胃肠肿瘤术后辅助化疗患者对口服营养补充体验的质性研究

Qualitative research on oral nutritional supplements experience in patients with postoperative adjuvant chemotherapy of gastrointestinal tumors

目的在口服营养补充广泛应用在胃肠道恶性肿瘤患者的营养治疗的背景下,了解胃肠肿瘤术后辅助化疗患者服用口服营养粉后的认识和感受,为临床指导提供依据,进而提高患者依从性,确保营养治疗效果。方法采用目的抽样法,以分层目的性选样策略,选取14名于2017年11月至2018年4月在南京市某三甲医院接受口服营养补充的胃肠肿瘤术后辅助化疗患者,对患者进行半结构式深入调研,运用Nvivo11软件,对调研结果进行分析和整理。结果分析提炼出3个主题,患者对口服营养补充的态度认知、服用问题反馈和健康信息关注情况。大部分患者对口服营养补充认识不足,仅有21%的患者在服用口服营养补充后对其持肯定态度;有合并症的患者有特殊需求、不明白服用方法和出现不适反应为患者服用问题反馈;半数患者不主动关注健康信息。主动关注的患者主要通过互联网和咨询医务人员。结论患者对口服营养补充的体验具有多面性,反映的问题也不容乐观。应采取医护一体化合作模式,改进健康教育流程,在院和延续护理中重视症状管理,推广多口味、多配方的营养粉和加强对网络健康信息的监管。以改善患者临床结局,进而提高生活质量。

Objective Under the background that oral nutrition supplement is widely used in the nutritional treatment of patients with gastrointestinal malignancies,we acquired the understanding and feeling of the patients with gastrointestinal tumors after surgery and receiving oral nutrition powder after adjuvant chemotherapy.To provide the basis for clinical guidance,improve the patient compliancel,ensure the therapeutic effect of nutritional support.Methods The purpose sampling method and the stratified purposive sampling strategy are adopted.A total of 14 patients with gastric and intestinal tumors in a tertiary-level hospital from November 2017 to April 2018 were investigated.They were all have received oral nutritional supplements After the operation.14 patients received semistructured in-depth interviews,and the interview data was analyzed and sorted out by Nvivo11 software.Results 3 subjects were extracted from the analysis including the attitude towards nutritional powder,the problems of taking nutritional powder,and the attention to health information.Most patients lack adequate awareness about oral nutrition supplement,and only 21%of them hold a positive attitude towards it after taking oral nutrition supplement.special needs of patients with comorbidities,do not understand the method and discomfort experience are patients‘problems;Half of patients passively pay attention to health information.Patients who are actively followed by the Internet and consultation with medical staff.Conclusions Patients’experience of oral nutrition supplement is multifaceted,and the problems reflected are not optimistic.By taking medical care of integration cooperation pattern,improve health education process,focusing on the symptom management while in hospital and the continual care at home,promoting more flavor formula nutrition powder and strengthening the supervision of network health information,the clinical outcomeand the life quality can be improved.