| Objective:To institute and implement a bundle of care in the treatment of patients with nasopharyngeal carcinoma undergoing concurrent chemoradio-therapy. To explore the effect of the care bundle on the psychological status, poisonous side reaction, nutritional status and the quality of life of patients with nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy, and to provide the scientific basis for the implementation of effective care in clinical.Methods:According to the concept of care bundles, query systematic reviews and evidence-based nursing information on the best practices report of the JBI, as well as Cochrane, OVID, Pubmed, NGC, experts to consult, and then draw up the care bundles plan for patients with nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy. From July2010to May2011,120patients with NPC who were initially cured in the department of Radiotherapy of Tumor Hospital of the Guangxi Medical University were selected, and randomly divided into2groups,60patients were selected as experimental group and the other60patients as the control group. There is no significant difference in gender, age, occupation, marital status, education level, income level staging and treatment (P>0.05). Balance of baseline data was comparable. Conventional nursing was applied in the control group, while in the experimental group, conventional nursing and the care bundle were both applied. On admission, the psychological status, nutritional status, the concentrations of Hb, ALB and TP, and the quality of life of the two groups were investigated. The psychological status, poisonous side reaction, nutritional status, and the concentrations of Hb, ALB and TP of the two groups in different periods (the treatment of14days,28days and42days) were investigated. Before discharge, the psychological status, poisonous side reaction, nutritional status, the concentrations of Hb, ALB and TP, and the quality of life of the two groups were investigated.The nutritional status and the quality of life of the two groups were investigated during three months and six months follow-up after their discharge. All the statistical data was analyzed through SPSS13.0package, and the data were considered to be significant as we found that the P was less than0.05(bilateral).Results:1. Two group patients’scores of SAS and SDS comparison in different periods:①On admission, the scores of SAS and SDS (46.78±2.76,49.12±3.10), which were more than the domestic normal persons, were statistically significant(P<0.01).②On admission, the difference of scores of SAS and SDS between the control group and the experimental group, was not statistically significant (P>0.05).③During the treatment, scores of SAS and SDS of two groups showed that:overall scores of SAS and SDS of two group patients assumed the trend of escalation, and the most great change is in the time of42days of concurrent chemoradiotherapy, but the increasing rate of the level of SAS and SDS form of the experimental group is lower than the control group during treatment period (P<0.01).④In different periods (the treatment of14days,28days,42days and discharge), scores of SAS and SDS in patients of the experimental group was lower than that in the control group (P<0.01).2. Two group patients’observation of poisonous side reaction in different periods:①With the advancement of treatment, poisonous side reaction assumed the trend of the escalation (P<0.01).②During the treatment, poisonous side reaction of nausea, vomiting and mucositis, dry mouth in the experimental group was less than that in control group (P<0.05).3. Two group patients’mini-nutritional assessment score and grade levels of nutrition comparison in different periods:①On admission, the difference of two group patients’mini-nutritional assessment score and grade levels of nutrition was not statistically significant (P>0.05).②With the advance of the treatment, the nutritional status of the two groups indicates a falling trend. In different periods, mini-nutritional assessment score of the two groups fell. After patients discharged from the hospital, the nutritional status of two groups assumed a trend of escalation, mini-nutritional assessment score of the two groups increased.③In different periods (the treatment of14days,28days,42days, discharge, three months and six months after their discharge), mini-nutritional assessment score and grade levels of nutrition of the two groups were different, the difference was statistically significant (P<0.05).4. Two group patients’concentrations of HGB, ALB and PA comparison in different periods:①On admission, the difference of the concentrations of HGB, ALB and PA between the control group and the experimental group was not statistically significant (P>0.05).②With the advancement of treatment, the concentrations of HGB, ALB and PA in the two groups assumed a falling trend.③In different periods (the treatment of14days,28days,42days, discharge, three months and six months after their discharge), the concentrations of HGB, ALB and PA of the two groups were different, the concentrations of HGB, ALB and PA in the experimental group was more than those in the control group (P<0.05).5. Two group patients’life quality before and after the treatment:①On admission, various domains form of the quality of life in the two groups were not significant(P>0.05).②After the treatment, the quality of life in the two groups declined. Scores of various functional domains and global heath condition of the experimental group comparing with the control group were statistically higher (P<0.05). Scores in regard to fatigue, appetite loss, swallowing, senses problems, speech problems, trouble with social eating, trouble with social contact, opening mouth, dry mouth and felt ill of the experimental group comparing with the control group were much lower (P<0.05).③Three months and six months after discharge, the quality of life of the patients in the two groups with NPC recovered, the quality of life in the two groups declined. Scores of various functional domains and global heath condition of the experimental group comparing with the control group were higher (P<0.05). Scores in regard to fatigue, appetite loss, swallowing, senses problems, speech problems, trouble with social eating, trouble with social contact, opening mouth, dry mouth and felt ill of the experimental group comparing with the control group were lower (P<0.05). Conclusion:1. Anxiety and depression symptoms existed in patients with NPC. With the advancement of treatment, anxiety and depressive symptoms aggravated. Implementing care bundles can effectively reduce anxiety and depression in patients, and enhance the confidence of patients.2. With the advancement of treatment, the incidence of poisonous side reaction increased, the degree aggravated. Implementing care bundles can effectively reduce the incidence of the poisonous side reaction, vomiting and mucositis, dry mouth for radiotherapy and chemotherapy.3. With the advance of treatment, the nutritional status of patients with NPC assumed a falling trend. Implementing care bundles can effectively improve nutritional status of patients with NPC.4. Concurrent chemoradiotherapy can affect the quality of life of the patients with NPC. After treatment, the quality of life in the two groups with NPC was declined. Implementing care bundles can effectively improve the quality of life of patients with nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy. |
PDF Full Text Request