| Objective:This study investigated the longitudinal changes of the symptom clusters of cervical cancer patients during three-dimensional painless brachytherapy on the basis of the cervical cancer symptom assessment scale,and explored the composition and change trajectory of the symptom clusters of patients at different time points.Further develop a set of management programs suitable for patients with cervical cancer brachytherapy,which can reduce the symptoms of patients,and evaluate the clinical application effect of this program.Methods:1.Longitudinal study of symptom clusters in patients with cervical cancer during three-dimensional painless brachytherapy(1)Strictly according to the inclusion and exclusion criteria,cervical cancer patients who received brachytherapy in a Grade three A general hospital,Guangdong Province from October 2021 to February 2022 were selected for questionnaire survey at six different time points.(2)To analyze the frequency,intensity and change of symptoms over time.Symptom clusters were extracted by exploratory factor analysis to explore the longitudinal variation of symptom clusters over time.2.Construction of symptom clusters management program for patients with cervical cancer during three-dimensional painless brachytherapy(1)In order to construct the first draft of symptom clusters management program for patients with cervical cancer during three-dimensional painless brachytherapy,Chinese and English literatures from Pub Med,CNKI and other Chinese and English databases until June 2022 were retrieved.(2)Expert letter consultation: 12 experts from the hospital and related fields were selected.After two rounds of letter consultation,the final draft of symptom clusters management program for patients with cervical cancer during three-dimensional painless brachytherapy was revised based on expert opinions.3.Preliminary application of symptom clusters management program for patients with cervical cancer during three-dimensional painless brachytherapy(1)78 patients who received brachytherapy for cervical cancer in the inpatient Department of a Grade three A general hospital,Guangdong Province from May 2022 to August 2022 were included,with39 cases in each group.(2)The control group was treated with routine nursing,and the intervention group was treated with symptoms clusters management program for patients with cervical cancer in close proximity.(3)SPSS 25.0 was used for statistical analysis of the data.If the measurement data met the normal distribution,it was expressed by mean ± standard deviation.If the normal distribution is not satisfied,the median and interquartile spacing are used.Counting data is expressed as frequency(percentage).Independent sample t-test was used for data satisfying normal distribution.Non-parametric test was used for data that did not satisfy the normal distribution.If normal distribution and homogeneity of variance are satisfied,repeated measure analysis of variance is adopted.Chi-square test was used for statistical analysis of the counting data.Results:1.Longitudinal investigation of symptoms in patients with cervical cancer during brachytherapy(1)This study found that at 6 different time nodes,the number of symptoms often appeared in patients with brachytherapy for cervical cancer was 5-14,and the number of symptoms gradually decreased with the passage of time in stage T1-T6.These symptoms are: nervousness,anxiety,pain,weakness or fatigue,vaginal or vulva discomfort or pain,abnormal vaginal bleeding/discharge,discomfort when urinating,burning pain when urinating.(2)There were 6 symptom clusters in patients with brachytherapy for cervical cancer from the beginning to the end of treatment,including somatic and psychological discomfort symptom clusters,urinary system related adverse reaction symptom clusters,pain related symptom clusters,chemotherapy related adverse reaction symptom clusters,vaginal related adverse reaction symptom clusters and intestinal related adverse reaction symptom clusters.(3)Chemotherapy related adverse reaction symptom cluster appeared at T1 time point.Pain related symptom cluster appeared at T1,T2 and disappeared after T3.Somatic and psychological symptoms only appeared in T1 and T2 periods.The symptom clusters of urinary related adverse reactions persisted during T1-T4,T6.The symptom clusters of vagina-related adverse reactions existed in T1,T3-T6 period.A cluster of intestine-related adverse reactions first appeared in T3 and persisted with T4 and T5.2.Construction of symptom clusters management program for patients with cervical cancer during brachytherapy(1)In the two rounds of correspondence,the questionnaire recovery rates of the experts were100% and 83.3%,75% and 60% of the experts put forward suggestions for modification,and the authority degree Cr of the experts in the two rounds was 0.91 and 0.93,respectively,indicating that the scheme was highly scientific.(2)Through literature review and expert correspondence consultation with Delphi method,the final intervention plan was formed,which included 4 periods of brachytherapy with 18 items.The four periods were before brachytherapy,during brachytherapy,discharge and follow-up.Including psychological assessment of symptoms,assessment of symptoms clusters of nursing intervention education and other specific measures3.Application of symptom clusters management program for patients with cervical cancer during three-dimensional painless brachytherapy(1)Symptom clusters total score and symptom score in two groups were analyzed using the independent sample Mann-Whitney U test.Results show that the different period of intervention group patients symptoms clusters scored lower than the control group,the difference was statistically significant,P<0.05.(2)The average score of anxiety and depression in the intervention group at discharge was18.68±1.77,lower than that in the control group(27.64±2.76),P<0.001.One month after discharge,the scores of anxiety and depression in the intervention group and the control group were 18.42±1.91 and25.54±2.01,respectively,P<0.001.(3)The average quality of life score of patients in the intervention group at discharge was122.47±4.05,higher than that in the control group(113.82±4.95),P<0.001.One month after discharge,the life quality scores of the intervention group and the control group were 123.39±4.03 and 115.03±3.57,respectively.P<0.001.Conclusion:1.Although the number of symptoms experienced by patients with cervical cancer during brachytherapy is small,there are dynamic changes,which affect patients’ quality of life.Clinical staff should develop preventive and targeted intervention programs according to the characteristics of the symptom cluster at each stage: during T1 and T2,emphasis should be placed on the intervention of somatic-psychological discomfort and pain-related symptom clusters.During T3,T4 and T5,the vaginal,urinary and intestinal-related adverse reaction symptom groups were mainly intervened,while during T6,the urinary and vaginal-related adverse reaction symptom groups were focused.2.Through the first part of the investigation of patients’ symptom groups,the second part of the guide retrieval and two rounds of expert consultation,the symptom group management program for cervical cancer patients during three-dimensional painless brachytherapy is highly scientific,practical and reliable.This program can provide patients with systematic and continuous symptom management,which contributes to improved quality of care.3.Symptom cluster management during three-dimensional painless brachytherapy is an intervention that can be implemented clinically without potential adverse effects.The symptom group management scheme during 3D painless brachytherapy is scientific,practical and reliable.It can reduce the adverse reactions of patients after brachytherapy and improve the quality of life.Reduce the length of hospital stay of patients,reduce the economic burden caused by the disease on the family,has better social benefits. |
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