| Objective:1.To investigate the preoperative anxiety,depression and cognitive function of patients with laryngeal carcinoma,and to analyze the correlation between anxiety,depression and cognitive function and the influencing factors of cognitive function.2.Construct a cognitive behavioral intervention program for patients with laryngeal carcinoma.3.Try the cognitive behavioral intervention program for patients with laryngeal carcinoma and evaluate the effect.Methods:1.From September 2017 to November 2018,89 patients who will carry out surgery for the first diagnosis of laryngeal carcinoma in two top-three hospitals,using the Hamilton Anxiety Scale(HAMA)and Hamilton Depression Table(HAMD),Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),Minimum Mental State Examination(MMSE),Montreal Cognitive Function Scale(MOCA)6 assessment tools for patients before surgery Anxiety,depression and cognitive function were investigated.The correlation between preoperative anxiety,depression and cognitive function and the factors affecting preoperative cognitive function in patients with laryngeal carcinoma were investigated by univariate analysis,correlation analysis and binary logistic regression analysis.2.Based on the literature review method and expert group meeting method to construct cognitive intervention program for patients with laryngeal carcinoma.3.From March 2018 to November 2018,a small sample trial intervention was conducted through the experimental design and the effect was evaluated.According to the purpose sampling method,25 patients with abnormal emotion and/or cognitive function in the investigational study were selected.According to the order of admission,14 patients were divided into control group and 11 patients in the intervention group.The control group received routine nursing.The intervention group was here.Based on the implementation of cognitive behavioral intervention programs.Based on the evaluation tools used in the investigative study,the Functional Assessment of Cancer Therapy-Cognitive Function(FACT-cog)and the Functional Assessment of Cancer Therapy-Head&Neck(FACT-H&N)were added to a total of 8 assessment tools for the two groups.The patients'anxiety,depression,cognitive function,and quality of life were investigated before and after the intervention,and data were collected by telephone follow-up 2 weeks after the intervention.Intervention effects were analyzed by independent sample t-test,analysis of variance,non-parametric rank sum test,(~2 test,and Fisher's exact probability method.The two-sided test level?=0.05.Results:1.(1)The preoperative HAMA score of patients with laryngeal cancer was 4~12(7.52±2.08),and 19(21.34%)had anxiety(HAMA?7).The total score of HAMD was 3~12(6.88±2.26),and 13 cases(14.61%)had depression(HAMD?8).The total score of SAS was 32~65(46.58±5.88),and 25 cases(28.09%)had anxiety(SAS?50).The total score of SDS was 33~59(45.39±5.81),and 13 cases(14.61%)had depression(SDS?53).The SAS and SDS scores were compared with the Chinese norm for single-sample t-test.The scores of patients with laryngeal cancer were higher than the domestic norm,and the difference was statistically significant(P<0.05).(2)The total cognitive function of patients with first-episode laryngeal cancer assessed by MMSE was 22~30(27.69±1.83),and 89 patients were higher than the cut-off value compared with the corresponding cultural level cut-off value.The total cognitive function of MOCA in patients with first-episode laryngeal cancer was 16~29(25.06±2.05),and 43patients(48.31%)had cognitive dysfunction.(3)There was a negative correlation between HAMA,HAMD,SAS,SDS and cognitive function(P<0.01),and the correlation coefficients were-0.573,-0.487,-0.620,-0.500,respectively.Among them,HAMA was negatively correlated with visual ability and execution ability,attention,language,and delayed recall(P<0.01).HAMD was negatively correlated with visual ability and execution ability,language(P<0.01),SAS and visual space and execution ability,Note that the language was negatively correlated(P<0.01),and SDS was negatively correlated with visual ability and execution ability,attention,and language(P<0.01).(4)Age,education level,and SAS are the influencing factors of preoperative cognitive function in patients with laryngeal cancer.Age and SAS are risk factors,and education level is a protective factor.2.According to the literature review and discussion of the expert group meeting,a cognitive behavioral intervention program for laryngeal cancer patients combined with telephone interviews was conducted once every 5 days,45 minutes,and 6 times.3.The baseline data of the control group and the intervention group were comparable,and the comparison between the group before and after the intervention group was found:(1)Anxiety and depression:The comparison between the two groups showed that the anxiety and depression(HAMA,HAMD,SAS,SDS)of the two groups were lower than those at admission,and the difference was statistically significant(P<0.05).The comparison between groups showed that the anxiety and depression scores of the intervention group were lower than those of the control group,and the difference was statistically significant(P<0.05).(2)Cognitive function:The comparison within the group showed that the cognitive function of the intervention group was higher than that of the admission group(P<0.05),and there was no significant difference between the control group(P>0.05).The scores of MMSE,MOCA total score,visual space and execution ability,attention,and delayed recall were higher than those of the control group,and the difference was statistically significant(P<0.05).(3)Quality of life:The intra-group comparison showed that the FACT-cog,FACT-H&N,and FACT-H&N scores of the intervention group were higher than those before the intervention(P<0.05),and the difference between the FACT-cog and the control group was not statistically significant(P>0.05).After the intervention,the comparison between the groups showed that the FACT-cog total score and perceived cognitive ability,quality of life,other people's comments,the FACY-H&N total score,and the social/family status and emotional status scores were high.In the control group(P<0.05),there was no significant difference in other dimensions(P>0.05).(4)Follow-up results:Two weeks after the intervention,patients were anxiously,depressed(SAS,SDS),cognitive function(MOCA),and quality of life(FACT-H&N)were followed up by telephone,and variance analysis was performed before and after the intervention:The SAS and SDS scores of the two groups were decreased(P<0.05)and the FACT-H&N scores were increased(P<0.05).The MOCA scores of the intervention group were increased(P<0.05),while the MOCA changes in the control group were not statistically significant(P<0.05).Conclusion:1.Patients with laryngeal cancer have obvious anxiety,depression and cognitive dysfunction before operation.MOCA can be used to assess patients with mild cognitive impairment,and combined with MMSE to further determine the degree of cognitive impairment for early prevention.2.Preoperative anxiety and depression were negatively correlated with cognitive function in patients with laryngeal cancer,indicating that the more serious the anxiety and depression of patients,the worse the cognitive function,and the improvement of negative emotion may have a certain effect on improving cognitive function.Factors affecting preoperative cognitive function include age,education level,and SAS,suggesting that psychological care and health education should be strengthened before surgery to alleviate anxiety and improve cognitive function.3.Cognitive behavioral interventions developed by literature review and expert group meetings can improve patients'anxiety,depression,cognitive function and quality of life,which is better than conventional care group;routine care can improve patients'anxiety,depression and quality of life.However,it has no obvious effect on its cognitive function.In summary,the program is feasible and effective. |
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