Development Of The Protocol Of Supportive Care Intervention For Patients With Lung Cancer

Lung cancer is the most common cancer with the highest incidence rate and the leading cause of cancer mortality both worldwide and in China.Patients with lung cancer generally suffer more psychosocial and physical hardship due to the diagnosis and aggressive treatment than patients diagnosed with other major cancers.In order to manage the psychosocial and physical hardship,researches have been conducted to prove that patients with lung cancer experience high level of supportive care need.Despite clear evidence of the comprehensive needs experienced by patients with lung cancer,these needs were largely unmet.In mainland China,especially,no research specifically targeting supportive care needs for patients with lung cancer has been reported yet,This was partially due to the difficulty in conducting research in this population.Patients' decreased functional status and short duration of survival make research recruitment is difficult and attrition rates is high.Accordingly,supportive care for patients with lung cancer in the Chinese population needs to be focused on.It is particularly important to build a rigorous supportive care intervention protocol to meet the needs of lung cancer patients and promote their comprehensive psychosocial rehabilitation.Aim To develop the protocol of supportive care intervention for lung cancer patients,The ultimate aim is to provide specific methods for the rehabilitation of lung cancer patients.Method Literature analysis,qualitative interview,expert meeting and expert consultation were adopted in this study.(1)Literature analysis: According to the established keywords and retrieval strategy,two researchers retrieved the literaturesfrom the Chinese and English databases.In addition,according to the inclusion and exclusion criterias,researchers conducted literature screening independently.If there is a difference among the researchers,it can be discussed by two parties or decided by the third party.According to the prior established data extraction table,data extraction was conducted.(2)Qualitative interview: Purpose sampling was adopted,the patients and caregivers were recruited from a tertiary hospital in Anhui Province.Researchers explained the intervention draft to patients and caregivers and seek their advice.The process of interview is recorded synchronously with two recordings and written notes.(3)Expert meeting: Ten days before the meeting,the researcher sent the intervention draft to the experts by email.On the expert meeting,the researcher gave the experts a intervention draft by paper once again.With the consent of experts,double recordings are recorded to ensure the effectiveness of the meeting.Besides,researcher gave the demographic data and expert authority self-assessment checklist.(4)Expert consultation:The experts at this stage were the same as the first round of the expert meeting.The researcher distributed an expert consultation questionnaire of the protocol of supportive care intervention for lung cancer patients,the expert authority self-assessment checklist,and patient version and professional version of the protocol of supportive care needs intervention for lung cancer patients.The expert marks the score of the indicators at all levels.The duration of face-to-face intervention was set at 30 min and the duration of telephone follow-up was 10-15 min.The intervention provider is a nurse who is assisted by the relevant doctor.(3)Expert meeting: A total of 11 experts participated in the expert meeting,the expert's coefficient of authority is 0.895.Result(1)Literature analysis: 13 articles included in the analysis.Most studies focused on supportive care needs for patients with prostate cancer,breast cancer,and digestive cancer.In addition,intervention providers include doctors,nurses and volunteers.Interventions were delivered by face-to-face only,telephone only,or a combination offace-to-face and telephone.In the choice of intervention effect index,most studies chose psychometric index.And most studies have the potential to reduce supportive care needs for patients by timely identification and giving tailored intervention.However,compared with usual care,five large-scale trials and three pilot studies failed to show a reduction in unmet needs for cancer patients receiving an intervention at any follow-up time point.(2)Qualitative interview: A total of five patients with lung cancer and five caregivers for patients participated in this interview,revisions to the intervention draft are: In the management of symptoms,the content of “prevention and treatment of vomiting and adverse reactions” was added,and the content such as “Prevention of Pulmonary Infection” was supplemented.The fear of disease progression,intrusive thinking into the psychological needs of the emotional part.According to the expert's opinion,we made the following revisions: The intervention manual was divided into manuals according to the stage of treatment and was separated into patient version and professional version.The form of expression has been modified,and added "postoperative prevention and treatment of constipation" and so on,And merge the "right way to stop smoking","preoperative respiratory preparation" and so on.The intervention time point combined with clinical practice to adjust.(4)Expert consultation:A total of 11 experts participated in the questionnaire,the questionnaire recovery rate was 100%,the expert coefficient of authority was 0.90,the coordination coefficient of the second-level expert opinion was 0.267(p < 0.001),and the third-level expert opinion coordination coefficient was 0.174(p < 0.001),The mean value of the importance of indicators at all levels ranged from 4.00 to 4.91,both of which were greater than 3.5,and the coefficients of variation were all less than 0.25.The opinions of experts were basically the same,and all the indicators were retained.Conclusion The reliability and scientificity of the protocol were guaranteed in theory and practice.But due to time constraints,and considering the completeness of theresults report,This study only reports the construction process and the results of the intervention protocol.Next,Our team is supposed to be based on the feasibility study,Further revising the intervention protocol,and a clinical randomized controlled trial will be conducted to verify the effectiveness.