| Objective: 1.To explore the types of symptom clusters in postoperative gastric cancer patients during intermittent chemotherapy,so as to provide scientific basis for the management of symptom clusters.2.According to Symptom Management Theory and combined with symptom cluster types,nursing intervention plan was formulated to intervent the symptom clusters in intermittent chemotherapy for postoperative patients with gastric cancer.To analyze the intervention effect on symptom burden,anxiety,depression and quality of life of patients and to continue the practice and development of continuity of care in the field of cancer.3.To deeply understand the real experience of patients and intervention team members in symptom clusters management during intermittent chemotherapy,and provide basis for improving symptom clusters intervention plan in the future.Methods: This study is a mixed methods research consisting of two parts.1.Part I: Quantitative research（1）The mothod of exploratory factor analysis was used to extract the symptom clusters of gastric cancer patients during intermittent chemotherapy.A total of 200 patients who received chemotherapy for the first three times after gastric cancer surgery in a top three hospital in Shanxi province from April 2020 to April 2021 were selected as the investigation subjects.MSAS-Ch was used to conduct a questionnaire survey.SPSS 24.0 was used for statistical analysis to determine the types and composition of the first three intermittent chemotherapy symptom clusters in postoperative gastric cancer patients.（2）Through quasi-experimental study design,49 patients who started first chemotherapy from April 2021 to July 2021 formed the control group,and 49 patients who started first chemotherapy from August 2021 to November 2021 formed the intervention group.Intervention was performed during the first,second and third chemotherapy intervals（each interval was 2 weeks）for a total of 6 weeks.The control group was given usual care during intermittent chemotherapy,and the intervention group received nursing intervention based on Symptom Management Theory on the basis of usual care.Using MDAS-Ch,SAS,SDS and QLQ-STO22 to compare two groups’ Symptom burden,anxiety,depression and quality of life scores.T-test,Wilcoxon test and x2 test were used for data analysis,and the test level was α=0.05,P < 0.05 was considered statistically significant.2.Part II: Qualitative research Descriptive phenomenological research method is adopted.Purposive sampling method was used to select eleven patients receiving intervention and five intervention group members for one-to-one semi-structured interviews.Colaizzi 7 step method was used to refine theme.Results: 1.Exploratory factor analysis results showed that there were 19 symptoms with an incidence of ≥20%,characteristic value of ≥1,and the factor loading of ≥0.45 in the first three intermittent chemotherapy after gastric cancer surgery,and 5 symptom clusters could be extracted.The cumulative variance contribution rate was 67.69%,which were:（1）Digestive tract symptom cluster（vomiting,nausea,dysphagia,loss of appetite,feeling of body swelling/abdominal distension,oral ulcer）,（2）Disease concomitant symptom cluster（weight loss,lack of energy/fatigue,pain,difficulty concentrating）,（3）Chemotherapy-specific symptom cluster（numbness or tingling in hands and feet,hair loss,itchy skin）,（4）Emotional affective symptom cluster（irritability,feeling "I don’t look like myself",anxiety）,（5）Neurohumoral system symptoms cluster（nervous tension,dizziness,arm or leg swelling）.Cronbach’s coefficients of internal consistency within the clusters were 0.920,0.911,0.953,0.871,0.557.2.Results of Quasi-experimental study（1）Finally,4 samples were dropped from the control group and the intervention group,and 49 patients were included in each group.（2）Before intervention,baseline data of the two groups were equally comparable（P>0.05）.（3）Comparison of Memorial Symptom Assessment Scale-Chinese:（1）When comparing groups,before intervention,two groups of patients’ total scores and scores of each symptom were no statistical difference（P>0.05）;After intervention,13 symptoms’ scores were no significant difference,including cough,lethargy,feeling of abdominal distention,dysuria,dyspnea（P>0.05）,however,there were statistic difference between the total score and 18 symptoms,such as difficulty in concentration,pain,fatigue,mental tension,dry mouth（P<0.05）,indicating that the symptom burden was reduced on the whole.（2）Within the group,there were statistically significant differences in the scores of pain and loss of appetite before and after intervention in the control group（P<0.05）,but there were no statistic difference in the scores of total scores and other 29 symptoms（P>0.05）;There was no statistic difference in the scores of cough,feeling body swelling/abdominal distension,dysuria and oral ulcer in the intervention group before and after intervention（P>0.05）,and the scores and total scores of the other 27 symptoms were lower than before intervention,with statistically significant differences（P<0.05）.（4）Comparison of Self-Rating Anxiety Scale:（1）When comparing groups,before intervention,two groups of patients’ scores were no statistical difference（P>0.05）;After intervention,the intervention group scored lower than the control group,there was a significant statistic difference in scores between the two groups（P<0.001）.（2）There was no significant difference in the scores of the control group before and after intervention（P>0.05）;The scores of the intervention group were significantly different before and after the intervention（P<0.001）.（5）Comparison of Self-rating depression scale: This description of result was It is basically consistent with the description of the fourth result（It is comparison of Self-Rating Anxiety Scale）.Here will not repeat it.（6）Comparison of Quality of Life Questionnaire of Stomach 22:（1）When comparing groups,before intervention,scores and total scores in all areas of quality of life between the two groups of patients had no statistic difference（P>0.05）;After intervention,the total scores and areas of pain,reflux,restricted eating,anxiety,dry mouth and body appearance showed statistic differences（P<0.05）,while there were no statistic difference in dysphagia,altered taste and alopecia（P>0.05）.It can be seen that the quality of life of patients in the intervention group was improved on the whole.（2）There were statistically significant differences in the scores of anxiety and taste change before and after intervention in the control group（P<0.05）,but there were no statistically significant differences in the total scores and other scores（P>0.05）;There were no statistically significant differences in the scores of eating restriction and hair loss before and after intervention in the intervention group（P>0.05）,while there were statistically significant differences in the scores of total scores and other areas（P<0.05）.3.Qualitative research results show that 16 interviewees were included in this research,and 3 themes and 10 sub-themes were summarized and extracted.The subjects were self-experience of patients during the intermittent chemotherapy,evaluation of symptom clusters intervention,and reflection on symptom clusters intervention.The corresponding sub-themes were reduced symptom burden,improved self-coping ability,reduced psychological stress and role conflict,and able to correctly view self-esteem and image.Symptom cluster intervention has positive effects on patients and caregivers,and can promote the process of continuous nursing service.Symptom cluster intervention should give priority to satisfying patients’ physiological comfort needs,actively providing information support for patients,giving play to the role of patients’ various support systems,and insisting on diversified intervention forms.Conclusions:1.There are multiple symptoms in postoperative patients with gastric cancer during the intermittent chemotherapy.In this regard,the establishment of nursing intervention program based on Symptom Management Theory and the implementation of flexible and diverse interventions through patient group,Tencent video conference and telephone follow-up can improve part of the symptom burden of patients,effectively reduce their anxiety and depression levels,and improve their quality of life.2.Symptom clusters intervention during the interval of chemotherapy has a positive impact on patients,Patients believe that the symptom group management method is convenient,practical and effective,and can solve the problem of inadequate self-coping ability of patients.Which reflects the characteristics of modern nursing that is patient-centered and pays attention to saving medical costs.It can also improve the ability of nurses to provide continuous care and promote the continuation of hospital care to the community and family. |
