| Hyperthermic intraperitoneal chemotherapy(HIPEC)is a new method in the treatment of patients with gastrointestinal malignancies.However,there exists a certain limitation in the current HIPEC nursing field;thus,it must develop a scientific and systematic HIPEC nursing model.Case management is a new and effective management model been widely used in the field of cancer care abroad,which provides a new way for developing the HIPEC nursing model.Purpose:1.To develop the Mandarin Chinese version of the 34-item Short-Form Supportive Care Needs Survey(SCNS-SF34-C(Mandarin))and the Chinese version of the Support Person's Unmet Needs Survey-Short Form(SPUNS-SFC),and then to test their psychometric properties.2.To explore the needs of patients with gastrointestinal cancers receiving HIPEC and to explore their support persons' needs.3.To construct the nurse-led case management model for patients with gastrointestinal cancers receiving HIPEC.Through this research,new,valid and reliable measurements for assessing the supportive care needs of cancer patients and the needs of cancer support persons in mainland China can be developed.Besides,This research not only can provide a preliminary scientific basis for standardizing the HIPEC nursing practice and improving the nursing quality,but also can provide references for further research and application on case management been used in the cancer care field in mainland China.Methods:1.The forward-backward translation method along with expert discussion and pilot investigation were used to develop the preliminary versions of the SCNS-SF34-C(Mandarin)and the SPUNS-SFC.Then,two cross-section studies using two large convenience samples of cancer patients and cancer support personsrecruited from the Sun Yat-Sen university cancer center and the cancer center of Guangzhou Medical University were carried out from November 2015 to May 2016.The psychometric properties of the SCNS-SF34-C(Mandarin)and the SPUNS-SFC were analyzed respectively.2.The needs of patients with gastrointestinal cancers receiving HIPEC as well as their support persons' needs were analyzed respectively through analyzing the related data obtained form the cross-section studies.3.The draft of clinical nursing pathway(CNP)for patients with gastrointestinal cancers receiving HIPEC around the time of the treatment(HIPEC-CNP)was designed according to the results of the retrospective case series.Then,based on the needs of patients with gastrointestinal cancers receiving HIPEC,their support persons' needs and the draft of HIPEC-CNP,the drafts of the nursing practice schemes and the nursing practice evaluation index system belonging to the nurse-led case management model for patients with gastrointestinal cancers receiving HIPEC were designed respectively through retrieving and summarizing the related evidences,literature reviewing,and content analyzing.Thereby,the draft of the nurse-led case management model for patients with gastrointestinal cancers receiving HIPEC was preliminarily established.After that,two rounds of Delphi-expert consultations were performed,and the draft of the preliminarily established model was evaluated and revised based on the experts' suggestions accordingly.Consequently,the final version of the nurse-led case management model for patients with gastrointestinal cancers receiving HIPEC was constructed.Results:1.The psychometric properties of the SCNS-SF34-C(Mandarin)and the SPUNS-SFC:(1)The SCNS-SF34-C(Mandarin)contains 33 items mapped into five domains: health system and information,psychological,patient care and support,physical and daily living,and sexuality,accounting for 69.757% of the total variance.It has good convergent validity and discriminant validity.Cronbach's alpha coefficients range from 0.854 to 0.942 for the five domains and 0.947 for the whole scale.(2)The SPUNS-SFC comprises 21 items across five domains: information,healthcare access and continuity,personal and emotional needs,worries about the future,and financial needs,accounting for 78.47% of the total variance.It shows good convergent validity and discriminant validity.Cronbach's alpha coefficients rangingfrom 0.87 to 0.95 for the five domains and a coefficient of 0.94 for the overall scale indicate high internal reliability.2.The needs of patients with gastrointestinal cancers receiving HIPEC and their support persons' needs:(1)Patients with gastrointestinal cancers receiving HIPEC ranked psychological needs and physical and daily living needs as the top two needs they needed most.Besides,the levels of these two needs in patients with gastrointestinal cancers receiving HIPEC were significantly higher than those in patients with gastrointestinal cancers without HIPEC(t=-4.353,P<0.001;t=-5.584,P<0.001).(2)The levels of healthcare access and continuity(t=-2.510,P<0.05),personal and emotional needs(t=-3.727,P<0.001),and financial needs(t=-2.757,P<0.05)in support persons of patients with gastrointestinal cancers receiving HIPEC were significantly higher than those in support persons of patients with gastrointestinal cancers without HIPEC.Worries about the future,personal and emotional needs were the top two needs of support persons of patients with gastrointestinal cancers receiving HIPEC,followed by information,healthcare access and continuity,and financial needs.3.The nurse-led case management model for patients with gastrointestinal cancers receiving HIPEC:The experts positive coefficients were 92.86% and 100%for the two rounds of Delphi expert consultations respectively.The authoritative coefficient was 0.925.The means of the importance-value for each item ranged from3.54 to 4.60,and the coefficient variations for each item ranged from 0.10 to 0.24.The coordination efficient was 0.413(P<0.001).The final version of the nurse-led case management model for patients with gastrointestinal cancers receiving HIPEC contained three major parts:(1)HIPEC-CNP(included time limits,entering standards,terminating standards,possible variations and 9 kinds of forms designed for each day of the CNP)(see Appendix 23);(2)7 kinds of nursing practice schemes(scheme for HIPEC nursing manipulation,nutrition support scheme,VTE prevention and excises scheme,pressure ulcer prevention and management scheme,bowel function management scheme,individualized psychological support scheme and individualized supportive care scheme for support persons)(see Appendix 23)and Healthcare management handbook to HIPEC(see Appendix 23);(3)the nursing practice evaluation index system which contained qualitative index(subjective evaluation index)and quantitative index(medical economic parameters and objective evaluation index)together(see Appendix 23).Conclusions:1.Preliminary evidences suggest that the SCNS-SF34-C(Mandarin)and the SPUNS-SFC are reliable and valid instruments for assessing the needs of Chinese cancer patients and cancer support persons respectively.2.Nursing staffs should pay attention to assess the psychological needs and physical and daily living needs of patients with gastrointestinal cancers receiving HIPEC as well as their support persons' unmet needs carefully around the time of the treatment,and then provided tailored supportive care to satisfy their needs.3.Satisfied results of two rounds of Delphi expert consultations imply that the nurse-led case management model for patients with gastrointestinal cancers receiving HIPEC is scientific,feasible and pratical,which not only provide a preliminary scientific basis for HIPEC nursing practice,but also provide references for further promoting the research and clinical application on case management been used in the cancer care field in mainland China.However,the clinical effects of the constructed model need to be evaluated through a randomized multi-center clinical study based on the well-established HIPEC-Clinical pathway(HIPEC-CP)in future. |
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