叙事护理对晚期肺癌化疗患者生命意义和生命质量的影响

The effect of narrative nursing on the meaning and quality of life in chemotherapy patients with advanced lung cancer

目的探讨叙事护理干预对晚期肺癌化疗患者生命意义和生命质量的影响。方法选取2020年10月至2021年11月同济大学附属上海市肺科医院肿瘤科治疗的晚期肺癌化疗患者86例为研究对象,采用随机数字表法分为对照组42例,叙事组44例。对照组实施肿瘤化疗患者常规护理,叙事组在常规护理基础上给予叙事护理干预,每个化疗周期7次,共计12~14次。采用晚期癌症患者生命意义量表、肺癌患者生命质量测定量表中文版、心理痛苦温度计分别于干预前、干预后1周、干预后3周、干预后2个月评价干预效果。结果最终对照组40例、叙事组42例纳入统计分析。干预后2个月,对照组患者生命意义总分、求意义的意志、生命意义与满足感、存在挫折、生命控制、苦难承受、死亡接纳维度得分分别为(98.60±9.17)、(14.90±1.91)、(13.38±2.62)、(16.40±2.73)、(26.48±3.19)、(14.30±1.68)、(13.15±3.07)分,明显低于叙事组的(112.02±9.73)、(16.45±2.24)、(16.31±1.96)、(19.40±2.42)、(28.76±3.48)、(16.14±1.82)、(14.95±2.39)分,差异有统计学意义(t值为-6.42~-2.98,均P<0.01),且组间和时间主效应差异有统计学意义(F值为2.76~24.47,均P<0.05)。干预后2个月,对照组患者生命质量总分、社会/家庭状况、情感状况、功能状况、肺癌特异模块得分分别为(90.75±11.65)、(18.58±3.75)、(15.65±3.85)、(13.48±3.34)、(22.00±4.93)分,低于叙事组的(102.12±9.32)、(20.36±4.29)、(18.10±3.25)、(16.74±4.05)、(24.80±3.83)分,差异有统计学意义(t值为-4.89~-1.99,均P<0.05),且组间效应差异有统计学意义(F值为5.14~24.47,均P<0.05)。干预后3周、2个月,对照组心理痛苦得分分别为(3.88±2.73)、(3.60±2.19)分,低于叙事组的(2.52±2.12)、(1.90±1.78)分,差异有统计学意义(t=2.50、3.85,均P<0.05),具有时间、组间及交互效应性(F=15.29、15.86、2.80,均P<0.05)。结论叙事护理干预有助提升晚期肺癌化疗患者生命意义,改善患者生命质量,缓解患者心理痛苦水平,值得在临床推广。

Objective To explore the impact of narrative nursing on the meaning and quality of life in chemotherapy patients with advanced lung cancer.Methods A total of 86 chemotherapy patients with advanced lung cancer hospitalized in the Oncology Department of Shanghai Pulmonary Hospital Affiliated to Tongji University from October 2020 to November 2021 were selected and divided into control group with 42 cases and narrative group with 44 cases by random number table method.The control group was treated with routine nursing of patients with tumor chemotherapy while the narrative group was implemented on narrative nursing intervention as well as routine nursing.A total of 12 to 14 times,each chemotherapy period was 7 times.The effect of the intervention was assessed by Meaning in Life Scale for Advanced Cancer Patients(MiLS)、Chinese Version of the Functional Assessment of Cancer Therapy-Lung(FACT-L 4.0)and Distress Thermometer(DT)before intervention,1 week,3 weeks and 2 months after intervention.Results Forty cases in the control group and 42 cases in the narrative group were involved in the statistical analysis.Two months after intervention,the total score of MiLS,the score of the will to search for meaning,the meaning of life and satisfaction,existential frustration,life control,suffering tolerance and death acceptance in the control group were(98.60±9.17),(14.90±1.91),(13.38±2.62),(16.40±2.73),(26.48±3.19),(14.30±1.68),(13.15±3.07)points,which were significantly lower than those in the narrative group(112.02±9.73),(16.45±2.24),(16.31±1.96),(19.40±2.42),(28.76±3.48),(16.14±1.82),(14.95±2.39)points,and the difference were statistically significant(t value were-6.42--2.98,all P<0.01),and the main effect between groups and time were statistically significant(F values were 2.76-24.47,all P<0.05).Two months after intervention,the total score of FACT-L,social/family status,emotional status,functional status and lung cancer specific module in control group were(90.75±11.65),(18.58±3.75),(15.65±3.85),(13.48±3.34),(22.00±4.93)points,which were lower than those in the narrative group(102.12±9.32),(20.36±4.29),(18.10±3.25),(16.74±4.05),(24.80±3.83)points,the differences were statistically significant(t values were-4.89--1.99,all P<0.05),and there was intergroup effect(F values were 5.14-24.47,all P<0.05).Three weeks and 2 months after intervention,the psychological distress score of control group were(3.88±2.73),(3.60±2.19)points,which were significantly higher than the narrative group(2.52±2.18),(1.90±1.78)points,and the differences were statistically significant(t=2.50,3.85,both P<0.05),with a time,groups,interaction effect(F=15.29,15.86,2.80,all P<0.05).Conclusions Narrative nursing can effectively improve the meaning and quality of life and relieve psychological distress in chemotherapy patients with advanced lung cancer.It is worthy of clinical promotion.