首次化疗的妇科恶性肿瘤患者完成全程用药的影响因素分析

Analysis of influencing factors on the completion of full course medication in gynecological malignant tumor patients undergoing first time chemotherapy

目的探讨首次化疗的妇科恶性肿瘤患者完成全程用药的影响因素,为提高用药依从性、完善妇科恶性肿瘤患者的化疗用药管理流程提供依据。方法选取2020年8月至2021年7月于首都医科大学附属北京妇产医院首次化疗且至少完成3个疗程的妇科恶性肿瘤患者,通过自行设计的化疗全程用药调查问卷,评价患者全程化疗过程中对化疗辅助药物的基本用药知识认知、用药依从性和化疗不良反应的应对能力,收集这三个量表中评分最高、最低的条目,并采用Pearson相关系数法分析基本用药知识认知、用药依从性、化疗不良反应应对能力得分之间的关系。结果单因素分析显示,付费方式、慢性病史、化疗后服药频次是首次化疗患者基本用药知识认知得分的影响因素,职业、经济来源是用药依从性得分的影响因素,职业、居住地、付费方式、化疗后服药种类是化疗不良反应应对能力得分的影响因素(P<0.05)。基本用药知识认知得分最高的条目是“了解所服药物的用法”,得分最低的条目是“了解忘记服药后的处理方法”;患者在自觉症状更坏时没有自行增加药量方面用药依从性最高,患者在无忘记服药的经历方面用药依从性最低;化疗不良反应应对能力得分中,得分居前3位的条目依次为“了解发热的处理方式”“了解便秘的处理方式”“了解腹泻的处理方式”,得分居后3位的条目依次为“了解血小板减低的危险”“了解血小板减低后的注意事项”“了解化疗后肝功能异常的处理方式”。Pearson相关系数法分析显示,化疗不良反应应对能力得分与基本用药知识认知、用药依从性得分呈正相关(P<0.05)。结论使用新农合付费、有慢性病史、化疗后服药频次>3次/d的患者对化疗辅助药物的知识认知水平较低,依靠退休金生活的患者用药依从性低,使用新农合付费的患者、化疗后服药种类≥5种的患者化疗不良反应应对能力较低。因此在化疗用药管理中,对这几类患者要进行重点宣教和干预,提高其基本用药知识的认知和用药依从性,进而提升化疗不良反应的应对能力。

Objective To explore the influencing factors of patients with gynecological malignant tumors who undergo chemotherapy for the first time to complete the whole course of medication,so as to provide a basis for improving medication compliance and improving the chemotherapy drug management process of patients with gynecologic malignant tumors.Method Patients with gynecological malignant tumors who completed at least 3 courses of first chemotherapy treatment in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from August 2020 to July 2021 were selected,and the basic drug knowledge cognition,medication compliance and coping ability of chemotherapy adverse reactions during the whole course of chemotherapy were evaluated through the self-designed chemotherapy medication questionnaire,and the items with the highest and lowest scores in these three scales were collected.The Pearson correlation coefficient was used to analyze the relationship between basic drug knowledge cognition,medication compliance,and ability to cope with chemotherapy adverse reactions in patients with gynecological malignant tumors undergoing chemotherapy for the first time.Result Univariate analysis showed that different payment methods,chronic disease history,and frequency of medication after chemotherapy were the influencing factors of basic drug knowledge cognition score of patients undergoing chemotherapy for the first time,and the difference was statistically significant(P<0.05).Occupation and economic source were the influencing factors of medication adherence score,and the difference was statistically significant(P<0.05).Occupation,place of residence,payment method,and type of medication taken after chemotherapy were the influencing factors of the ability to cope with chemotherapy adverse reactions,and the difference was statistically significant(P<0.05).The items with the highest scores of basic medication knowledge and cognition were“understand the usage of the drugs taken”,the items with the lowest scores were“understand the treatment method after forgetting to take the medication”.Patients had the highest medication adherence in terms of not increasing medication dosage on their own when they perceive their symptoms to worsen,the patients had the lowest medication adherence in terms of energy without forgetting to take medication.In the scores of coping ability to cope with adverse reactions of chemotherapy,the scores of“understanding the treatment of fever”“understanding the treatment of constipation”“understanding the treatment of diarrhea”ranked the top 3,and the scores of“understanding the risk of thrombocytopenia”“understanding the precautions after thrombocytopenia”“understanding the treatment of abnormal liver function after chemotherapy”ranked in the bottom 3.The results of Pearson correlation coefficient showed that the score of coping ability to cope with chemotherapy adverse reactions was positively correlated with the score of basic drug knowledge and medication compliance(P<0.05).Conclusion Patients who used NCMS payment,had a history of chronic disease,and took drugs after chemotherapy with a frequency of>3 times per day had a low level of knowledge and cognition of chemotherapy adjuvant drugs,patients who relied on pensions for a low level of medication compliance,and rural patients who used NCMS payment,and 5 or more types of drugs after chemotherapy had a low ability to cope with chemotherapy adverse reactions.Therefore,in the management of chemotherapy drugs,it is necessary to focus on education and intervention for these types of patients,improve their awareness of basic medication knowledge and medication compliance,and then improve their ability to cope with chemotherapy adverse reactions.