Construction And Application Effect Of Family Meeting Mode For Patients With Advanced Cancer

Part One Research on the construction of family meeting modeObjective: To initially construct a family meeting model for patients with advanced cancer,describe the people,forms,contents,processes and evaluation indicators of family meetings and can be used as a guide for the clinical practice of family meetings of the patients with advanced cancer.Methods: An expert consultation questionnaire of family meeting was formed,based on the previous literature review,semi-structured interviews,group discussions and other investigations and studies.Then the modified Delphi technique was used to identify the items through two rounds of expert consultation among 20 experts.Results:1.The positive coefficients of experts in the two rounds of consultation were 100%,the authoritative coefficients were 0.73 and 0.72,respectively.The coordination coefficient of expert advice in the two rounds were 0.227(P <0.001)and 0.343(P <0.001),respectively.2.The family meeting model constructed in this study had four first-level indicators: family meeting time,form and participants,pre-meeting preparation,meeting holding process,and post-meeting follow-up.The consultant rated the importance of the listed items > 4 points and the coefficient of variation < 0.3,and finally formed 43 items.Conclusions: Based on the expert consensus of family meeting and literature search at home and abroad,the modified Delphi method was used to form the family meeting model for patients with advanced cancer,and the results were scientific and reliable.Part Two The second part the research on the application effect of family meeting modelObjective: To use the family meeting model of patients with advanced cancer to hold family meeting,and to evaluate the influence of this model on the quality of life of patients,as well as the degree of distress,psychological status,and satisfaction of medical communication on the concerns of patients' main caregivers.Methods: This study was conducted in a non-randomized controlled trial with a non-synchronous control design.A total of 32 patients with advanced cancer who met the inclusion criteria and admitted to the medical oncology of three-A hospital from September 2019 to November 2019 were selected as the control group by convenient sampling method,and the treatment and nursing were carried out according to the treatment plan and nursing routine of the medical oncology.A total of 32 patients with advanced cancer who met the inclusion criteria from December 2019 to January 2020 were selected as the experimental group,except for routine therapy and nursing,the constructed family meeting mode was adopted to hold family meeting within 72 hours after admission,including pre-meeting preparation(to evaluation mainly concerns of patients,information demand,site preparation,etc.),main process of meeting(the opening,the self introduction,information share,discuss,and so on),the post-meeting follow-up(to evaluate the solution degree of concerns of main caregivers in 48 hours after meeting,two weeks after assess patients' quality of life in the two weeks after meeting,follow up regularly in We Chat group).Participants included: the moderator(the superior physicians or department head could hold meeting),concerned doctor,nurse,1-3 patients primary caregivers of patients or the patient's medical decision agents,to decide whether to invite psychological consultant or dietitian according to the evaluation results,and to determine whether patients after discussions with family members to attend according to the patient's personality and will.Observational indexes: At admission and two weeks later,patients in both groups were rated on the quality of life scale(EORTC-QLQ-C30).At the time of admission and 48 hours after the family meeting,the main caregivers of the experimental group were assessed with a questionnaire before and after the meeting to assess their degree of distress.At admission and two weeks later,the primary caregivers of the two groups were scored using the self-rating anxiety scale(SAS),the self-rating depression scale(SDS),and the cancer clinical doctor-patient/nurse-patient communication satisfaction questionnaire(DNPCSQC).Results:1.Two weeks after admission,scores of role function,emotional function,cognitive function and general health in EORTC QLQ-C30 in the experimental group were higher than those in the control group,and scores of symptoms were lower than those in the control group,with statistically significant differences(P<0.05).2.The degree of distress of main caregivers' attention problems in the experimental group was significantly lower 48 hours after the family meeting than that at admission(P<0.05).3.Two weeks after admission,the SAS and SDS scores of the main caregivers in the experimental group were lower than those in the control group,and the doctor-patient/nurse-patient communication satisfaction scores were higher than those in the control group,with statistically significant differences(P<0.05).Conclusions: The clinical application of structured family meeting model has a good effect,which could improve the life quality of patients with advanced cancer,effectively reduce the anxiety,depression and the degree of distress of main caregivers' major concerns of the mild cancer patients,and improve their satisfaction with medical communication.Structured family meetings for patients with advanced cancer are essential.