Characterizing the patient experience during neoadjuvant therapy for pancreatic ductal adenocarcinoma:A qualitative study

BACKGROUND Neoadjuvant therapy(NT)has increasingly been utilized for patients with localized pancreatic ductal adenocarcinoma(PDAC).It is the recommended approach for borderline resectable(BR)and locally advanced(LA)cancers and an increasingly utilized option for potentially resectable(PR)disease.Despite its increased use,little research has focused on patient-centered metrics among patients undergoing NT,including patient experiences,preferences,and recommendations.A better understanding of all aspects of the patient experience during NT may identify opportunities to design interventions aimed at improving quality of life;it may also facilitate the completion of NT and receipt of surgery,ultimately optimizing long-term outcomes.AIM To understand the experience of patients initiating and receiving NT to identify opportunities to improve neoadjuvant cancer care delivery.METHODS Semi-structured interviews of patients with localized PDAC during NT were conducted to explore their experience initiating and receiving NT.Interviews took place between August 2020 and October 2021.Due to the descriptive nature of the research,questions were open ended.Interviews were conducted over the phone,audio recorded and then transcribed.All interviews were coded by two independent researchers using NVivo 12,iteratively identifying themes until thematic saturation was achieved.An integrative approach to qualitative analysis was used,utilizing both inductive and deductive methods.RESULTS A total of 12 patients with localized PDAC were interviewed.Patients with BR(n=7),PR(n=2),and LA(n=3)cancers participated in the study.All patients indicated that choosing NT was the doctor’s recommendation,while most reported not being familiar with the concept of NT(n=11)and that NT was presented as the only option(n=8).Five themes describing the patient experience emerged:physical symptoms,emotional symptoms,coping mechanisms,access to care,and life factors.The most commonly cited recommendation for improving the experience of NT was improved education before and during NT(n=7).Patients highlighted the need for more information on the rationale behind choosing NT prior to surgery,the anticipated surgery and its likelihood of surgery occurring after NT,as well as general information prior to starting NT treatment.The need for seeing different members of the healthcare team,including ancillary services was also frequently cited as a recommendation for improving the experience of NT(n=5).CONCLUSION This study provides a framework to allow for a better understanding of the PDAC patient experience during NT and highlights opportunities to improve quality and quantity of life outcomes.

Exploring the Experiences of Chinese Patients Waiting for Heart Transplantation

Background: Patients waiting for heart transplantation (HT) have complex physiological and psychosocial problems. Factors such as psychological state, behavior, social relationships, and cultural background of patients influence the HT process, such as causing psychotic disorder, difficult decision and close dependence. Care during the waiting period needs to be aimed at not only treating the symptoms but also the specific status. Purpose: To describe the physical and psychosocial experiences of the patients waiting for HT in one general hospital in the northern part of China. Methods: A qualitative approach was used in this study. Fifteen patients waiting for HT were selected based on purposive sampling, and semi-structured interviews were carried out. Results: In the analysis process, reported experiences of the participants were categorized into five main themes as follows: 1) feeling the impact;2) uncertainty about the future;3) difficult to make decisions;4) negative emotions and 5) request support. Conclusion: This study provides an in-depth description of patients waiting for HT who haveexperienced many physical, psychosocial, and familial problems due to disease and their cultural background. It found that Chinese patients have some special experiences due to their psychosocial background. This study suggests that nurses should focus on not only physical but also psychosocial problems of these patients, and provide understandings to develop more effective strategies to solve their problems. Relevance to Clinical Practice: This study focused on the special patients who are waiting for heart transplantation, and got the special results about the feelings and experiences. The results can help the doctors and nurses to help the patients pass the special period smoothly.

Symptom experience in patients with cancer-related fatigue:A systematic review and meta-synthesis

To understand the real experiences of patients with cancer-related fatigue and to promote quality of life,the researchers used computer searches of PubMed,EMbase,CINAHL,PsycINFO,Web of Science,and China National Knowledge Infrastructure,China Biology Medicine disc,Wanfang Data,China Science and Technology Journal Database for relevant qualitative studies from the inception to November 1,2021.The results showed that a total of 16 papers were included,and 57 outcomes were distilled into 9 categories,which were pooled into four integrated outcomes,such as somatic,psychological and social support and so on.It is concluded that patients with cancer-related fatigue are not only in the midst of multidimensional,unspeakable somatic experiences,and complex psychological experiences,they are also hindered in coping with fatigue symptom and social life.Therefore,healthcare professionals should provide health interventions and psychological support to those patients whenever possible.

Patient Life Experience and Activity of Daily Living before and after Total Knee Arthroplasty

Background: As the population ageing, more patients suffer from joint disease. Joint replacement surgery performed in Taiwan is about 10,000 to 20,000 cases yearly. Aims: The purpose of this study is to realize Total Knee Arthroplasty (TKA) patients’ views about life experiences and difficulty in daily life before and after the surgery. Methods: In this study, in-depth interview with interview guideline was used to analyze patients’ experience by using a qualitative research method, and questionnaires were used to collect quantity data. Results: 1) A total of 20 participants were recruited. Average age was 75.15 (SD = 6.468). Eighteen of the participants were female and the other two were male. The majority of participants indicated that their home facilities were convenient or very convenient. 2) Motivations of the participants to undergo TKA were joint pain, limited joint range of motion, and weakness in legs. Participants’ expectations after surgery were no more pain and ease in walking, and able to manage daily life. 3) Depending on the time after surgery, joint pain and walking ability had improved to some extent. The joint range of motion increased, but kneeling remained difficult, and the participants’ mood and exercise capacity were improved. Conclusions: The finding can be as a reference for clinical practitioner to provide preoperative education for total knee arthroplasty patients.

女性先天性心脏病患者生育体验的Meta整合

目的了解先天性心脏病女性患者生育体验,为先天性心脏病女性患者生育管理提供参考。方法系统检索中英文数据库中关于先天性心脏病女性患者生育相关体验的质性研究,检索时限为建库至2024年5月。根据澳大利亚JBI循证卫生保健中心质性研究质量评价工具对文献进行质量评价,并对结果进行Meta整合。结果共纳入6篇文献,提取21个研究结果,归纳为10个研究类别,4个整合结果:生育决策影响因素复杂;与生育相关的多重忧虑;生育相关管理经验不足及专业指导需求较高;与生育相关的成长与收获。结论先天性心脏病女性患者的生育决策受到多重因素影响,患者面对生育问题存在多方面的担忧与需求。医护人员应关注患者与生育相关的需求,为其提供专业的生育辅助决策,加强先天性心脏病生育相关的风险评估与宣教。

恶性肿瘤住院患者戒烟失败的质性研究

目的 深入了解恶性肿瘤患者戒烟失败的原因及心理,为住院患者戒烟干预提供参考依据。方法 采用质性研究中的现象学研究方法,使用半结构式访谈方式对13例戒烟失败的恶性肿瘤住院患者进行深入访谈,运用Colaizzi内容分析法,分析其戒烟失败的原因及心理体验。结果 导致患者戒烟失败的原因包括:对自身疾病认知不足、对吸烟危害认知不足、烟草依赖、社交需要、工作和生活的压力、缺乏戒烟的支持和帮助;患者在戒烟失败后存在侥幸、及时行乐、盲目从众、寻求慰藉、愧疚等心理。结论 恶性肿瘤患者戒烟失败受个人、家庭和社会等诸多因素的影响,因此,在帮助患者戒烟过程中,需要医院、家庭和社会共同协作,达到帮助患者戒烟的目的。

护理本科生担任标准化病人角色期间真实体验与需求的质性研究

为探讨护理本科生在担任标准化病人角色后的真实体验,分析其心理状态和需求,为进一步完善情境模拟教学体系提供参考,采用半结构式访谈法对12位担任过标准化病人的护理本科生进行深入访谈,并运用Colaizzi分析法对资料进行分析、比较、归纳和提炼。研究显示,护生扮演SP角色会产生一定的心理负担,护理管理者应对SP做好充分预教育,采取措施促进SP护生的积极体验,为护生提供更积极有效的学习机会。

恶性肿瘤临终病人生命末期尊严体验的质性研究

目的:了解恶性肿瘤临终病人生命末期的尊严体验,为改善照护质量提供参考依据。方法:采用目的抽样方法选取2022年7月—2023年8月在杭州市4所三级医院住院的18例恶性肿瘤临终病人,对其尊严体验进行半结构式访谈,采用内容分析法进行资料分析,提炼主题。结果:恶性肿瘤临终病人的尊严体验归纳为3个主题:对尊严的理解、尊严受损的因素、尊严得到维护的因素。结论:医护人员可通过改善工作态度、提升临床照护质量、多学科协作、实施个性化照护、建立良好的社会支持系统改善恶性肿瘤临终病人的尊严体验,提升生命末期的生存质量。

癌症病人生育力保护决策体验质性研究的Meta整合

目的:系统整合有关癌症病人进行生育力保护决策的质性研究,为医护人员了解病人信息需求并进行决策辅助提供循证依据。方法:系统检索中国知网、维普数据库、万方数据库、PubMed、Web of Science、the Cochrane Library、CINAHL数据库中收录的关于癌症病人生育力保护决策体验的质性研究,检索时限为建库至2022年12月18日。采用2016版澳大利亚Joanna Briggs Institute(JBI)循证卫生保健中心质性研究质量评价标准评价文献质量,采用汇集性整合法进行Meta整合。结果:共纳入12篇文献,归纳成8个类别,并综合成3个整合结果。病人对于生育力保护的态度、病人的决策需求、病人对专业咨询的建议。结论:癌症病人生育决策还存在着信息支持不足,专业咨询不成熟等问题,医护人员应该重视病人生育需求,强化病人决策支持系统,满足癌症病人的生育决策需求。

护士主导的病人术前访视体验与需求的Meta整合

目的:系统评价病人参与术前访视的体验及需求,为优化临床护理术前访视质量提供参考。方法:计算机检索PubMed、Web of Science、EMbase、CHINAL、the Cochrane Library、中国知网、维普数据库、万方数据库、中国生物医学文献数据库等有关护患参与的术前访视体验及需求的质性研究文献。检索时限为建库至2023年10月。依据2016版澳大利亚乔安娜布里格斯研究所(JBI)循证卫生保健中心制定的质性研究质量评价标准进行文献质量评价,采用汇集性整合方法对结果进行整合分析。结果:共纳入11篇文献,包括6项现象学研究、5项描述性质性研究;提炼出44个研究结果,归纳为10个新类别,综合成3个整合结果:病人在术前阶段承受身心压力;多方面支持的需求;正性行为可促进病人健康。结论:现有证据表明,术前访视阶段,护理工作应聚焦于病人的心理情绪及信息需求,提供多方面的支持,协助病人平稳度过术前阶段,增强疾病康复信心,提升整体满意度。

恶性青光眼患者不确定感体验的质性研究

描述恶性青光眼患者的不确定感体验。采用目的抽样,解释性现象学的方法,对14名患者进行访谈,以疾病不确定性理论为理论框架,并使用Grbich的批评性话语分析(CDA)方法进行分析。恶性青光眼患者存在不同程度的心理问题,此外,信息缺乏,情绪的改变,日常生活及社会功能的改变,不确定感和生活质量下降为主要问题。青光眼患者受心理和情绪影响较大,心理症状较重,及时进行心理干预,减轻其不确定感可能会改善这类人群的生活质量。

儿科护士实施人文关怀体验的质性研究

目的了解儿科护士实施人文关怀的真实体验,为促进对护士的关怀和提高护理质量提供参考。方法采用目的抽样法选取15名儿科护士进行半结构式访谈,运用Colaizzi 7步分析法提炼主题。结果儿科护士实施人文关怀过程中的体验归纳为3个主题及11个亚主题,即正性体验(积极实施人文关怀、护患关系改善、职业认同感和价值感增强),负性体验(无奈与挫败、儿科护理人文关怀实践难度高),儿科护理人文关怀实践过程中的阻碍因素(专业技能及人文知识缺乏、工作负荷重、缺乏团队支持、缺乏评价标准、患儿家属信任与尊重的缺失、职场暴力)。结论儿科护士在工作中实施人文关怀较为积极,但也存在诸多障碍。需要加大对儿科护士人文关怀能力及专业知识的培训力度,加强团队合作,制定儿科护理人文关怀评价标准,同时注重对护士的关怀。

ICU清醒患者创伤成长体验的质性研究

目的探讨重症监护病房(intensive care unit,ICU)清醒患者创伤后成长(post-traumatic growth,PTG)的真实体验。方法采用描述性质性研究法,借鉴PTG模型设计访谈提纲,选取2022年8月-2023年7月贵阳市某三级甲等综合医院的15例急诊ICU清醒患者进行深入访谈,用Colaizzi现象学方法分析资料。结果萃取出承受多重创伤反应、与他人的关系改善、自我转变、创伤后的人生转变4项一级主题及15项二级主题。结论临床医护要关注清醒患者的积极经历,并根据其PTG心路历程制定心理干预措施,促进临床干预范式转变,促进康复。

住院患者身体约束真实体验研究的系统评价

目的:系统评价住院患者身体约束的真实体验。方法:计算机检索数据库The Cochrane Library、PubMed、Medline、Embase、Wed of Science、CBM、CNKI、VIP和WanFangData,搜集关于住院患者身体约束真实体验的质性研究,检索时限均从建库到2016年1月。进行文献质量评价后,采用Meta整合方法对研究结果进行归纳、诠释。结果:共纳入7篇文献,提炼出40个结果、10个类别和5个整合结果,分别为:患者对使用约束的理解、患者约束的心理感受、患者约束的身体感受、患者应对约束的方式、患者对约束的建议。结论:医护人员对患者进行身体约束时要多次、全面地告知其使用约束的理由,关注患者身体和心理的改变,帮助他们建立积极的应对方式,并根据患者的建议适当调整约束的规范和流程。

肾病患者行肾穿刺心理体验的质性研究

目的深入了解肾病患者行肾穿刺的真实心理体验,以期为肾病患者制订针对性的干预措施提供参考。方法 2013年3月至2014年4月,采用目的抽样法选择北京市某三级甲等医院肾科病房收治的10例行肾穿刺的患者为研究对象,采用现象学研究方法对其进行半结构式访谈,现场录音,借助NVivo 8.0统计软件,根据Colaizzi的7步分析法对资料进行分析,提炼主题。结果肾病患者行肾穿刺的心理体验可归纳为2个类属6个主题,即穿刺前准备不足、对肾穿刺针陌生且恐惧、不确定手术效果、术后应对无所适从及采取祈祷和坦然面对的应对方式。结论护理人员应针对行肾穿刺肾病患者的主要心理问题采取干预措施,帮助患者积极面对手术,以提高肾穿刺成功率,减少相关并发症的发生。

截瘫患者直接照顾者照护体验的质性研究

目的深入了解截瘫患者直接照顾者照护过程的真实体验及需求,为提高截瘫患者家庭的生活质量提供帮助。方法采用立意抽样法选择17名截瘫患者直接照顾者作为研究对象,进行深入访谈,采用Colaizzi分析法对资料进行分析、整理并提炼主题。结果截瘫患者直接照顾者的照护体验包括以下7个方面:极度震惊和无法接受;心存侥幸;持续的身心疲惫;羞耻感;经济负担过重;缺乏经验;渴望社区服务。结论截瘫患者直接照顾者的体验受疾病进程的影响,且其社会支持体系不够完善;医护人员及社会机构除了关心患者外,还应主动关心其直接照顾者,帮助他们解决照护过程中的需求和困难。

重度烧伤患儿不同病期父母照护体验的质性研究

目的深入了解重度烧伤患儿父母在患儿烧伤不同病期的照护体验,以期为提供适合患儿父母需求的护理服务提供依据。方法 2014年7月至2015年1月,采用目的抽样法,选取解放军第181医院烧伤科收治的16名重度以上烧伤患儿父母作为访谈对象,采用质性研究中的现象学研究法,对16名重度烧伤患儿父母进行面对面、半结构式的深入访谈,并以Colaizzi现象学研究法进行资料分析。结果提炼出关于重度烧伤患儿父母在患儿烧伤不同病期的照护体验的主要主题共6个,即承受较重的心理负担、生活重心转移、承受多重压力、信息支持不足、被患儿的护理问题困扰及期待心理。结论重度烧伤患儿父母在患儿烧伤不同病期的照护体验各有不同且动态变化,医护人员应及时为其提供情感支持,满足患儿父母的信息和技能需求;同时,呼吁建立完善的社会保障体系,普及公众烧伤预防和急救知识,为患儿及其家人提供一定的经济、社会及专业支持。

前列腺癌患者子女照护体验的质性研究

目的了解前列腺癌患者子女在照护患者期间的真实感受,为护士对患者子女进行心理支持提供依据。方法采用目的抽样法选取2009年3月至2012年2月在丽水市中心医院接受手术治疗的前列腺癌患者子女12人,采用质性研究中的深度访谈法收集资料,并用现象学分析法进行资料分析。结果前列腺癌患者子女照护体验主要有5个主题:承受较重的心理负荷,承受繁重的照顾任务,经济负担过重,工作压力过大,被患者的护理问题所困扰。结论在前列腺癌患者的治疗过程中,应积极帮助与指导患者子女,教授其必要的知识技能并为其提供人文关怀和情感支持,为其更好地照护患者提供必要帮助,以提高前列腺癌患者的治疗效果及生活质量。

急性心肌梗死电除颤成功患者体验及护理需求的质性研究

目的探讨急性心肌梗死电除颤成功患者的真实体验,探寻其生理、心理、社会支持等状况,为实施针对性护理提供参考。方法采用质性研究的现象学研究方法,对18例急性心肌梗死电除颤成功患者进行半结构式深入访谈,并运用Colaizzi分析方法对资料进行整理分析。结果急性心肌梗死电除颤成功患者对电除颤场景无记忆,存在感恩、焦虑恐惧、反刍性沉思、创伤后成长等体验;通过分析和归纳,护理需求归纳为5个主题:期望得到家庭和社会的关怀与支持、期望得到更多的信息支持、护理安全的需求、希望护士具有丰富的专业技能、积极重返社会的需求。结论急性心肌梗死电除颤成功患者负性心理体验与积极心理体验并存,护士需敏锐捕捉识别患者的心理反应与需求,给予情感、心理、社会支持,缓解负性情绪,积极引导正性心理,帮助患者获得创伤后成长,促进其身心康复。

甲状腺相关性眼病患者患病体验的质性研究

目的探讨和了解甲状腺相关性眼病(thyroidassociated ophthal mopathy,TAO)患者的患病体验,以期为制定针对性的干预措施提供参考。方法 2014年1月至2015年6月,采用目的抽样方法选择在第二军医大学长征医院住院治疗的11例TAO患者为研究对象,采用现象学研究方法对其进行半结构式访谈,并用Nancy的7步分析法对访谈资料进行分析。结果TAO患者的患病体验可归纳为5个主题:生活里的多方面受到影响、就医经历坎坷、应对方式多样、渴望社会支持、期待治疗效果。结论护理人员应关注TAO患者的患病体验,了解他们的需求,制定并实施针对性的护理干预措施,呼吁家庭、社会多关心患者,为患者提供更多的支持和帮助。