Effects Of Different Psycho-Intervention On Quality Of Life In Patients With Acute Leukemia Receiving Chemotherapy

Objectives To understand the quality of life and affective factors of overall health status about quality of life in patients with acute leukemia receiving chemotherapy, and investigate the effects of different interventions on quality of life, self-efficacy, social support, medical response, the degree of remission in them.Methods Basing on this experimental research study,180 acute leukemia patients receiving chemotherapy were chosen from the three different hospitals (1st,2nd & 3rd xiangya hospitals) of central south university in Hunan province. They were randomly assigned to four different groups namely cognitive, muscle relaxation, cognitive muscle relaxation and a control group of 45 cases. Other than the routine nursing care, the cognitive group also received other interventions during admission. cognitive intervention was given three times each time 1 hour before chemotherapy, during chemotherapy and after chemotherapy respectively; the muscle relaxation group, other than the conventional care during their hospital stay, other separate outside progressive muscle relaxation therapy was sought, twice a day, every 30 minutes, until discharge; cognitive muscle relaxation group received not only the hospital routine nursing care but also other separate interventions as the cognitive group and the muscle relaxation group; the control group only received the routine nursing care care. Before and after intervention only cancer patients were selected using scales like the European organization for research and treatment of Cancer Quality of Life Questionnaire EORTC QLQ-C30, General Self-efficacy Scale GSES Social Support Rating Scale SSRS, Medical Coping Modes Questionnaire MCMQ to evaluate the quality of life, self-efficacy, social support, coping style, based on clinical information in order to make assessment of patients remission by physician in charge, comparing the effects of different interventions.Results 1.the overall health status of acute leukemia patient's quality of life before chemotherapy was 4.11±1.21. The top three scores were cognitive function, financial difficulties, and emotional function, followed by physical function, fatigue, nausea and vomiting. Multiple linear regression showed that age, KPS score, degree of satisfaction with medical care work had impacts on the overall health status of patients' quality of life. The total coefficient of determination(R) is 0.317, multiple correlation coefficient (R) is 0.563.2. Repeated measures analysis of variance showed that apart from avoidance, objective support, the degree of remission, the main effects of intervention on the overall health status, self-efficacy, confrontation, resignation, the total social support, subjective support, support utilization were significant (P<0.05);apart from objective support, the main effects of time of the other nine observed indicators were significant (P <0.05);There were significant interactions (P<0.05) between time and intervention except avoidance, objective support, the degree of remission.Interaction diagram indicated that the scores of the overall health status, self-efficacy, support utilization increased the most,and avoidance and resignation decreased the most in the cognitive muscle relaxant group over the time, the scores of confrontation, the total social support, subjective support increased the most in the cognitive group.3.Paired T test results shows that the cognitive group other than constipation, diarrhea, had economic difficulties, muscle relaxation group except social function, diarrhea, economic difficulties, cognitive muscle relaxation group other than diarrhea, had economic difficulties, the quality of life of all the item scores were statistically significant between pre and post interventions in the three intervention groups (P<0.05); the total quality of life, physical function, fatigue, nausea, vomiting, pain, shortness of breath scores were significant(P>0.05), but slightly improved in the control group.Multiple complete random comparative analysis of variance of the quality of life before intervention among the four groups showed that there were no statistically significant differences(P>0.05); and after intervention, apart from diarrhea and financial hardships the four groups had no statistical difference. Among the rest, the quality of life differences were statistically significant (P<0.05).4.Paired T test results show that the level of self-efficacy of the cognitive and cognitive muscle relaxant groups were higher after intervention than before(P<0.05), but there was no significant different in muscle relaxant and control groups(P>0.05).Multiple complete random comparative analysis of variance among the four groups showed that before intervention,the self-efficacy among four groups were not significance(P>0.05); but after intervention, self-efficacy showed statistically significant differences among them(P<0.05).5.Wilconox sign-rank test results showed that the scores of confrontation after interventions were significantly higher than before (P<0.05), the scores of avoidance and resignation were significantly lower than before (P<0.05)in the cognitive muscle relaxation group;The scores of confrontation after interventions were significantly higher than before (P<0.05), the scores of resignation were significantly lower than before (P<0.05), the score of avoidance were not significance(P>0.05) in the cognitive and muscle relaxation groups. after intervention, the scores of confrontation, avoidance and resignation had no significant difference (P> 0.05) in the control group.Kruskal-Wallis H test results showed that among the four groups before intervention had no significant difference (P>0.05); after intervention, the scores of confrontation and resignation showed statistically significant differences, but the score of avoidance were not significance(P>0.05).6.Paired T test results show that the total social support scores were higher after intervention than before in the cognitive group and the cognitive muscle relaxant group, which were statistically significant (P<0.05); but in the muscle relaxant group and control group, the total social support scores showed no significant difference (P>0.05).Wilconox sign-rank test results show that the scores of subjective support and support utilization after interventions were significantly higher than before in the cognitive group and the cognitive muscle relaxant group(P<0.05), the scores of the rest had no significantly difference between pre and post interventions in the four groups (P>0.05).Multiple complete random comparative analysis of variance among the four groups showed that before intervention, the total social support scores had no statistically significant difference (P>0.05); but after intervention, the total social support scores showed statistically significant differences among them(P<0.05).Kruskal-Wallis H test results showed that the scores of subjective support, objective support and support utilization before intervention had no significant difference among the four groups (P>0.05); after intervention, the scores of subjective support and support utilization showed statistically significant differences(P<0.05).7.Wilconox sign-rank test results show that the degree of remission was higher after intervention than before in the four groups, the differences were statistically significant (P<0.05). Kruskal-Wallis H test points showed that the degree of remission had no statistically significant difference (P> 0.05) among the four groups before and after intervention.Conclusion 1.Cognitive function, economic difficulties, emotional function were the most poor aspects in acute leukemia patients'quality of life with chemotherapy.Age, KPS score, degree of satisfaction with medical care work had impacts on the overall health status of acute leukemia patients'quality of life.2.Three kinds of interventions can improve most aspects of leukemia patients'quality of life with chemotherapy. In the control group, only a small number of quality of life improved narrowly.3.Compared to the muscle relaxation intervention, the cognitive and cognitive muscle relaxation interventions can improve acute leukemia patients'self-efficacy, totle social support, sujective support and support utilization more effectively.4.The cognitive muscle relaxation intervention can improve acute leukemia patients'coping style completely, the cognitive and muscle relaxation interventions can improve it partly.5.There is no significant difference among the three interventions regarding the influence on the degree of recovery in acute leukemia patients with chemotherapy.