| Objective:By making end-of-life needs cards game as applied to the patients with advanced lung cancer in the form of death education,guide the patients in the game of death is unable to avoid problems in the process of the thinking,and by sharing chosen card reason to help people release pressure associated with death,then the six-week MBCR intervention on the patients,patients with the heart of mindfulness to actively face the problems existing in the present,Finally,it can improve the death anxiety,anxiety,depression and stress in patients with advanced lung cancer.Method:This study selected 77 patients with advanced lung cancer who were hospitalized in THE SECOND AFFILIATED HOSPITAL OF ZUNYI MEDICAL UNIVERSITY from May 2021 to November 2021 as the research objects,the patients were divided into the control group and the intervention group by the random number table method.The control group was given routine health education,the intervention group was given a six-week end-of-life needs card combined with MBCR nursing measures on this basis,which mainly included four steps:(1)Designed the "End-of-life Needs Questionnaire for Advanced Cancer Patients" and carried out a reliability and effect test,and converted it into the content of the end-of-life needs card.(2)Discussed the MBCR implementation plan with psychologists,and produced a patient guidebook and guided audio for mindfulness cancer rehabilitation training.(3)The patients in the intervention group were divided into groups of 8-10 people according to the order of enrollment,a total of 4 groups of patients.First,this study conducted a face-to-face group form of end-of-life needs card activity,(4)On the second day after the end-of-life needs card activity,the first training of MBCR was carried out in a group form,and the second two trainings were carried out in the form of one-to-one telephone guidance.After the 6-week intervention,the hospital anxiety,depression and stress perception scores of the patients were compared.Results:1.Reliability and validity of the end-of-life needs questionnaire for advanced cancer patients: The end-of-life needs questionnaire for advanced cancer patients has 50 items in 5 dimensions.Internal consistency Cronbach’s alpha coefficient is 0.935.The Cronbach’s alpha coefficient of each dimension is between 0.934-0.945.The test-retest reliability correlation coefficient is 0.859.The I-CVI is between 0.83-1 and the S-CVI/Ave is 0.95.Exploratory factor analysis shows that the total cumulative explanatory variables of the questionnaire are 65.514%.2.Cross-sectional survey:(1)Confirmatory factor analysis shows that the standardized factor loading of each item in this questionnaire is between 0.606-0.830.The AVE value is between 0.527-0.606.The CR value is between 0.902-0.944,and the square root of the AVE value of each dimension is greater than its correlation coefficient with other dimensions.(2)The scores of each dimension of end-of-life needs of advanced cancer patients from high to low are medical service needs(3.70±0.90),psychological needs(3.52±0.87),spiritual needs(3.41±0.76),social support needs(3.29±0.94)),medical decision needs(3.10±0.87),and the total score of end-of-life needs of hospitalized patients with advanced cancer(3.44±0.58).(3)Among the top 10 items of end-of-life needs of advanced cancer patients,the dimensions of medical service needs,the needs of medical choices,psychological needs,social support needs,and spiritual needs include 2items,1 item,3 items,1 item,3 items respectively.(4)Among the last 10 items of end-of-life needs of advanced cancer patients,the need for medical services,the need for medical decision-making,the need for psychological needs,the need for social support,and the need for spirituality include 0,3,2,2,3 items.(5)Age,culture,metastasis,number of hospitalizations,and escort are the influencing factors of the total score of end-of-life needs in advanced cancer patients.3.Intervention results:(1)"B5 I need to have the right to choose a treatment plan and express the expected effect" in the top 10 cards of the end-of-life needs card selection frequency is considered to be the most important need by most patients.The death anxiety score of the intervention group is significantly lower than that of the control group after the end-of-life needs card activity,and the difference is statistically significant(P<0.05).(2)After 6 weeks of MBCR training,the scores of hospital anxiety,depression and stress perception in the intervention group are significantly lower than those in the control group,and the difference is statistically significant(P<0.05).(3)Bootstrap mediation analysis shows that the mediating effect of death anxiety between anxiety,depression and stress is 0.138.The 95% confidence interval [0.021,0.267] does not contain 0,which indicates that the mediating effect is significant.Death anxiety is a mediator of anxiety,depression and stress.Conclusion:1.The "Questionnaire on the End-of-Life Needs of Advanced Cancer Patients" has good reliability and validity,it can be used as a tool for death education and understanding of the end-of-life needs of advanced cancer patients after being converted into the end-of-life needs card.2.Patients with advanced cancer have a higher overall need score at the end of life.The scores of each dimension from high to low are: medical service needs>psychological needs>spiritual needs>social support needs>medical choice needs.Age,culture,transfer,number of hospitalizations,and escort are the influencing factors of patients’ end-of-life needs.3.The use of dying demand cards as a form of death education can effectively reduce the death anxiety of patients.MBCR can effectively reduce patient stress,anxiety and depression.Death anxiety is a mediator of anxiety,depression and stress.The decrease of death anxiety value can reduce anxiety,depression and stress value. |
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