甲状腺癌术后患者随访需求调查及影响因素分析

Investigation of follow-up needs and its influencing factors of postoperative patients with thyroid cancer

目的了解甲状腺癌术后患者对随访的需求并分析其影响因素,为构建甲状腺癌术后患者的随访管理体系提供参考依据。方法采用便利抽样的方法对2所三级甲等医院2020年3–4月期间的甲状腺癌术后患者的随访需求、恢复、焦虑及压力情况进行问卷调查,分别采用自行设计的随访需求问卷、15项恢复质量量表(QoR-15)、广泛性焦虑量表(GAD-7)和压力知觉量表(PSS-4)进行评分,分值越高分别表示需求程度越高、恢复质量越佳、焦虑程度越严重及压力越大。结果本研究共发放问卷382份,回收问卷351份,有效问卷349份,有效回收率99.4%。(1)随访需求情况。随访形式选择:网络平台是首选的随访方式(72.2%),最希望由医生进行随访(82.5%),多数患者希望术后1个月开始随访(67.6%)且希望在下午(50.7%),每次随访时长以10~15 min为宜(47.3%),更愿意接受1次/1个月的随访频率(41.3%)且希望终身随访(69.9%);随访内容需求程度:有13项随访条目的需求人数超过80%,随访需求程度得分前5名分别为检验结果答疑、复诊指导、转移复发知识、用药指导及开检查检验单,其得分分别为(4.78±0.47)分、(4.70±0.51)分、(4.70±0.57)分、(4.65±0.59)分、(4.57±0.64)分;影响随访需求程度得分的多重线性回归分析结果发现,年龄(小)、婚姻状况(未婚)、医疗付费方式(有医疗保险)及术后间隔时间(<1个月)与随访需求程度得分密切相关(P<0.05)。(2)恢复、焦虑及压力情况:随访需求程度总分为(72.93±8.52)分,QoR-15、GAD-7及PSS-4总分分别为(79.87±29.95)分、(4.77±3.59)分及(6.51±3.10)分,QoR-15总分与随访需求程度总分呈正相关关系(r=0.131,P=0.014),GAD-7及PSS-4总分与随访需求程度总分未呈现出明显相关性(r=0.068,P=0.207;r=0.008,P=0.881)。结论年轻、未婚、有医疗保险、术后早期的甲状腺癌患者是随访需求较高的人群,术后恢复越好的患者对随访需求越高,医务人员应重视出院后的随访服务,以患者需求为导向,合理安排随访的内容、频次、时间段等,以提升医疗服务质量。

Objective To understand the follow-up needs of postoperative patients with thyroid cancer and analyze its influencing factors,so as to provide a reference for the establishment of a follow-up management system for patients with thyroid cancer.Methods Convenience sampling was used to conduct a questionnaire survey on the followup need,recovery,anxiety,and stress of patients after thyroid cancer surgery in 2 tertiary A hospitals from March to April in 2020.The self-designed follow-up needs questionnaire,the Quality of Recovery Questionnaire 15(QoR-15),the Generalized Anxiety Disorder-7(GAD-7),and the Perceived Stress Scale(PSS-4)were scored.The higher score,the higher need,the better recovery,and the more serious anxiety and stress.Results In this study,382 questionnaires were distributed,which of 351 were returned and of 349 were valid,the valid callback rate was 99.4%(349/351).(1)Follow-up needs.Follow-up form:Online platform was the preferred follow-up method(72.2%),the most patients hoped that the follow-up would be conducted by a doctor(82.5%)and hoped to start the follow-up at 1 month after the operation(67.6%)and in the afternoon(50.7%),the duration of each follow-up was 10–15 min(47.3%),and accepted the followup frequency of 1 times per month(41.3%)and the lifetime follow-up(69.9%).Needs degree of follow-up contents:There were 13 follow-up items requiring more than 80%of patients.The top 5 items with the higher follow-up needs score were the question on test results,returning visit guidance,knowledges of metastasis and recurrence,medication guidance,and issuance of inspection orders,and their scores were 4.78±0.47,4.70±0.51,4.70±0.57,4.65±0.59,4.57±0.64,respectively.The results of multiple linear regression analysis were found that the age(young),marital status(unmarried),medical payment method(with medical insurance),and postoperative interval(<1 month)were closely related to the follow-up needs score(P<0.05).(2)Recovery,anxiety,and stress statuses:The total QoR-15 score of patients was 79.87±29.95,which was positively correlated with the total score of follow-up needs(72.93±8.52,r=0.131,P=0.014).No significant correlation was found between the total score of GAD-7(4.77±3.59)or PSS-4(6.51±3.10)and the total score of follow-up needs(r=0.068,P=0.207;r=0.008,P=0.881).Conclusions Young,unmarried,medically insured,and early postoperative patients with thyroid cancer have higher follow-up needs.Patients with better recovery after surgery have a higher follow-up needs.Medical staff should pay attention to follow-up services after discharge,rationally arrange content,frequency,and time period of follow-up according to follow-up needs of patients,so as to improve quality of medical services.