以患者需求为导向的膀胱癌输尿管皮肤造口全程化个案管理方案研究

Study of the whole process case management program for patients with bladder cancer undergoing skin ureterostomy based on the needs of patients

目的 建立以患者需求为导向的膀胱癌输尿管皮肤造口患者全程化个案管理方案,为膀胱癌输尿管皮肤造口患者规范管理提供依据。方法 采用便利抽样法选取2022-01-01-2022-10-31山东省肿瘤医院收治的165例行膀胱癌输尿管皮肤造口术患者,应用支持性照护需求问卷(SCN34)及尿路造口患者出院延续护理需求评估量表进行调查,并对10例患者行半结构访谈,明确患者需求,制定全程化个案管理方案。结果 患者住院期间支持性照护需求总分为98.84±36.96。多元线性回归结果显示,居住地、文化程度和家庭人均收入是患者住院期间照护需求的主要影响因素,均P<0.05。患者出院康复期延续护理需求总分为142.74±45.92,多元线性回归结果显示,居住地、家庭人均收入和工作状态是出院患者延续护理需求的主要影响因素,均P<0.05。根据患者需求制定膀胱癌输尿管皮肤造口患者全程化个案管理方案,包括入案及剔除标准、个案管理同意书、患者信息登记表、全程化个案管理记录单和结案标准。结论 建立以患者需求为导向的膀胱癌输尿管皮肤造口患者全程化个案管理方案,可满足患者个性化需求,有效提高患者生活质量、自我护理能力及日常生活能力。

Objective To establish a demand-oriented case management program for patients with bladder cancer undergo-ing skin ureterostomy,and provide the basis for standardized management of bladder cancer patients with skin ureterosto-my.Methods The convenience sampling method was used to select 160 patients with bladder cancer undergoing ureteros-tomy in Shandong Cancer Hospital and Institute from January 1 to October 31,2022.The supportive care needs question-naire(SCN34)and the continuous care needs assessment scale for urostomy patients after discharge were used to conduct a survey,and 10 patients were interviewed semi structurally to clarify the needs of patients and develop a full process case management plan.Results The total score of supportive care needs for patients during hospitalization was 98.84±36.96.The results of multiple linear regression showed that place of residence,education level,and per capita household income were the main influencing factors for patients care needs during hospitalization,all P<o.05.The total score of the patients need for continued care during the recovery period after discharge was 142.74±45.92.The results of multi-ple linear regression showed that residence,per capita household income,and work status were the main influencing fac-tors for the continued care needs of discharged patients,all P<o.05.The whole process case management scheme for bladder cancer patients with ureteral skin stoma included the inclusion and exclusion criteria,case management consent form for bladder cancer patients with ureteral skin stoma,patient information registration form,whole process case man-agement record sheet,and case closure criteria.Conclusions Establishing a whole process case management plan for bladder cancer patients with ureteral skin stoma guided by the needs of patients can meet the personalized needs of patients and effectively improve the self-care ability,quality of life and daily living ability of patients.