| Objective:To design a truth disclosure project for cancer patients undergoing chemotherapy by medical and nursing integration,and to explore the influence of the project on the status of cancer patients' cognition,anxiety,depression,quality of life and nurse-patient communication satisfaction.Method:1.The design of truth disclosure project for cancer patients undergoing chemotherapy by medical and nursing integration.By the methods of literature review and Delphi expert consultation,we designed truth disclosure project and strategy for cancer patients undergoing chemotherapy by medical and nursing integration.2.The clinical effect observation of truth disclosure project for cancer patients undergoing chemotherapy by medical and nursing integration.This part of the study was non-randomized controlled trial study,and adopted the non-synchronous control design.In order to avoid different reactions caused by different chemotherapy protocol,this study selected common gastrointestinal cancer patients in our country as the research object.A convenience sampling method was used.89 cases of gastrointestinal cancer patients undergoing chemotherapy from December 2016 to March 2017 were enrolled into the control group according to the time of admission.In order to avoid contamination,the study on experimental group did not begin until all the patients in the control group completed their test.From July 2017 to October 2017,93 patients of gastrointestinal cancer patients undergoing chemotherapy were selected as the experimental group.The control group was given routine nursing care: nurses did not actively participate in the truth disclosure,gave medical protection to the cancer patients according to the request of the family and did not tell the diagnosis and examination results to the patients without the consent of the families.In addition to the routine nursing,the experimental group patients and their family were assessed on the disclosure status and their willing on truth disclosure by the nurse within 24 hours of admission.For the family members who did not want the patients to know the truth,we gave intervention by truth disclosure project for cancer patients undergoing chemotherapy by medical and nursing integration.The doctors,nurses,and the family members together discussed the truth disclosure strategy.At the time of first informing the truth,the responsibility nurses presented with the doctor,and timely support and educational intervention was done for the patients after truth disclosure.Observation index: For the situation that patients not only knew their cancer diagnosis,but also knew the tumor staging and prognosis,completely disclosure was recorded.For the situation that the patients only knew cancer diagnosis,and did not know tumor stage and prognosis,partly disclosure was recorded.For the situation that patients did not know their diagnosis at all,truth non-disclosure was recorded.The informed status of the two groups was evaluated before and after the 3 cycles of chemotherapy.Self-rating Anxiety Scale(SAS),self-rating Depression Scale(SDS)and the EORTC Quality of Life Questionnaire-Core 36(QLQ-C30)were used to evaluate the anxiety,depression scores and quality of life in two groups before and after 3 cycles of chemotherapy.The satisfaction degree of information communication of nurses in two groups after three chemotherapy cycles was investigated by using the DNPCSQC(clinical nurse patient communication satisfaction questionnaire).The SPSS21.0 software was used for statistical analysis.Result1.Truth disclosure project and strategy for cancer patients undergoing chemotherapy by medical and nursing integration was formulated scientifically.2.The final study was completed in 85 cases of the control group and 88 cases of the intervention group in gastrointestinal cancer patients undergoing chemotherapy.There were no significant differences in the general data of the two groups,the rate of truth disclosure before chemotherapy,the scores of anxiety and depression,and the scores of life quality in all areas.3.After intervention,the informed status of patients in the intervention group(completely disclosure 57.95%,partly disclosure 32.96%,and non-disclosure 9.09%)was different from that in the control group(completely disclosure 35.30%,partly disclosure 42.35%,and non-disclosure 22.35%),and the difference was statistically significant(P < 0.01).4.The anxiety(SAS)and depression(SDS)scores in the intervention group were significantly lower than those before intervention(P < 0.01).The anxiety and depression scores in the control group were significantly higher than those before chemotherapy(P < 0.01).After 3 cycles of chemotherapy,the scores of anxiety and depression in the intervention group were lower than those in the control group(P < 0.01).5.After three cycles of chemotherapy,the total health status,body function,role function,emotional function,cognitive function,social function,fatigue,nausea and vomiting,and loss of appetite were statistically significant in the EORTC QLQ-C30 between the experimental group and control group(P < 0.05).6.The five items of nurse communication time,the amount of information given by nurses,the nurse given information content,and mutual understanding with nurse communication,and the effect of providing information for help was higher than those of the control group(P < 0.01).ConclusionThe truth disclosure project and strategy for cancer patients undergoing chemotherapy by medical and nursing integration is feasible.The truth disclosure project and strategy for cancer patients undergoing chemotherapy by medical and nursing integration can improve the truth disclosure rate of patients with chemotherapy and nurse patient communication satisfaction,and improve the degree of anxiety and depression and quality of life of chemotherapy patients.This study provides a theoretical basis and specific guidance for nurses to participate in cancer chemotherapy patients' truth disclosure. |
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