Jeon Sangchoon, Schulman-Green Dena, McCorkle Ruth, Dixon Jane K
Sangchoon Jeon, PhD, is Research Scientist, and Dena Schulman-Green, PhD, is Research Scientist, Division of Acute Care and Health Systems, Yale School of Nursing, West Haven, Connecticut. Ruth McCorkle, PhD, RN, FAAN, is Florence Schorske Wald Professor of Nursing, Division of Acute Care and Health Systems, Yale School of Nursing, West Haven, Connecticut. Jane K. Dixon, PhD, is Professor, Division of Acute Care and Health Systems, Yale School of Nursing, West Haven, Connecticut.
Nurs Res. 2019 Jan/Feb;68(1):57-64. doi: 10.1097/NNR.0000000000000318.
We created the Measurement of Transitions in Cancer Scale to assess patients' perceptions of the extent of change they experience with cancer-related transitions and how well they feel they are managing these transitions. For some transitions, we found that the more change that was reported, the worse management was reported; however, the benchmark by which patients assess how well they have managed may vary with the extent of change.
The aim of the study was to identify approaches to combine reports of extent and management of change.
Among women with breast cancer, we explored relationships of composite measures (arithmetic and geometric means, subtractive and proportional need for improvement) with other indicators of well-being (symptoms, anxiety, depression, uncertainty, self-efficacy, knowledge of care options, medical communication competence). We examined statistical significance using false rate discovery for multiple tests on correlations with clinical outcomes.
Greater extent and less management were significantly associated with higher total symptoms, anxiety, depression, uncertainty, and less self-efficacy in Personal Transitions, but not in Care Transitions. The arithmetic and geometric means had weak correlations with clinical outcomes, whereas the subtractive and proportional need for improvement had significant correlations with most clinical outcomes both in Personal and Care Transitions. The combined proportional need for improvement in Personal Transitions was significantly associated with total symptoms, anxiety, depression, uncertainty, and self-efficacy. The Care Transitions score was also significantly associated with total symptoms, anxiety, uncertainty, and self-efficacy.
These approaches can be applied to other aspects of self-management that require assessment of the extent and management of an experience. The four approaches yield different results. We recommend the need for improvement composites to capture correlations with the clinical outcomes.
我们创建了癌症转变测量量表，以评估患者对与癌症相关转变所经历的变化程度的认知，以及他们感觉自己对这些转变的应对情况。对于某些转变，我们发现报告的变化越多，报告的应对情况越差；然而，患者评估自己应对得如何的基准可能会随变化程度而有所不同。
本研究的目的是确定将变化程度和应对情况报告相结合的方法。
在乳腺癌女性患者中，我们探讨了综合测量指标（算术平均数和几何平均数、减法和比例改进需求）与其他幸福感指标（症状、焦虑、抑郁、不确定性、自我效能感、护理选择知识、医疗沟通能力）之间的关系。我们使用错误率发现法对与临床结果的相关性进行多次测试，以检验统计学意义。
在个人转变方面，变化程度越大且应对情况越少，与更高的总症状、焦虑、抑郁、不确定性以及更低的自我效能感显著相关，但在护理转变方面并非如此。算术平均数和几何平均数与临床结果的相关性较弱，而减法和比例改进需求在个人转变和护理转变中与大多数临床结果均有显著相关性。个人转变中综合比例改进需求与总症状、焦虑、抑郁、不确定性和自我效能感显著相关。护理转变得分也与总症状、焦虑、不确定性和自我效能感显著相关。
这些方法可应用于自我管理的其他方面，这些方面需要评估经历的程度和应对情况。这四种方法产生不同的结果。我们建议使用改进需求综合指标来捕捉与临床结果的相关性。
