Application Of Patient Self-Management Program Based On BCW Theory In Outpatient Colorectal Polypectomy

Objective(s):1.To explore the status and needs of self-management of outpatient endoscopic colorectal polypectomy.2.To construct a self-management scheme for patients undergoing endoscopic colorectal polypectomy based on the behavior change wheel(BCW)theory.3.To implement and evaluate the self-management program for outpatient endoscopic colorectal polypectomy based on BCW theory.Method(s):1.Seven patients who underwent colorectal polypectomy and seven medical staff in the Digestive Endoscopy Center of the Second Affiliated Hospital of Kunming Medical University were selected for semi-structured interviews.Descriptive research methods were adopted to understand the current situation and needs of self-management of patients undergoing colorectal polypectomy in the outpatient department.2.The draft program was drawn up through literature research and qualitative interview,and 18 experts in the field of digestive endoscopy medical care management in different provinces and cities in China were consulted by Delphi expert consultation method.After two rounds of expert consultation,the self-management plan for outpatients undergoing endoscopic colorectal polypectomy was determined.3.A non-contemporaneous controlled study was adopted,and 201 outpatients who were diagnosed and treated in the digestive endoscopy center of the Second Affiliated Hospital of Kunming Medical University in Yunnan Province from July to December2022,all of the selected outpatients met the inclusion and exclusion criteria.The control group received routine care,and the intervention group received routine care.Self-management protocol for outpatient undergoing endoscopic colorectal polypectomy.The outcome indicators were evaluated using the Boston Bowel Preparation Scale,the Adult Health Self-management Skill Rating Scale,the Hospital Anxiety and Depression Scale,the Morisky Medication Adherence Scale-8 items,the incidence of complications,and patient satisfaction.Statistical analysis used two independent samples t-test,chi-square test,rank sum test,P<0.05 was considered statistically significant.Result(s):1.Descriptive qualitative research extracted 3 themes of self-management status and needs of outpatient undergoing endoscopic colorectal polypectomy:(1)Patients lack the ability of perioperative self-management,including bowel preparation drug intolerance,lack of disease and surgery-related knowledge,difficulty in remembering nursing content;(2)Patients lack opportunities for perioperative self-management,including lack of medical care support in the home environment and lack of social support for active self-management of diseases;(3)Patients lack the motivation for perioperative self-management,including insufficient awareness of the importance of perioperative self-management and negative inner coping.2.The self-management program for outpatients undergoing endoscopic colorectal polypectomy based on BCW theory was constructed by Delphi expert consultation method.The program mainly includes three parts:motivational intervention,opportunity intervention,and ability intervention.There are 7 intervention functions of restriction,empowerment,environmental reconstruction and training,with a total of 44 specific intervention measures.3.A total of 201 outpatients were included in the implementation and evaluation phase of the plan,101 cases in the control group,and 100 cases in the intervention group.There was no statistical difference in the baseline data such as the age,gender,body mass index,disease history,history of colonoscopy,Bristol stool type,operation time period,anesthesia method(P<0.05);the bowel preparation scores of the whole bowel segment and transverse colon segment in the intervention group were higher than those in the control group(t=-2.106,P<0.05;t=-2.327,P<0.05);After receiving personalized bowel preparation guidance,the bowel preparation scores of the whole bowel segment and transverse colon segment in the intervention group were higher than those in the control group(t=-2.703,P<0.05;t=-2.450,P<0.05);the mean hospital anxiety score of the intervention group 30 minutes before operation showed that the patients had no obvious anxiety symptoms,and their anxiety level was significantly lower than the control group,the difference was statistically significant(t=2.484,P<0.05);30 days after operation,the scores of the Adult Health Self-management Skill Rating Scale of the intervention group were significantly higher than those of the control group,include health self-management cognition,self-management behavior,self-management environment and the total score(t=-7.471,P<0.01;t=-8.996,P<0.01;t=-10.478,P<0.01;t=-15.681,P<0.01);There was no perforation occur in both the intervention group and the control group,and there was no difference in the incidence of bleeding and abdominal pain(P>0.05).The incidence of abdominal distension in the intervention group was lower than the control group,the difference was statistically significant(X~2=4.625,P<0.05);The Morisky Medication Adherence Scale-8 items score of the intervention group was better than the control group,and the difference was statistically significant(t=-2.368,P<0.05);Medical and nursing satisfaction of the intervention group was significantly better than the control group,and the difference was statistically significant(t=-2.203,P<0.05).Conclusion(s):The intervention of outpatient self-management program based on BCW theory can improve the self-management level of outpatients undergoing endoscopic colorectal polypectomy,improve the quality of bowel preparation for ordinary patients and patients with constipation,relieve preoperative anxiety,and reduce the incidence of postoperative abdominal distension,improve medication compliance and satisfaction after surgery.