| Objective: Based on the Corbin and Strauss Chronic Illness Trajectory Model, we attempt to understand the needs and experience of patients suffering from primary brain glioma in various developmental stages of disease, and to analyze dynamic changes of patients’ needs and experiences; accordingly, to develop targeted interventions and explore the role and influence of nursing interventions originated from chronic disease trajectory pattern on the quality of life, anxiety and depression level in patients with primary glioma.Method: Sequential exploration strategy was adopted, and this study was mainly divided into two parts. The first part was qualitative research, on the basis of the Corbin and Strauss Chronic Illness Trajectory Model, we selected primary glioma patients received treatments in a tertiary hospital in Suzhou, by means of the phenomenological research methods, we conducted semi-structured in-depth interviews, and analyzed the data using Colaizzi 7-step analysis, to learn the needs and experience of illness-related work,biographical work and everyday life work for glioma patients at the period of diagnosing disease, peri-operative period, the period of accepting chemotherapy and radiotherapy, and the stable period, and accordingly we developed the nursing interventions related to the chronic disease trajectory model. The second part was based on nursing interventions formed on the Corbin and Strauss Chronic Illness Trajectory Model, we proceeded a single-blind, randomized controlled trial, and we included the primary glioma patients meeting the inclusion criteria from a tertiary hospital of Suzhou by method of convenience sampling, the patients were separated to different groups according to the random numbers from random number table. The control group received the routine care and follow-ups were lasted, while the intervention group was added the nursing interventions formed on the Corbin and Strauss Chronic Illness Trajectory Model, the data before intervention andafter intervention(at the time point of discharge, and end of chemotherapy, 3 months after the end of chemotherapy) were collected. EORTC QLQ-C30 scale was adopted as main index, the Hospital Anxiety and Depression Scale(HAD) was taken as a secondary evaluation tool. All data were analyzed and processed with SPSS18.0 statistical package.Results: PartⅠ, the qualitative research: We achieved the experience of four different stages on the Corbin and Strauss Chronic Illness Trajectory Model, which are presented as follows:(1) The period of diagnosing disease: suffering from the severe symptoms of disease; longing for the illness, treatment and other related knowledge. The lack of self-concept, unadapted to the disease. Negative emotions, uncertainty were identified to be the most serious experience.(2) Peri-operative period: the disease symptoms tended to be relieved after surgery or other treatment; longing for the knowledge related to perioperative care, diet, disease. Coming to aeeept the disease; tending to believing fatalism and let the disease be. The contradictory emotions might co-exist; the social role of patients might be suspended temporarily; the economic burden appeared be too heavy;social supports were needed.(3) The period of accepting chemotherapy and radiotherapy:the side effects during chemotherapy and radiotherapy tended to be serious; lacking the knowledge of chemotherapy, complications, rehabilitation exercises. Biographieal work appeared to be recover:reconstituting identity, and recasting biography. Negative emotions tended to be heavier for those patients accompanied by complications; everyday life work gradually recovered within limits; they showed the eager to return the role of society;economic burden tended to be heavy.(4) The stable period: the need for the knowledge on preventing the relapse of diseases, the formation of healthy lifestyle. The biographieal work tended to be stable, the same gone to everyday life work, social role within the limits of disease; the emotions tended to be positive and more appreciation was seen. The part Ⅱ,the nursing intervention based on Corbin and Strauss Chronic Illness Trajectory Model: A total of 69 patients were included in the study, with 34 cases in control group, 35 patients in intervention group. Baseline data for the two groups were not statistically significant(P>0.05). The results show that:(1) Significant differences were found in physical function,cognitive function, role function, emotional function, social function, fatigue, nausea,vomiting, pain, insomnia, appetite loss, pain, diarrhea, constipation economic difficulties,the total health between the intervention group and control group(P< 0.05).(2) The anxiety and depression level in intervention group tend to be lower than the control group,and the difference was statistically significant(P <0.05).Conclusion: The qualitative research results have showed that patients in different disease stages have different experience and needs in illness-related work, biographical work and everyday life work, and tend to change dynamically. The intervention studies have revealed that the Corbin and Strauss Chronic Illness Trajectory Model-based nursing intervention can significant improve the quality of life in patients with primary glioma,relieve anxiety and depression level, which warrants application and promotion. |
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