The Application And Evaluation Of Stepped Care Models In Psychological Distress Of Patients With Head And Neck Cancer

Objective:To explore the effect of the stepped care models on improving the psychological distress of patients with head and neck cancer and its impact on patients'quality of life,and to lay the theoretical and practical basis for the research in the field of psychological care for patients with head and neck cancer.Methods:This research was designed according to a randomized controlled trial.104 HNC patients with psychological distress were selected from the oncology department,otolaryngology department,general surgery department and stomatology department of our hospital from May 2017 to May 2018.They were randomized to the intervention group?52cases?and the control group?52 cases?according to random number table method.The control group was given usual psychological care,including admission education,disease knowledge and general psychological support.Intervention group received a 4-step stepped psychological care program guided by stepped care models:1 week of watchful waiting,2weeks of guided self-help,3 weeks of face-to-face PST course,4 weeks of professional psychotherapy and/or psychotropic medication.It's mainly carried out by the nurses,senior nurses,nurses with psychological counseling qualifications,psychiatrists or psychological counselors gradually.Patients'general information questionnaire,the Hospital Anxiety and Depression Scale?HADS?,the core quality of life scale?EORTC QLQ-C30 V3.0 and QLQ-H&N35 V1.0?,care service satisfaction scale?NSNS?were selected as the research tools for pre-and post-intervention evaluation.HADS scale was used for psychological assessment of patients after each step to determine whether the patient met the effective criteria for intervention.The ineffective ones proceeded the next intervention,and the effective ones didn't receive subsequent intervention.The data was statistically analyzed using SPSS19.0.Results:1.The research results of the general information showed that there was no statistically significant difference in general information between the two groups?P>0.05?.2.The research results of the study on psychological distress showed that there was no significant difference in HADS score,anxiety and depression sub-score before intervention?P>0.05?.After the psychological intervention,all three scores of the intervention group were lower than those in the control group,and there's a statistical difference?P<0.05?.The anxiety score decreased?3.38±1.85?,the depression score decreased?3.71±2.02?,and the total score decreased?7.10±3.02?.The decrease degree of anxiety and depression score was better,with statistically significant difference?P<0.05?.In each stage of intervention,3patients?T₁?,12 patients?T₂?,15 patients?T₃?,and 7 patients?T₄?of intervention group were effective and there were 37 cases in total.6 patients?T₁?,4 patients?T₂?,6 patients?T₃?,and2 patients?T₄?of control group were effective and there were 18 cases in total.In the intervention group,the effective rate of intervention in the first stage?6.00%?was lower than that in the control group?14.54%?without statistical difference?P>0.05?.The rate in the subsequent stages and the overall effective rate?71.15%?was higher than that in the control group?34.61%?,with statistically significant difference?P<0.05?.3.The results of the study on quality of life showed that there was no statistical difference in the scores of QLQ-C30 and QLQ-H&N35 in all fields between the two groups before intervention?P>0.05?.After the intervention,the 11 scores of the intervention group on QLQ-C30 were higher than that of control group,including physical function,role function,emotional function and other fields.And the scores of 11 fields on QLQ-H&N35 were superior to the control group,such as head and neck pain,swallowing function,feeling etc,with statistical difference?P<0.05?.Among them,in 13 fields of QLQ-C30 the 13 scores of the intervention group on QLQ-C30 were higher than before,such as body function,role function,emotional function etc.The same as the 13 fields of QLQ-H&N35,such as head and neck pain and swallowing function etc,with statistical difference?P<0.05?.The physical function,emotional function,cognitive function,social function and overall health status of the control group on QLQ-C30 were improved compared with before,and the fatigue symptoms were improved,but there was no statistical difference?P>0.05?.The score of control group only in the sensation and social relations on QLQ-H&N35 were better than before and the difference was statistically significant?P<0.05?.4.The results of the study on care service satisfaction showed that the satisfaction of care service in the intervention group?81.15±7.70?was better than that of the control group?67.89±7.79?after intervention,and the difference was statistically significant?P<0.05?.Conclusion:The stepped care models can gradually and effectively improve the psychological distress for head and neck cancer patients with anxiety or depression,and improve the overall quality of life and care services satisfaction of patients,with important operability and clinical practice value.