乳腺癌患者内分泌治疗服药监控平台的设计及应用

The effectiveness of computer-based monitoring system for patients with breast cancer receiving adjuvant hormonal therapy

目的探索基于乳腺癌内分泌服药监控平台的护士随访对接受内分泌治疗的乳腺癌患者服药依从性和生活质量的影响。方法构建针对内分泌治疗乳腺癌患者的服药监控平台,采用随机对照研究设计,患者被随机分为实验组157例和对照组154例。实验组在常规护理的基础上,实施基于药物监控平台的护士随访。对照组采用常规随访模式,参加医院的门诊常规随访。分别评价两组在3个月、6个月、18个月和24个月的服药依从性和生活质量。结果实验组的服药依从性评分分别在6个月、18个月、24个月较对照组显著提高(P<0.05),生活质量问卷各个维度存在显著的时间效应,但不具有组间差异(P>0.05)。结论基于药物监控平台的护士随访可提高内分泌治疗的乳腺癌患者的服药依从性,但对改善总体生活质量效果不明显。

Objective To evaluate the effect of nurse-led follow-up on medication adherence and quality of life for breast cancer patients receiving adjuvant hormonal therapy. Methods A randomized controlled trial was conducted with 157 patients in the intervention group and 154 in the control group. A self-design web-database medication monitoring platform was designed for managing patients such as texting,reminding and mailing. Participants were randomized to follow-up care as usual（yearly outpatient clinic visits） or nurse-led telephone follow-up（monthly consultation with structured intervention）. Telephone follow-up was performed by four trained breast care nurses （BCN） and consisted of a semi-structured interview including managing the side-effects of endocrine therapy,compliance with hormonal therapy and an open discussion of these issues. Patients＇ medication adherence and quality of life were evaluated by Morisky Medication Adherence Questionnaire（MAQ） and FACT-B at baseline and 3,6 18 and 24 months,respectively. Results The Nurse-led telephone follow-up did not significantly improve the quality of life（P〉0.05）. MAQ score in the intervention group was significantly greater than that in the control group（P〈0.05） at 3, 6, 18 and 24 months. Conclusion Nurse-led follow-up using computer-based monitoring system can improve patients＇ medication adherence, but there is no obvious increase in quality of life.