness and quality of life were 3.41±0.32 and 3.60±0.34 respectively in patients with advanced cancer..3.Correlation analysis showed that the attitude,belief and motivation of ACP readiness were positively correlated with the five functional dimensions of the quality of life(physical,emotional,cognitive,social and role)and the overall health dimension,and were negatively correlated with the three symptom dimensions of the quality of life(fatigue,nausea,vomiting and pain)and six single items.4.Multiple linear regression analysis showed that patients’ ACP readiness was influenced by whether they had been in contact with or received rescue experience,place of residence,course of disease,education level and stage of disease(P < 0.05).The influence factors of ACP attitude dimension were whether the patients had contact with or received rescue experience,place of residence,education level and course of disease(P <0.05);The course of disease,whether they had heard of ACP,the number of hospitalizations,whether they had contact or rescue experience were the factors influencing the ACP belief dimension(P < 0.05).Hospitalization times,occupation,disease stage,contact or rescue experience were the influencing factors of ACP motivation dimension(P < 0.05).5.The total score of ACP participation of primary caregivers was(3.54±0.32),and the total score of prescient sadness was(3.62±0.29).6.Univariate analysis showed that there were statistically significant differences in the ACP participation of family primary caregivers with different gender,education level,place of residence,bereavement experience,hearing of ACP,and experience or contact with rescue experience(P < 0.05).7.Correlation analysis showed that ACP participation of primary caregivers was correlated with presentiment sadness.The conditioned dimension of ACP participation of primary caregivers was negatively correlated with the total score of loss,guilt,anxiety and presentiment sadness of presentiment sadness,and the readiness dimension was negatively correlated with the total score of sadness,loss and presentiment sadness of presentiment sadness.8.Multiple linear regression analysis showed that education level,income level,whether there were significant events in the recent three months,gender,whether they had heard of ACP,and whether they had bereavement experience were influencing factors of ACP participation of primary caregivers(P < 0.05).Income level,whether they had heard of ACP,education level,gender,and whether there had been major events in the last three months were the influencing factors of ACP condition dimension of the main caregivers(P< 0.05).Educational level,income level,whether there were significant events in the recentthree months,gender,whether they had heard of ACP,and whether they had bereavement experience were the influencing factors of ACP thinking dimension(P <0.05).Bereavement experience,significant events in the last three months,gender,hearing of ACP and education level were the factors influencing ACP readiness dimension(P <0.05).Conclusion1.The ACP readiness of advanced cancer patients was above the medium level,among which the higher the city level,the higher the education level,the longer the course of the disease,the recurrence of the disease,the more times of hospitalization,the patients who had received or been in contact with the rescue and had heard of ACP,the higher the ACP readiness.ACP readiness was positively correlated with quality of life in patients with advanced cancer.The higher the ACP readiness,the higher the quality of life.Therefore,it is necessary to formulate targeted intervention programs according to the influencing factors of patients’ ACP readiness,so as to further improve the ACP readiness of patients with advanced cancer,so as to achieve the purpose of improving the quality of life of patients with advanced cancer.2.The level of ACP participation of family primary caregivers of patients with advanced cancer was above the medium level.Among them,the male,the higher the education level,the bereavement experience,the heard of ACP and the experience or contact with rescue experience of family primary caregivers,the higher the ACP participation.In addition,the ACP participation of family primary caregivers was negatively correlated with the level of presentiment sadness,and the higher the ACP participation,the lower the level of presentiment sadness.Therefore,it is necessary to improve the participation of family primary caregivers in ACP for advanced cancer patients in a targeted way,so as to lay a foundation for the clinical implementation of family-centered ACP,so as to further achieve the purpose of reducing the decision-making and psychological pressure of family primary caregivers and relieving the presentiment sadness of family primary caregivers.Part II Family-Centered ACP Intervention in patients with advanced cancer and their family primary caregiversObjective To evaluate the effect of family-centered ACP intervention in patients with advanced cancer and their family primary caregivers on improving ACP readiness in patients with advanced cancer and their family primary caregivers on the basis of previous research.The effect of improving the quality of life of patients and alleviating the presentiment sadness of the main caregivers in the family provides a reference for further promoting the family-centered clinical practice of ACP.Methods Advanced cancer patients who met the inclusion criteria and their main family caregivers were selected by convenience sampling from June 2022 to October 2022 in the Department of Oncology of a third-class A hospital in Yunnan Province as the subjects of this study.According to the principle of randomization,the subjects were divided into control group and intervention group.The control group received routine nursing measures for cancer patients,and the intervention group received "family-centered" ACP.The patients with advanced cancer were evaluated by the ACP readiness scale and the Quality of Life Scale(EORTCQLQ-C30)before,1 week and 1month after the intervention.Family primary caregivers were evaluated using the Surrogate Decision Maker Advance Medical Care Plan Participation Questionnaire(ACPES-SDM)and the Primary caregiver with Cancer family Predictive Grief Scale(AGS).SPSS26.0statistical software was used for statistical analysis of the data.Results1.Before intervention: there were no significant differences in general demographic data,disease characteristics,ACP readiness,various dimensions,quality of life and scores in various fields between the two groups(P > 0.05).2.ACP readiness of cancer patients: There were statistically significant differences in ACP readiness of patients before and after intervention(1 week,1 month)and the time effect,intergroup effect and interaction effect of each dimension(P < 0.05).In order to further explore the significance of the interaction effect of ACP readiness between the two groups,simple effect analysis was further conducted in this study,which showed:After intervention(1 week,1 month),the difference of ACP readiness score between the two groups was statistically significant(P < 0.05),and one month after intervention,the ACP readiness score in the intervention group was significantly higher than that in the control group,and the improvement of ACP readiness level in the intervention group was significantly better than that in the control group.3.Quality of life of cancer patients: Before and after intervention(1 week,1 month),there were statistically significant differences in quality of life and the time effect,group effect and interaction effect of each dimension between the two groups(P < 0.05).In order to further explore the significance of interaction effect of quality of life between the two groups,simple effect analysis was further conducted in this study and showed that there were statistically significant differences between the two groups in other areas except nausea and vomiting,pain,constipation,diarrhea and economic difficulties 1 week after intervention(P < 0.05).1 month after intervention,there were statistically significant differences in all areas of quality of life between the two groups(P < 0.05),and the quality of life of patients in the intervention group was significantly higher than that in the control group.4.Before intervention: there were no significant differences in the general information,total score of ACP participation and all dimensions,total score of premonmonial sadness and scores of all dimensions between the two groups of family main caregivers(P > 0.05).5.ACP participation of family primary caregivers: There were statistically significant differences in ACP participation of family primary caregivers before and after intervention(1 week,1 month)and the time effect,group effect and interaction effect of each dimension(P < 0.05).In order to further explore the significance of interaction effect of ACP participation of primary caregivers in two groups of families,simple effect analysis was further conducted in this study,which showed that:After intervention(1 week,1month),there was a statistically significant difference between the two groups in ACP participation scores of family primary caregivers(P < 0.05),and at 1 month after intervention,ACP readiness scores of family primary caregivers in the intervention group were significantly increased,and the level of ACP participation in the intervention group was significantly higher than that in the control group.6.The level of premonitoringsadness among primary caregivers: there were statistically significant differences in premonitoringsadness among primary caregivers before and after intervention(1 week,1 month)and the time effect,group effect and interaction effect of each dimension(P < 0.05).In order to further explore the significance of the interaction effect of premonition sadness among primary caregivers in two groups of families,simple effect analysis was further conducted in this study,which showed that:After intervention(1 week,1 month),there was a statistically significant difference between the two groups in the score of the primary caregivers’ presentiment sadness(P <0.05),and at 1 month after intervention,the score of the primary caregivers’ presentiment sadness in the intervention group was significantly decreased,and the score of the primary caregivers’ presentiment sadness in the intervention group was significantly improved compared with the control group.Conclusion "Family-centered" ACP can effectively improve the ACP readiness and quality of life of patients with advanced cancer,and it is of great significance to improve the ACP participation of family primary caregivers of patients with advanced cancer and alleviate their presentiment sadness.