A Study On The Adjustment Of Psychological Stress Of Patients With Breast Cancer In Perioperative Period Based On Cooperative Dialogue Patient Mutual Aid Model

Objective:As a new psychological nursing model,patient mutual assistance can effectively improve the psychological status of perioperative breast cancer patients.However,since the patient mutual assistance service is still in the development stage,the effect is not very satisfactory.The lack of professionalism and standardization of service capabilities is the main reason restricting its development.This study intends to take the patient mutual help service model for ward visits as an example,and by summing up the relevant factors affecting ward visits and understanding the actual needs of patients,build a cooperative dialogue based breast cancer volunteer patient mutual help training program and evaluate the implementation effect of the program.Methods:In this study,a qualitative research method was used to observe and record the interview process of 56 breast cancer patients undergoing ward visits.Semi-structured interviews were conducted on 9 of these patients,and thematic analysis of the interview data was conducted.Based on the results of qualitative data analysis,a cooperative dialogue-based training program for breast cancer patients'mutual help volunteers was constructed,and patient volunteers were trained.Eighty-one inpatients with breast surgery in a hospital were selected as the research object,and they were divided into a cooperative dialogue visit group?28 cases?,a routine visit group?26 cases?,and a control group?27 cases?by the method of dice throwing.The cooperative dialogue visit group consisted of ward visiting volunteers who were trained to conduct ward visits according to the training requirements;the routine visit group was given routine visits by untrained patient volunteers;the control group had no patient volunteers to conduct ward visits.The two visiting groups received ward visits 1-7 days before surgery and 3-7 days after surgery,and continued to accept volunteer online visit services through We Chat after discharge from hospital to three months after surgery.Self-rating anxiety scale?SAS?,disease uncertainty scale?MUIS?,and body image scale?BIS?were used to evaluate patients'anxiety,disease uncertainty and body image satisfaction.The measurement time was before the visit,after the visit,and three months after the operation.The control group also received the above scale measurement before surgery,at discharge,and three months after surgery.After data collection and collation,univariate analysis of variance,repeated measures analysis of variance,and simple effects test were used to compare the questionnaire scores of the three groups of patients to evaluate the application effect of the training program.Results:1 Qualitative research on mutual assistance services for patients with breast cancerThe results showed that psychological defense,poor communication,noisy environment and single topic were the main factors affecting the ward visit.The communication needs included two aspects of physical rehabilitation and psychological pain:Among them,physical rehabilitation included the function of the affected arm,wound recovery,follow-up treatment,and traditional Chinese medicine;and psychological pain included anxiety,uncertainty,and self-image.Physical rehabilitation needs could be more fully communicated during ward visits,while psychological distress needed to be further strengthened.2 Construction of training program for mutual assistance volunteers of breast cancer patients based on cooperative dialogueBased on the above research results,the cooperative dialogue psychotherapy theory was combined with knowledge about breast cancer and a training program was constructed.Topics include:cooperative positions in communication,"I don't know"-the core of a cooperative attitude,becoming a talking partner,equality and truthfulness,respect,patience and curiosity,as well as breast cancer diagnosis and rehabilitation guidance,postoperative prevention and treatment of arm lymphedema.Knowledge of endocrine therapy,maintenance of PICC,intravenous infusion port,etc.The training was completed in 4 sessions for a total of 10 hours.3 Effectiveness of ward visits based on cooperative dialogues in debugging perioperative breast cancer patients'anxiety,disease uncertainty and body satisfactionThe results of repeated measures analysis of variance showed that the effect of time on the SAS scores were statistically different(F_time=26.432,P<0.001),and there was an interaction between time and groupstime point,at baseline,the SAS scores of the three groups of patients were not significantly different in pairs?P=1.000?.After the visit?the control group was discharged?,the SAS scores of the cooperative dialogue visit group and the routine visit group were significant when compared with the control group?P<0.001?.Three months after the operation,the SAS scores of the cooperative dialogue visit group was still significantly lower than that of the control group?P<0.001?,and there was no significant difference in the SAS scores between the routine visit group and the control group?P=0.659?.For fixed group factors,the SAS scores of patients in the cooperative dialogue visit group after the visit and three months after the visit were significantly lower than those before the visit?P<0.05?,and there was no significant difference between the scores after the visit and three months after the visit?P=0.138?.The SAS scores of patients in the routine visit group after the visit and three months after the visit were significantly lower than those before the visit?P<0.05?,and there was no significant difference between the scores after the visit and three months after the visit?P=0.301?.Patients in the control group had no significant difference in SAS scores before and after discharge?equivalent to those in the visiting group?,and before and after three months of surgery?P>0.05?.Three months after surgery,the SAS scores were significantly lower than that at discharge?P=0.041?.The univariate analysis of variance on the MUIS scores of the patients showed that there was no significant difference in the MUIS scores before the visit of the three groups?F=0.133,P=0.876?;after the visit?when the control group was discharged?,the MUIS scores of the three groups had significant differences?P=0.021?.The MUIS scores of patients in the cooperative dialogue visit group were significantly lower than those in the control group?P=0.047?.There was no significant difference in MUIS scores between the routine visit group and the control group?P=0.619?.Results of analysis of variance with repeated measurements of the patient's BIS scores suggested that there was a statistically significant difference in the effect of time on the BIS scores(F_time=74.307,P<0.001),andcontinue with the simple effects test.For fixed time factors,at baseline,there was no significant difference in BIS scores between the three groups?P>0.050?.After the visit?when the control group was discharged?,the BIS scores of the cooperative dialogue visit group were significantly lower than the control group?P=0.002?,the BIS scores of patients in the routine visit group were not significantly different from that of the control group?P=0.116?.Three months after surgery,the BIS scores of the patients in the cooperative dialogue visit group were still significantly lower than that of the control group?P<0.001?,and patients in the routine visit group.There was no significant difference in the BIS scores between patients in the routine visit group and the control group?P=0.325?.Fixed group factors,there was no significant difference in BIS scores before and after the visit in the cooperative dialogue visit group?P=0.105?,and the BIS scores in the three months after surgery were significantly lower than those before and after the visit?P<0.001?.There was no significant difference in BIS scores before and after the visit in the conventional visit group?P=0.905?,and the BIS scores at three months after surgery were significantly lower than that before the visit?P=0.021?.There was no significant difference in BIS scores at three months after the operation and after the visit?P=0.104?.For the patients in the control group,there were no significant differences in BIS scores before and after discharge,and before and after three months after surgery?P>0.05?,and BIS scores at three months after surgery were significantly lower than at discharge?P=0.024?.The results suggested that cooperative dialogue visits could significantly improve anxiety,body satisfaction,and disease uncertainty in breast cancer patients during perioperative period.Compared with conventional visits,the results of visits were better.Conclusion:Psychological defense,poor communication,noisy environment,and single topic are the main factors affecting the effect of ward visits.Based on this,constructing a cooperative dialogue-based volunteer training program for breast cancer patients based on cooperation and dialogue is an effective measure to guide volunteers in conducting ward visits.It is also an effective strategy to adjust the psychological stress of perioperative breast cancer patients.