Distress management in cancer patients:Guideline implementation based on CAN-IMPLEMENT

基于指南整合和应用方法的恶性肿瘤患者心理痛苦管理

Objective:To standardize the distress management of gastric cancer patients receiving chemotherapy,the adapted Cancer-related Distress Management Guidelines were implemented in nursing practice among gastric cancer patients receiving chemotherapy based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT).Methods:Based on the theoretical framework of CAN-IMPLEMENT,A multidisciplinary team was established,barriers and facilitators obstacles of guidelines implementation in medical oncology units were assessed,corresponding solutions were formulated,the guidelines implementation process was monitored,and implementation results were evaluated.Results:The multidisciplinary team developed review criteria,standardized work paths,assessment tools,training manuals for healthcare professionals,education manuals for patients and their caregivers.After guidelines implementation,the completion rate of the distress management record came up to 97.9%(189/193).From September 2017 to December 2018,the compliance of medical staff on most items in the audit checklist was improved,ranging from 57.1%(100/175)to 100.0%(193/193).The positive distress rate of gastric cancer patients receiving chemotherapy was decreased from 22.7%(32/141)to 9.3%(18/193)(P<0.05),and the Median(range)of the distress score declined from 2(0e9)to 0(0e7)(P<0.001).Conclusions:The implementation of guidelines based on CAN-IMPLEMENT promotes the establishment of a distress management system in the medical oncology units.The review standards,standardized work paths,and evaluation tools for distress in cancer patients formulated by the multidisciplinary team had clinical applicability and effectiveness.Quality control in the practice of distress management was effective.The compliance of healthcare professionals with distress management was improved.The distress of gastric cancer patients receiving chemotherapy was alleviated effectively.

目的依据指南整合和应用方法(A Guideline Adaptation and Implementation Planning Resource,CAN-IMPLEMENT),将改编制订的癌因性心理痛苦管理指南应用于胃癌化疗患者的护理实践,规范胃癌化疗患者的痛苦管理。方法基于CAN-IMPLEMENT应用部分的理论框架,组织建立多学科小组,评估在肿瘤内科病房实施指南的障碍和有利因素,制订相应的解决方案,对指南实施过程进行监测,并对实施结果进行评价。结果多学科小组制订了审查标准、标准化工作路径、评估工具、医疗保健专业人员培训手册、患者及其照顾者教育手册。指南实施后,心理痛苦管理记录完成率达到97.9%。2017年9月至2018年12月,医务人员心理痛苦管理审查清单中大部分项目的实施依从性提高,完成率从57.1%(100/175)到100.0%(193/193)不等(P<0.001)。胃癌化疗患者心理痛苦发生率由22.7%(32/141)降至9.3%(18/193)(P<0.05),心理痛苦评分中位数(范围)由2(0-9)降至0(0-7)(P<0.001)。结论基于CAN-IMPLEMENT的指南应用推动了肿瘤病房心理痛苦管理体系的建立。多学科小组制订的癌症患者心理痛苦审查标准、标准化工作路径、评估工具具有临床适用性和有效性,心理痛苦管理实践过程中进行质量控制行之有效,医疗保健专业人员提高了对癌症患者实施心理痛苦管理方案的依从性,有效减轻了胃癌化疗患者的心理痛苦。