对不同人员报告的胃癌化疗不良反应一致性研究

Consistency study on reports of stomach neoplasm chemotherapy-related adverse reactions reported by different people

目的调查胃癌患者、主要照顾者及护理记录对化疗不良反应的报告的一致性。方法采用便利抽样法,选取2018年6月—2019年6月于郑州大学第一附属医院行胃癌根治术并接受化疗的患者及其主要照顾者102对,于第2个化疗周期和第4个化疗周期后,收集患者自我记录、主要照顾者记录和护理人员记录的患者化疗不良反应发生率,并采用中文版安德森症状评估表(MDASI)评价不良反应的严重程度。同时采用Kappa检验分析患者及其主要照顾者与护理人员对量表中13项化疗不良反应报告的一致性。结果第2个化疗周期结束后,除乏力和苦恼2种不良反应外,患者报告的其他不良反应严重程度与主要照顾者和护理人员记录的比较,差异无统计学意义(P>0.05);患者报告的乏力、苦恼、睡眠不安、恶心及口干发生率高于主要照顾者和护理人员记录,差异有统计学意义(P<0.05);患者在食欲下降、气短、睡眠不安、呕吐、疼痛、恶心、口干、嗜睡、健忘及麻木10个方面与主要照顾者有较好的一致性(P<0.05),在食欲下降、气短、呕吐、疼痛、恶心、口干、嗜睡、健忘及麻木9个方面与护理人员具有较好的一致性(P<0.05);主要照顾者在食欲下降、苦恼、气短、呕吐、疼痛、恶心、口干、嗜睡、健忘及麻木10个方面与护理人员存在较好的一致性(P<0.05)。第4个化疗周期结束后,患者乏力、苦恼、睡眠不安及悲伤感自我报告严重程度高于主要照顾者和护理人员记录,差异有统计学意义(P<0.05);患者报告的乏力、苦恼、睡眠不安、悲伤感及口干发生率高于主要照顾者和护理人员记录,差异有统计学意义(P<0.05);患者食欲下降、气短、呕吐、疼痛、恶心、口干、健忘及麻木8个方面与主要照顾者有较好的一致性(P<0.05),在食欲下降、呕吐、疼痛、恶心、口干、健忘及麻木7个方面与护理人员具有较好的一致性(P<0.05);主要照顾者在食欲下降、睡眠不安、呕吐、疼痛、恶心、口干、健忘及麻木8个方面与护理人员存在较好的一致性(P<0.05)。结论护理人员和患者主要照顾者低估了胃癌患者化疗不良反应的发生率和严重程度,单纯的护理记录不能准确反映患者的化疗症状,应考虑将患者的自我报告作为参考数据之一。

Objective To investigate the consistency of reports of adverse reactions to chemotherapy in patients with stomach neoplasms,main caregivers and nursing records.Methods By convenient sampling method,a total of 102 pairs of patients who underwent radical gastrectomy and received chemotherapy in the First Affiliated Hospital of Zhengzhou University from June 2018 to June 2019 and their main caregivers were selected.After the second and fourth cycles of chemotherapy,the incidence of adverse reactions to chemotherapy in patients was collected from records patients themselves,main caregivers and nursing staff,and the severity of adverse reactions was assessed using the Chinese version of M.D.Anderson Symptom Inventory(MDASI).At the same time,Kappa test was used to analyze the consistency of reports of patients,their main caregivers and nursing staff to the 13 adverse reactions of chemotherapy in the scale.Results After the second chemotherapy cycle,except for the two adverse reactions of fatigue and distress,the severity of other adverse reactions reported by the patients was not statistically significantly different compared with the records of the main caregivers and nursing staff(P>0.05).The incidence of fatigue,distress,sleep disturbance,nausea and dry mouth reported by the patients was higher than that recorded by the primary caregivers and nursing staff,and the differences were statistically significant(P<0.05).The patients showed good consistency with main caregivers in 10 aspects such as appetite loss,shortness of breath,sleep disturbance,vomiting,pain,nausea,dry mouth,drowsiness,forgetfulness and numbness(P<0.05).The patients showed good consistency with the nursing staff in 9 aspects such as appetite loss,shortness of breath,vomiting,pain,nausea,dry mouth,lethargy,forgetfulness and numbness(P<0.05).The main caregivers showed good consistency with the nursing staff in 10 aspects such as appetite loss,distress,shortness of breath,vomiting,pain,nausea,dry mouth,lethargy,forgetfulness and numbness(P<0.05).After the fourth chemotherapy cycle,the self-reported severities of fatigue,distress,sleep disturbance and sadness of patients were higher than those recorded by the main caregivers and nursing staff,and the differences were statistically significant(P<0.05).The incidence of fatigue,distress,sleep disturbance,sadness and dry mouth reported by patients were higher than those recorded by the main caregivers and nursing staff,and the differences were statistically significant(P<0.05).The patients showed good consistency with the primary caregivers in 8 aspects such as appetite loss,shortness of breath,vomiting,pain,nausea,dry mouth,forgetfulness and numbness(P<0.05),and they showed good consistency with the nursing staff in 7 aspects such as appetite loss,vomiting,pain,nausea,dry mouth,forgetfulness and numbness(P<0.05).The primary caregivers showed good consistency with the caregivers in 8 aspects such as appetite loss,sleep disturbance,vomiting,pain,nausea,dry mouth,forgetfulness and numbness(P<0.05).Conclusions Nursing staff and the main caregivers of patients underestimate the incidence and severity of chemotherapy-related adverse reactions in patients with stomach neoplasms.Simple nursing records cannot accurately reflect the patients'chemotherapy symptoms,so self-reports of patients should be considered as one of the reference data.