乳腺癌术后运动指导与实施的影响因素分析:一项基于知识转化框架的质性研究

Influencing factors of exercise guidance and implementation after breast cancer surgery:a qualitative study based on the knowledge transformation framework

目的探讨乳腺癌术后运动指导与实施的障碍因素与促进因素,为乳腺癌患者术后运动方案的制订提供参考。方法采用目的抽样法,于2022年7—9月选择上海中医药大学附属第七人民医院乳腺外科的10名医护人员和10例乳腺癌术后患者为研究对象,对其进行半结构化访谈。基于知识转化框架制订访谈提纲,采用内容分析法进行结果分析。结果研究提炼出3个层面的影响因素。系统层面包括护理人员的工作量、宣教材料、规范和职责以及对循证证据的信任;实践者层面包括运动知识水平、对患者依从性的担忧以及对运动的重视;患者层面包括运动知识水平、自身个性和兴趣、静脉管路、治疗的不良反应、心理状态、天气环境、重视健康以及家属的关心。结论医护人员需要从科室、自身以及患者3个层面考虑对乳腺癌患者术后的运动指导,应该充分考虑患者的情况和主观体验,以提高患者的运动依从性。

ObjectiveTo explore the obstacle factors and promoting factors of exercise guidance and implementation after breast cancer surgery,so as to provide reference and basis for the formulation of exercise program after breast cancer patients.MethodsUsing the objective sampling method,a total of 10 medical staff and 10 patients with breast cancer after operation from the breast surgery department of the Seven People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine hospital in Shanghai were selected as research objects from July to September 2022.A semi-structured interview was conducted.The interview outline was developed based on the knowledge transformation framework,and the results were analyzed by the content analysis method.ResultsThe study extracted three levels of influencing factors.The system level included caregiver workload,educational materials,norms and responsibilities and trust in evidence-based evidence.The practitioner level included the level of exercise knowledge,the concern about patient compliance and the emphasis on exercise.The patient level included sports knowledge level,personality and interest,venous line,adverse reaction of treatment,psychological state,weather environment,attention to health and concern of family members.ConclusionsThe medical staff need to consider the postoperative exercise guidance for breast cancer patients from the department,themselves and patients,and should fully consider the patients'conditions and subjective experience to improve the patients'exercise compliance.