| Objective:1.To explore the status quo and influencing factors of supportive care needs of caregivers of elderly patients with lung cancer,and to explore the relationship between supportive care needs of caregivers,coping level of spouses and supportive care needs of patients.2.To construct a network supportive care service plan for caregivers of elderly patients with lung cancer based on dyadic coping theory combined with quantitative research results and literature content analysis data,and preliminarily verify its feasibility and clinical effect.Methods:1.Using cross-sectional design,caregivers of elderly patients with lung cancer who were admitted to the oncology department of three Class ⅲ Grade A general hospitals in Suzhou from April to October 2022 were selected by convenience sampling.The self-made general demographic data questionnaire,supportive care needs Scale for Caregivers,supportive care needs Scale for patients,and Dyad Coping Scale were used to investigate.SPSS 25.0 software was used for statistical description,chi-square test,multivariate Logistic regression analysis,and Spearman rank correlation analysis.2.Through literature review,literatures on supportive care services for caregivers of cancer patients were systematically searched in Chinese and English databases from the establishment of the database to October 2022.Two nursing postgraduate students independently screened the literature,extracted data,and evaluated the quality of the literature.Finally,a descriptive analysis was conducted on the included literature and the first draft of the network supportive care service plan for caregivers of elderly patients with lung cancer was initially formed.3.Based on the results of previous quantitative research and literature content analysis,the categories,sub-themes and intervention indicators of network supportive care services for caregivers of elderly patients with lung cancer were proposed.Fifteen experts from clinical medicine,nursing,psychology,nutrition,rehabilitation and other professional fields were selected to demonstrate and revise the content of the scheme for two rounds.The network supportive care service plan for caregivers of elderly patients with lung cancer based on dyadic coping theory was finally determined,and the feasibility and clinical effect of the plan were preliminarily verified by quasi-experimental design.Results:1.Quantitative research results: The dimension score of supportive care needs of spouse caregivers of 241 elderly patients with lung cancer from high to low was 54.0(17.0);The score of psychological and emotional needs dimension was 42.0(22.5);The work and social needs dimension scored 32.0(22.0);The score of information demand dimension was 23.0(7.0),and the unmet demand rate of 39 items out of 45 items was more than 50%,accounting for 86.7%.Logistic regression analysis showed that whether the caregiver had chronic disease,cumulative time of caring for the patient,current living area,daily time of caring for the patient,previous experience of caring for others,personal monthly income,time of illness,gender,whether the caregiver had chronic disease,and education level were all dimensions of the supportive care needs of the caregivers of elderly patients with lung cancer Influencing factors(P<0.05).Spearman rank correlation analysis showed that there was a positive correlation between supportive care needs of spouse caregivers and supportive care needs of patients(r=-0.135-0.825,P<0.01),and a negative correlation between the supportive care needs of spouse caregivers and the supportive care needs of patients(r=0.120-0.725,P<0.05).There was a positive correlation between the scores of caregivers’ binary coping and the scores of patients’ binary coping(r=0.430-0.888,P<0.01).2.Results of program construction: A total of 15 articles were included in the analysis of literature inclusion.Through two rounds of Delphi expert correspondence consultation,the network supportive care service plan for spouse caregivers of elderly lung cancer patients with the theoretical framework of dual coping theory was finally determined: There were 5 primary indicators(health care service information support service,care skills support service,social and work support service,psychological and emotional support service,communication support service),including 20 secondary indicators and 57 tertiary indicators.3.Intervention study results: In the recruitment stage of the feasibility study,a total of 21 pairs of lung cancer patients and their spouse caregivers met the inclusion and exclusion criteria,and 15 pairs agreed to participate in this study,with a recruitment rate of 71.4%,3 pairs fell off during the intervention process,and 12 pairs completed the intervention and questionnaire data collection,with a retention rate of 80%.After the implementation of the network supportive care service program for the spouse caregivers of elderly patients with lung cancer for 42 days,it was found that the health care service,psychological and emotional,information,work and social needs of the caregivers were improved,and the total score was statistically significant(P<0.01).After intervention,the stress communication,negative coping,empowering coping,supportive coping,joint coping,coping quality evaluation and total scores of elderly patients with lung cancer and their caregivers were improved compared with those before intervention.The difference was statistically significant(P<0.05).After intervention,the medical system services and information,psychology,care and support,physiological and daily life needs and total scores of elderly patients with lung cancer were improved,with statistical significance(P<0.01),but there was no statistical significance in the dimension of sexual needs compared with that before intervention(P>0.05).After intervention,the physical health scores,mental health scores and total scores of caregivers of elderly patients with lung cancer were improved compared with those before intervention.The difference was statistically significant(P<0.01).Mental health scores and total scores of elderly patients with lung cancer were improved after intervention.The difference was statistically significant(P<0.05),but there was no significant difference between physical health score and before implementation(P>0.05).After intervention,the social support level of elderly patients with lung cancer and their caregivers was significantly higher than that before intervention,the difference was statistically significant(P<0.01).After intervention,the mental resilience of elderly patients with lung cancer and their caregivers was significantly improved compared with that before intervention,with statistical significance(P<0.01).Conclusions:The incidence and mortality of lung cancer in China are increasing year by year,and the care burden of caregivers of elderly patients with lung cancer is also increasing.It is of great significance to explore how to build a supportive care service plan for caregivers of elderly patients with lung cancer based on network for meeting the unmet needs of caregivers,improving care ability,improving the prognosis and rehabilitation of patients at home,and reducing the waste of medical resources.1.The supportive care service needs of caregivers of elderly patients with lung cancer are comprehensive,continuous and personalized.The supportive care needs of caregivers are poor,and there are different degrees of unmet needs in health care service needs,psychological and emotional needs,work and social needs and information needs.The higher the patient’s supportive care needs,the worse the dyadic coping ability of the couple.2.The network supportive care service plan for caregivers of elderly patients with lung cancer in this study was constructed strictly in accordance with standardized processes,accurately targeted the comprehensive needs of caregivers,and relied on mobile health support to effectively interact and feedback with caregivers.3.The preliminary verification effect of the network supportive care service program for caregivers of elderly patients with lung cancer based on dyad coping theory shows that it can help to meet the supportive care needs of elderly patients with lung cancer and their caregivers,improve the stress coping ability of couples,improve the quality of life of couples,improve the level of social support and psychological resilience.The pre-experiment of the scheme confirmed that the scheme had certain clinical application value,and the research objects had good acceptance and compliance,which provided effectiveness verification and reference for other types of network supportive care services for caregivers of elderly cancer patients.In the future,high-quality randomized controlled trials with large sample size can be carried out to verify the clinical effect of the protocol. |
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