食管癌患者加速康复模式下出院心理体验的质性研究

Qualitative study of psychological experience of esophageal cancer patients to be discharged after enhanced recovery after surgery

目的:了解经过加速康复治疗的食管癌患者出院时心理的真实体验,为针对性干预提供参考。方法:2019年4—10月,对14例食管癌加速康复外科治疗后即将出院的患者进行深度访谈,采用半结构式访谈的方法收集资料,对访谈资料进行转录、编码、类属分析、描述和组织。结果:提炼出"加速康复"相关的正性与负性情绪并存的复杂心理感受,对出院返家后的医疗护理服务需求2个部分。正性心理体验包括住院时间短超出预期,痛感较低;负性心理体验包括担心复发、担心未完全康复,病耻感和担心照顾者人力不足。对医疗护理服务需求包括专业健康指导、可及的技术支持和同质化的医疗资源。结论:加速康复模式下,食管癌患者面临出院时,正性与负性心理体验并存,需加强关注,给予健康指导和心理疏导。食管癌患者对出院后医疗护理服务需求较大,多样化、信息化、可及化的延续护理和构建三级甲等医院与社区医院间的医联体是未来发展方向。

Objective To understand psychological experience of esophageal cancer patients to be discharged after enhanced recovery after surgery,to provide information for intervention in the future.Methods From April to October,2019,14 esophageal cancer patients who were to be discharged were recruited.Semi-structured interviews were conducted to collect data.Results Two major themes which were"positive and negative psychological experience exist side by side after enhanced recovery after surgery"and"medical and nursing service needs after discharge"were extracted including 5 first-level theme and 15 second-level theme.Positive experience included shorter duration of hospital stay and lower pain.Negative experience included worrying about recurrence,worrying about not fully recovered,stigma and lack of caregivers.Medical and nursing service needs included health guidance,technical support and homogeneous medical resource.Conclusions Nurses should pay more attention to the esophageal cancer patients to be discharged with health education and psychological counseling.Continuing nursing care should be more diverse,information-based and available.Construction of first-class hospital and community hospital will be a direction of development to solve the patients′problem after discharge.